|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$217.05 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$452.93
|
| Rate for Payer: Aetna Medicare |
$605.00
|
| Rate for Payer: BCBS Complete |
$227.90
|
| Rate for Payer: BCN Commercial |
$537.33
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Mclaren Medicaid |
$217.05
|
| Rate for Payer: Meridian Medicaid |
$227.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$574.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$574.38
|
| Rate for Payer: UHC Medicaid |
$217.05
|
| Rate for Payer: UHCCP Medicaid |
$217.05
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
25000
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$842.16 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$1,028.50
|
| Rate for Payer: BCBS Trust/PPO |
$999.34
|
| Rate for Payer: BCN Commercial |
$999.34
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$1,040.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.00
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$907.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,028.50
|
| Rate for Payer: Nomi Health Commercial |
$992.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PHP Commercial |
$1,028.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,052.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.16
|
| Rate for Payer: UHC Core |
$1,010.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$907.50
|
|
|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$217.69 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$455.72
|
| Rate for Payer: Aetna Medicare |
$605.00
|
| Rate for Payer: BCBS Complete |
$228.57
|
| Rate for Payer: BCN Commercial |
$542.80
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Mclaren Medicaid |
$217.69
|
| Rate for Payer: Meridian Medicaid |
$228.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$580.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$580.24
|
| Rate for Payer: UHC Medicaid |
$217.69
|
| Rate for Payer: UHCCP Medicaid |
$217.69
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Aetna Commercial |
$37.05
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Mclaren Medicaid |
$18.32
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.22
|
| Rate for Payer: UHC Medicaid |
$18.32
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna Commercial |
$800.75
|
| Rate for Payer: Aetna Medicare |
$893.00
|
| Rate for Payer: BCBS Complete |
$379.75
|
| Rate for Payer: BCN Commercial |
$908.82
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Mclaren Medicaid |
$361.67
|
| Rate for Payer: Meridian Medicaid |
$379.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$971.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.49
|
| Rate for Payer: UHC Medicaid |
$361.67
|
| Rate for Payer: UHCCP Medicaid |
$361.67
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$282.75 |
| Rate for Payer: Aetna Commercial |
$142.03
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCN Commercial |
$165.33
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$201.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.44
|
| Rate for Payer: UHC Medicaid |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Aetna Commercial |
$199.20
|
| Rate for Payer: Aetna Medicare |
$257.50
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCN Commercial |
$276.38
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Mclaren Medicaid |
$109.48
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.95
|
| Rate for Payer: UHC Medicaid |
$109.48
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$110.83
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCN Commercial |
$159.35
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.85
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$110.83
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCN Commercial |
$159.35
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.85
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.66 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.94
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: BCBS MAPPO |
$64.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.92
|
| Rate for Payer: BCN Commercial |
$212.92
|
| Rate for Payer: BCN Medicare Advantage |
$64.75
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$222.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.75
|
| Rate for Payer: Healthscope Commercial |
$233.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.25
|
| Rate for Payer: Mclaren Medicaid |
$45.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.99
|
| Rate for Payer: Meridian Medicaid |
$47.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: Nomi Health Commercial |
$212.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PACE Senior Care Partners |
$61.51
|
| Rate for Payer: PACE SWMI |
$64.75
|
| Rate for Payer: PHP Commercial |
$220.15
|
| Rate for Payer: PHP Medicare Advantage |
$64.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.33
|
| Rate for Payer: Priority Health Medicare |
$65.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.26
|
| Rate for Payer: Railroad Medicare Medicare |
$64.75
|
| Rate for Payer: UHC Core |
$216.26
|
| Rate for Payer: UHC Exchange |
$64.75
|
| Rate for Payer: UHC Medicaid |
$45.66
|
| Rate for Payer: UHC Medicare Advantage |
$64.75
|
| Rate for Payer: UHCCP Medicaid |
$45.66
|
| Rate for Payer: VA VA |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.25
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$180.26 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: BCBS Trust/PPO |
$213.91
|
| Rate for Payer: BCN Commercial |
$213.91
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$222.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Healthscope Commercial |
$233.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: Nomi Health Commercial |
$212.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PHP Commercial |
$220.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.26
|
| Rate for Payer: UHC Core |
$216.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.25
|
|
|
PR INCISION&SUBCUTANEOUS PLMT CRANIAL BONE GRAFT
|
Professional
|
Both
|
$1,641.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$1,230.75 |
| Rate for Payer: Aetna Commercial |
$113.39
|
| Rate for Payer: Aetna Medicare |
$820.50
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCN Commercial |
$182.32
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Mclaren Medicaid |
$50.91
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,230.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.28
|
| Rate for Payer: UHC Medicaid |
$50.91
|
| Rate for Payer: UHCCP Medicaid |
$50.91
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Aetna Commercial |
$145.09
|
| Rate for Payer: Aetna Medicare |
$185.00
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCN Commercial |
$167.32
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Mclaren Medicaid |
$68.59
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$203.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.86
|
| Rate for Payer: UHC Medicaid |
$68.59
|
| Rate for Payer: UHCCP Medicaid |
$68.59
|
|
|
PR INCOBOTULINUMTOXIN A
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0588
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$5.34
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.26
|
| Rate for Payer: BCN Commercial |
$5.34
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.00
|
|
|
PR INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 99340
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Aetna Medicare |
$112.50
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.75
|
|
|
PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
HCPCS 59856
|
| Min. Negotiated Rate |
$286.27 |
| Max. Negotiated Rate |
$750.46 |
| Rate for Payer: Aetna Commercial |
$543.81
|
| Rate for Payer: Aetna Medicare |
$473.00
|
| Rate for Payer: BCBS Complete |
$300.58
|
| Rate for Payer: BCN Commercial |
$750.46
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Mclaren Medicaid |
$286.27
|
| Rate for Payer: Meridian Medicaid |
$300.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$708.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$708.43
|
| Rate for Payer: UHC Medicaid |
$286.27
|
| Rate for Payer: UHCCP Medicaid |
$286.27
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,884.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$332.92 |
| Max. Negotiated Rate |
$1,413.00 |
| Rate for Payer: Aetna Commercial |
$636.21
|
| Rate for Payer: Aetna Medicare |
$942.00
|
| Rate for Payer: BCBS Complete |
$349.57
|
| Rate for Payer: BCN Commercial |
$873.95
|
| Rate for Payer: Cash Price |
$1,507.20
|
| Rate for Payer: Cash Price |
$1,507.20
|
| Rate for Payer: Mclaren Medicaid |
$332.92
|
| Rate for Payer: Meridian Medicaid |
$349.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,413.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$825.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.02
|
| Rate for Payer: UHC Medicaid |
$332.92
|
| Rate for Payer: UHCCP Medicaid |
$332.92
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$464.07
|
| Rate for Payer: Aetna Medicare |
$476.00
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCN Commercial |
$640.91
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Mclaren Medicaid |
$246.02
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$714.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$605.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$605.01
|
| Rate for Payer: UHC Medicaid |
$246.02
|
| Rate for Payer: UHCCP Medicaid |
$246.02
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$128.44 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Aetna Commercial |
$239.76
|
| Rate for Payer: Aetna Medicare |
$415.00
|
| Rate for Payer: BCBS Complete |
$134.86
|
| Rate for Payer: BCN Commercial |
$333.65
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Mclaren Medicaid |
$128.44
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$622.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.96
|
| Rate for Payer: UHC Medicaid |
$128.44
|
| Rate for Payer: UHCCP Medicaid |
$128.44
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Aetna Commercial |
$405.93
|
| Rate for Payer: Aetna Medicare |
$436.00
|
| Rate for Payer: BCBS Complete |
$225.21
|
| Rate for Payer: BCN Commercial |
$562.72
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Mclaren Medicaid |
$214.49
|
| Rate for Payer: Meridian Medicaid |
$225.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$654.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$531.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.21
|
| Rate for Payer: UHC Medicaid |
$214.49
|
| Rate for Payer: UHCCP Medicaid |
$214.49
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$36.82 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCN Commercial |
$36.82
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.00
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$11,294.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$1,772.37 |
| Max. Negotiated Rate |
$8,470.50 |
| Rate for Payer: Aetna Commercial |
$3,957.60
|
| Rate for Payer: Aetna Medicare |
$5,647.00
|
| Rate for Payer: BCBS Complete |
$1,860.99
|
| Rate for Payer: BCN Commercial |
$4,617.78
|
| Rate for Payer: Cash Price |
$9,035.20
|
| Rate for Payer: Cash Price |
$9,035.20
|
| Rate for Payer: Mclaren Medicaid |
$1,772.37
|
| Rate for Payer: Meridian Medicaid |
$1,860.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,470.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,772.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,363.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,363.46
|
| Rate for Payer: UHC Medicaid |
$1,772.37
|
| Rate for Payer: UHCCP Medicaid |
$1,772.37
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,769.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$1,699.95 |
| Max. Negotiated Rate |
$5,231.59 |
| Rate for Payer: Aetna Commercial |
$3,915.31
|
| Rate for Payer: Aetna Medicare |
$3,384.50
|
| Rate for Payer: BCBS Complete |
$1,784.95
|
| Rate for Payer: BCN Commercial |
$4,504.24
|
| Rate for Payer: Cash Price |
$5,415.20
|
| Rate for Payer: Cash Price |
$5,415.20
|
| Rate for Payer: Mclaren Medicaid |
$1,699.95
|
| Rate for Payer: Meridian Medicaid |
$1,784.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,076.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,699.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,231.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,231.59
|
| Rate for Payer: UHC Medicaid |
$1,699.95
|
| Rate for Payer: UHCCP Medicaid |
$1,699.95
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Aetna Commercial |
$70.38
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: BCBS Complete |
$38.47
|
| Rate for Payer: BCN Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Mclaren Medicaid |
$36.64
|
| Rate for Payer: Meridian Medicaid |
$38.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.68
|
| Rate for Payer: UHC Medicaid |
$36.64
|
| Rate for Payer: UHCCP Medicaid |
$36.64
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$76.44
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCN Commercial |
$109.06
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Mclaren Medicaid |
$39.83
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.65
|
| Rate for Payer: UHC Medicaid |
$39.83
|
| Rate for Payer: UHCCP Medicaid |
$39.83
|
|
