|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$26.38
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$25.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,605.50
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: BCN Medicare Advantage |
$25.37
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Commercial |
$36.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.64
|
| Rate for Payer: PACE SWMI |
$25.37
|
| Rate for Payer: PHP Medicare Advantage |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.83
|
| Rate for Payer: Priority Health Medicare |
$25.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.37
|
| Rate for Payer: UHC Medicare Advantage |
$26.13
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$52.61
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,742.33
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Cofinity Commercial |
$56.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.05
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Medicare Advantage |
$40.44
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$210.02
|
| Rate for Payer: Aetna Medicare |
$163.00
|
| Rate for Payer: BCBS Complete |
$106.24
|
| Rate for Payer: BCBS MAPPO |
$156.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: BCN Medicare Advantage |
$156.73
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$225.69
|
| Rate for Payer: Cofinity Commercial |
$210.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.73
|
| Rate for Payer: Mclaren Medicaid |
$101.18
|
| Rate for Payer: Meridian Medicaid |
$106.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$164.57
|
| Rate for Payer: PACE SWMI |
$156.73
|
| Rate for Payer: PHP Medicare Advantage |
$156.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.71
|
| Rate for Payer: Priority Health Medicare |
$156.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.73
|
| Rate for Payer: UHC Medicare Advantage |
$161.43
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,480.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$479.04 |
| Max. Negotiated Rate |
$1,315.89 |
| Rate for Payer: Aetna Commercial |
$989.36
|
| Rate for Payer: Aetna Medicare |
$767.86
|
| Rate for Payer: BCBS Complete |
$502.99
|
| Rate for Payer: BCBS MAPPO |
$738.33
|
| Rate for Payer: BCBS Trust/PPO |
$714.79
|
| Rate for Payer: BCN Commercial |
$1,093.66
|
| Rate for Payer: BCN Medicare Advantage |
$738.33
|
| Rate for Payer: Cash Price |
$1,184.00
|
| Rate for Payer: Cash Price |
$1,184.00
|
| Rate for Payer: Cofinity Commercial |
$1,063.20
|
| Rate for Payer: Cofinity Commercial |
$989.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.33
|
| Rate for Payer: Mclaren Medicaid |
$479.04
|
| Rate for Payer: Meridian Medicaid |
$502.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$775.25
|
| Rate for Payer: PACE SWMI |
$738.33
|
| Rate for Payer: PHP Medicare Advantage |
$738.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,315.89
|
| Rate for Payer: Priority Health Medicare |
$738.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$738.33
|
| Rate for Payer: UHC Medicare Advantage |
$760.48
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$430.47 |
| Max. Negotiated Rate |
$1,183.59 |
| Rate for Payer: Aetna Commercial |
$887.84
|
| Rate for Payer: Aetna Medicare |
$689.07
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCBS MAPPO |
$662.57
|
| Rate for Payer: BCBS Trust/PPO |
$477.58
|
| Rate for Payer: BCN Commercial |
$983.71
|
| Rate for Payer: BCN Medicare Advantage |
$662.57
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$954.10
|
| Rate for Payer: Cofinity Commercial |
$887.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.57
|
| Rate for Payer: Mclaren Medicaid |
$430.47
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$695.70
|
| Rate for Payer: PACE SWMI |
$662.57
|
| Rate for Payer: PHP Medicare Advantage |
$662.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,183.59
|
| Rate for Payer: Priority Health Medicare |
$662.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,183.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$662.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.57
|
| Rate for Payer: UHC Medicare Advantage |
$682.45
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,851.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,606.34 |
| Rate for Payer: Aetna Commercial |
$1,210.53
|
| Rate for Payer: Aetna Medicare |
$939.52
|
| Rate for Payer: BCBS Complete |
$612.13
|
| Rate for Payer: BCBS MAPPO |
$903.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.81
|
| Rate for Payer: BCN Commercial |
$1,335.07
|
| Rate for Payer: BCN Medicare Advantage |
$903.38
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cash Price |
$1,480.80
|
| Rate for Payer: Cofinity Commercial |
$1,300.87
|
| Rate for Payer: Cofinity Commercial |
$1,210.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.38
|
| Rate for Payer: Mclaren Medicaid |
$582.98
|
| Rate for Payer: Meridian Medicaid |
$612.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$948.55
|
| Rate for Payer: PACE SWMI |
$903.38
|
| Rate for Payer: PHP Medicare Advantage |
$903.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,606.34
|
| Rate for Payer: Priority Health Medicare |
$903.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,606.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$903.38
|
| Rate for Payer: UHC Medicare Advantage |
$930.48
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,644.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$1,850.80 |
| Rate for Payer: Aetna Commercial |
$349.03
|
| Rate for Payer: Aetna Medicare |
$270.89
|
| Rate for Payer: BCBS Complete |
$174.23
|
| Rate for Payer: BCBS MAPPO |
$260.47
|
| Rate for Payer: BCBS Trust/PPO |
$538.34
|
| Rate for Payer: BCN Commercial |
$379.70
|
| Rate for Payer: BCN Medicare Advantage |
$260.47
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cofinity Commercial |
$375.08
|
| Rate for Payer: Cofinity Commercial |
$349.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.47
|
| Rate for Payer: Mclaren Medicaid |
$165.93
|
| Rate for Payer: Meridian Medicaid |
$174.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$273.49
|
| Rate for Payer: PACE SWMI |
$260.47
|
| Rate for Payer: PHP Medicare Advantage |
$260.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,850.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$562.81
|
| Rate for Payer: Priority Health Medicare |
$260.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.47
|
| Rate for Payer: UHC Medicare Advantage |
$268.28
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,938.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$566.87 |
| Max. Negotiated Rate |
$2,516.36 |
| Rate for Payer: Aetna Commercial |
$1,552.90
|
| Rate for Payer: Aetna Medicare |
$1,205.24
|
| Rate for Payer: BCBS Complete |
$780.32
|
| Rate for Payer: BCBS MAPPO |
$1,158.88
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$1,697.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,158.88
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,668.79
|
| Rate for Payer: Cofinity Commercial |
$1,552.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,158.88
|
| Rate for Payer: Mclaren Medicaid |
$743.16
|
| Rate for Payer: Meridian Medicaid |
$780.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,216.82
|
| Rate for Payer: PACE SWMI |
$1,158.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,158.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$743.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,516.36
|
| Rate for Payer: Priority Health Medicare |
$1,158.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,516.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,158.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.65
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,639.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$482.87 |
| Max. Negotiated Rate |
$3,247.30 |
| Rate for Payer: Aetna Commercial |
$1,533.28
|
| Rate for Payer: Aetna Medicare |
$1,190.01
|
| Rate for Payer: BCBS Complete |
$770.48
|
| Rate for Payer: BCBS MAPPO |
$1,144.24
|
| Rate for Payer: BCBS Trust/PPO |
$482.87
|
| Rate for Payer: BCN Commercial |
$1,677.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.24
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$1,533.28
|
| Rate for Payer: Cofinity Commercial |
$1,647.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.24
|
| Rate for Payer: Mclaren Medicaid |
$733.79
|
| Rate for Payer: Meridian Medicaid |
$770.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,201.45
|
| Rate for Payer: PACE SWMI |
$1,144.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,485.94
|
| Rate for Payer: Priority Health Medicare |
$1,144.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,485.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,178.57
|
|
|
PR SPLINT
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$903.75
|
| Rate for Payer: Aetna Medicare |
$701.42
|
| Rate for Payer: BCBS Complete |
$463.63
|
| Rate for Payer: BCBS MAPPO |
$674.44
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$674.44
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$971.19
|
| Rate for Payer: Cofinity Commercial |
$903.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$674.44
|
| Rate for Payer: Mclaren Medicaid |
$441.55
|
| Rate for Payer: Meridian Medicaid |
$463.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$708.16
|
| Rate for Payer: PACE SWMI |
$674.44
|
| Rate for Payer: PHP Medicare Advantage |
$674.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.09
|
| Rate for Payer: Priority Health Medicare |
$674.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$845.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$674.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$674.44
|
| Rate for Payer: UHC Medicare Advantage |
$694.67
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$958.15 |
| Max. Negotiated Rate |
$1,413.90 |
| Rate for Payer: Aetna Commercial |
$1,335.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,214.07
|
| Rate for Payer: BCN Commercial |
$1,214.07
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,351.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.80
|
| Rate for Payer: Healthscope Commercial |
$1,413.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,178.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,335.35
|
| Rate for Payer: PHP Commercial |
$1,335.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,382.48
|
| Rate for Payer: UHC Core |
$1,311.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,178.25
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$903.75
|
| Rate for Payer: Aetna Medicare |
$701.42
|
| Rate for Payer: BCBS Complete |
$463.63
|
| Rate for Payer: BCBS MAPPO |
$674.44
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$674.44
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$971.19
|
| Rate for Payer: Cofinity Commercial |
$903.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$674.44
|
| Rate for Payer: Mclaren Medicaid |
$441.55
|
| Rate for Payer: Meridian Medicaid |
$463.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$708.16
|
| Rate for Payer: PACE SWMI |
$674.44
|
| Rate for Payer: PHP Medicare Advantage |
$674.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.09
|
| Rate for Payer: Priority Health Medicare |
$674.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$845.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$674.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$674.44
|
| Rate for Payer: UHC Medicare Advantage |
$694.67
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$373.11 |
| Max. Negotiated Rate |
$2,471.13 |
| Rate for Payer: Aetna Commercial |
$1,335.35
|
| Rate for Payer: Aetna Medicare |
$408.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.94
|
| Rate for Payer: BCBS Complete |
$2,471.13
|
| Rate for Payer: BCBS MAPPO |
$392.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.45
|
| Rate for Payer: BCN Commercial |
$1,221.45
|
| Rate for Payer: BCN Medicare Advantage |
$392.75
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,351.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.75
|
| Rate for Payer: Healthscope Commercial |
$1,413.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,178.25
|
| Rate for Payer: Mclaren Medicaid |
$2,353.45
|
| Rate for Payer: Meridian Medicaid |
$2,471.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$412.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,335.35
|
| Rate for Payer: PACE Senior Care Partners |
$373.11
|
| Rate for Payer: PACE SWMI |
$392.75
|
| Rate for Payer: PHP Commercial |
$1,335.35
|
| Rate for Payer: PHP Medicare Advantage |
$392.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,353.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.77
|
| Rate for Payer: Priority Health Medicare |
$392.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.15
|
| Rate for Payer: Railroad Medicare Medicare |
$392.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,382.48
|
| Rate for Payer: UHC Core |
$1,311.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.75
|
| Rate for Payer: UHC Medicare Advantage |
$404.53
|
| Rate for Payer: VA VA |
$392.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,178.25
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna Commercial |
$175.31
|
| Rate for Payer: Aetna Medicare |
$136.06
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$130.83
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: BCN Medicare Advantage |
$130.83
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$188.40
|
| Rate for Payer: Cofinity Commercial |
$175.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.83
|
| Rate for Payer: Mclaren Medicaid |
$83.50
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.37
|
| Rate for Payer: PACE SWMI |
$130.83
|
| Rate for Payer: PHP Medicare Advantage |
$130.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.18
|
| Rate for Payer: Priority Health Medicare |
$130.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.83
|
| Rate for Payer: UHC Medicare Advantage |
$134.75
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$501.12 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Aetna Commercial |
$1,793.50
|
| Rate for Payer: Aetna Medicare |
$548.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.38
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$527.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.52
|
| Rate for Payer: BCN Commercial |
$1,640.52
|
| Rate for Payer: BCN Medicare Advantage |
$527.50
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,814.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.50
|
| Rate for Payer: Healthscope Commercial |
$1,899.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,582.50
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$553.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,793.50
|
| Rate for Payer: PACE Senior Care Partners |
$501.12
|
| Rate for Payer: PACE SWMI |
$527.50
|
| Rate for Payer: PHP Commercial |
$1,793.50
|
| Rate for Payer: PHP Medicare Advantage |
$527.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,835.70
|
| Rate for Payer: Priority Health Medicare |
$527.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,286.89
|
| Rate for Payer: Railroad Medicare Medicare |
$527.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,856.80
|
| Rate for Payer: UHC Core |
$1,761.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.50
|
| Rate for Payer: UHC Medicare Advantage |
$543.32
|
| Rate for Payer: VA VA |
$527.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,582.50
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Aetna Commercial |
$938.68
|
| Rate for Payer: Aetna Medicare |
$728.53
|
| Rate for Payer: BCBS Complete |
$481.07
|
| Rate for Payer: BCBS MAPPO |
$700.51
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$700.51
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$938.68
|
| Rate for Payer: Cofinity Commercial |
$1,008.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.51
|
| Rate for Payer: Mclaren Medicaid |
$458.16
|
| Rate for Payer: Meridian Medicaid |
$481.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.54
|
| Rate for Payer: PACE SWMI |
$700.51
|
| Rate for Payer: PHP Medicare Advantage |
$700.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.80
|
| Rate for Payer: Priority Health Medicare |
$700.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.51
|
| Rate for Payer: UHC Medicare Advantage |
$721.53
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Aetna Commercial |
$938.68
|
| Rate for Payer: Aetna Medicare |
$728.53
|
| Rate for Payer: BCBS Complete |
$481.07
|
| Rate for Payer: BCBS MAPPO |
$700.51
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$700.51
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,008.73
|
| Rate for Payer: Cofinity Commercial |
$938.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.51
|
| Rate for Payer: Mclaren Medicaid |
$458.16
|
| Rate for Payer: Meridian Medicaid |
$481.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.54
|
| Rate for Payer: PACE SWMI |
$700.51
|
| Rate for Payer: PHP Medicare Advantage |
$700.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.80
|
| Rate for Payer: Priority Health Medicare |
$700.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$878.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.51
|
| Rate for Payer: UHC Medicare Advantage |
$721.53
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,286.89 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Aetna Commercial |
$1,793.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.61
|
| Rate for Payer: BCN Commercial |
$1,630.61
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,814.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.00
|
| Rate for Payer: Healthscope Commercial |
$1,899.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,582.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,793.50
|
| Rate for Payer: PHP Commercial |
$1,793.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,835.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,286.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,856.80
|
| Rate for Payer: UHC Core |
$1,761.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,582.50
|
|
|
PR SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$946.40 |
| Rate for Payer: Aetna Commercial |
$145.75
|
| Rate for Payer: Aetna Medicare |
$113.12
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS MAPPO |
$108.77
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$108.77
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cofinity Commercial |
$145.75
|
| Rate for Payer: Cofinity Commercial |
$156.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.77
|
| Rate for Payer: Mclaren Medicaid |
$70.29
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.21
|
| Rate for Payer: PACE SWMI |
$108.77
|
| Rate for Payer: PHP Medicare Advantage |
$108.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.23
|
| Rate for Payer: Priority Health Medicare |
$108.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.77
|
| Rate for Payer: UHC Medicare Advantage |
$112.03
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$1,259.47 |
| Rate for Payer: Aetna Commercial |
$33.93
|
| Rate for Payer: Aetna Commercial |
$33.93
|
| Rate for Payer: Aetna Medicare |
$26.33
|
| Rate for Payer: Aetna Medicare |
$26.33
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$25.32
|
| Rate for Payer: BCBS MAPPO |
$25.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.47
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: BCN Medicare Advantage |
$25.32
|
| Rate for Payer: BCN Medicare Advantage |
$25.32
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.59
|
| Rate for Payer: PACE SWMI |
$25.32
|
| Rate for Payer: PACE SWMI |
$25.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.93
|
| Rate for Payer: Priority Health Medicare |
$25.32
|
| Rate for Payer: Priority Health Medicare |
$25.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.32
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$1,875.99 |
| Rate for Payer: Aetna Commercial |
$32.79
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.99
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$24.47
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Cofinity Commercial |
$32.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.69
|
| Rate for Payer: PACE SWMI |
$24.47
|
| Rate for Payer: PHP Medicare Advantage |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.69
|
| Rate for Payer: Priority Health Medicare |
$24.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.47
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
|
|
PR SPORTS PHYSICAL
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$169.97 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna Commercial |
$356.63
|
| Rate for Payer: Aetna Medicare |
$276.79
|
| Rate for Payer: BCBS Complete |
$178.47
|
| Rate for Payer: BCBS MAPPO |
$266.14
|
| Rate for Payer: BCBS Trust/PPO |
$463.85
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: BCN Medicare Advantage |
$266.14
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$383.24
|
| Rate for Payer: Cofinity Commercial |
$356.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.14
|
| Rate for Payer: Mclaren Medicaid |
$169.97
|
| Rate for Payer: Meridian Medicaid |
$178.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$279.45
|
| Rate for Payer: PACE SWMI |
$266.14
|
| Rate for Payer: PHP Medicare Advantage |
$266.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.43
|
| Rate for Payer: Priority Health Medicare |
$266.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$423.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.14
|
| Rate for Payer: UHC Medicare Advantage |
$274.12
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$208.31 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna Commercial |
$436.83
|
| Rate for Payer: Aetna Medicare |
$339.03
|
| Rate for Payer: BCBS Complete |
$218.73
|
| Rate for Payer: BCBS MAPPO |
$325.99
|
| Rate for Payer: BCBS Trust/PPO |
$327.02
|
| Rate for Payer: BCN Commercial |
$725.69
|
| Rate for Payer: BCN Medicare Advantage |
$325.99
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$469.43
|
| Rate for Payer: Cofinity Commercial |
$436.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.99
|
| Rate for Payer: Mclaren Medicaid |
$208.31
|
| Rate for Payer: Meridian Medicaid |
$218.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.29
|
| Rate for Payer: PACE SWMI |
$325.99
|
| Rate for Payer: PHP Medicare Advantage |
$325.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.12
|
| Rate for Payer: Priority Health Medicare |
$325.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$518.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.99
|
| Rate for Payer: UHC Medicare Advantage |
$335.77
|
|
