|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$20.82
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$83.85
|
| Rate for Payer: BCN Commercial |
$79.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.50
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
PR PROHEALTH WORKSTATION EVAL
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
98300182
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 99359
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health HMO/PPO |
$48.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.91
|
|
|
PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 99358
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS Trust/PPO |
$147.73
|
| Rate for Payer: BCN Commercial |
$133.41
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO |
$117.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.12
|
|
|
PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY
|
Professional
|
Both
|
$2,772.00
|
|
|
Service Code
|
HCPCS 33960
|
| Min. Negotiated Rate |
$1,108.80 |
| Max. Negotiated Rate |
$1,801.80 |
| Rate for Payer: Aetna Medicare |
$1,386.00
|
| Rate for Payer: BCBS Complete |
$1,108.80
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.80
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$1,631.44 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.44
|
| Rate for Payer: BCN Commercial |
$56.68
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Mclaren Medicaid |
$24.92
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO |
$52.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,097.28 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.28
|
| Rate for Payer: BCN Commercial |
$44.96
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO |
$39.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.94
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 99356
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Medicare |
$151.50
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99357
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 99354
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$151.45 |
| Rate for Payer: Aetna Medicare |
$116.50
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99355
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$1,295.39 |
| Rate for Payer: Aetna Commercial |
$38.74
|
| Rate for Payer: Aetna Medicare |
$30.07
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS MAPPO |
$28.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,295.39
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: BCN Medicare Advantage |
$28.91
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Cofinity Commercial |
$41.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.36
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: PACE SWMI |
$28.91
|
| Rate for Payer: PHP Medicare Advantage |
$28.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health HMO/PPO |
$40.38
|
| Rate for Payer: Priority Health Medicare |
$29.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.91
|
| Rate for Payer: UHC Exchange |
$28.91
|
| Rate for Payer: UHC Medicare Advantage |
$28.91
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$1,127.92 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: BCBS Complete |
$20.58
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.92
|
| Rate for Payer: BCN Commercial |
$38.06
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Mclaren Medicaid |
$19.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Meridian Medicaid |
$20.58
|
| Rate for Payer: Nomi Health Commercial |
$35.05
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO |
$34.79
|
| Rate for Payer: Priority Health Medicare |
$29.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.21
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UHC Medicare Advantage |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
|
|
PR PROMETHAZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J2550
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$2.98
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.26
|
| Rate for Payer: BCN Medicare Advantage |
$2.87
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.01
|
| Rate for Payer: Nomi Health Commercial |
$3.44
|
| Rate for Payer: PACE SWMI |
$2.87
|
| Rate for Payer: PHP Medicare Advantage |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.87
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.87
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$2,782.00
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$1,088.89 |
| Max. Negotiated Rate |
$1,808.30 |
| Rate for Payer: Aetna Commercial |
$1,459.11
|
| Rate for Payer: Aetna Medicare |
$1,132.45
|
| Rate for Payer: BCBS Complete |
$1,112.80
|
| Rate for Payer: BCBS MAPPO |
$1,088.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,264.22
|
| Rate for Payer: BCN Commercial |
$1,655.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,088.89
|
| Rate for Payer: Cash Price |
$2,225.60
|
| Rate for Payer: Cash Price |
$2,225.60
|
| Rate for Payer: Cofinity Commercial |
$1,568.00
|
| Rate for Payer: Cofinity Commercial |
$1,459.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,088.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,143.33
|
| Rate for Payer: Nomi Health Commercial |
$1,306.67
|
| Rate for Payer: PACE SWMI |
$1,088.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,088.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,808.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,735.21
|
| Rate for Payer: Priority Health Medicare |
$1,099.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,735.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,088.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,088.89
|
| Rate for Payer: UHC Exchange |
$1,088.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,088.89
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$2,148.00
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$707.39 |
| Max. Negotiated Rate |
$2,619.31 |
| Rate for Payer: Aetna Commercial |
$947.90
|
| Rate for Payer: Aetna Medicare |
$735.69
|
| Rate for Payer: BCBS Complete |
$859.20
|
| Rate for Payer: BCBS MAPPO |
$707.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,619.31
|
| Rate for Payer: BCN Commercial |
$1,110.77
|
| Rate for Payer: BCN Medicare Advantage |
$707.39
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cofinity Commercial |
$947.90
|
| Rate for Payer: Cofinity Commercial |
$1,018.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.76
|
| Rate for Payer: Nomi Health Commercial |
$848.87
|
| Rate for Payer: PACE SWMI |
$707.39
|
| Rate for Payer: PHP Medicare Advantage |
$707.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,150.53
|
| Rate for Payer: Priority Health Medicare |
$714.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,150.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.39
|
| Rate for Payer: UHC Exchange |
$707.39
|
| Rate for Payer: UHC Medicare Advantage |
$707.39
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$2,041.00
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$816.40 |
| Max. Negotiated Rate |
$2,727.08 |
| Rate for Payer: Aetna Commercial |
$1,287.32
|
| Rate for Payer: Aetna Medicare |
$999.12
|
| Rate for Payer: BCBS Complete |
$816.40
|
| Rate for Payer: BCBS MAPPO |
$960.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,727.08
|
| Rate for Payer: BCN Commercial |
$1,461.15
|
| Rate for Payer: BCN Medicare Advantage |
$960.69
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cofinity Commercial |
$1,383.39
|
| Rate for Payer: Cofinity Commercial |
$1,287.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$960.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,008.72
|
| Rate for Payer: Nomi Health Commercial |
$1,152.83
|
| Rate for Payer: PACE SWMI |
$960.69
|
| Rate for Payer: PHP Medicare Advantage |
$960.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,533.19
|
| Rate for Payer: Priority Health Medicare |
$970.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,533.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$960.69
|
| Rate for Payer: UHC Exchange |
$960.69
|
| Rate for Payer: UHC Medicare Advantage |
$960.69
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$557.36 |
| Max. Negotiated Rate |
$1,678.30 |
| Rate for Payer: Aetna Commercial |
$1,117.48
|
| Rate for Payer: Aetna Medicare |
$867.30
|
| Rate for Payer: BCBS Complete |
$1,032.80
|
| Rate for Payer: BCBS MAPPO |
$833.94
|
| Rate for Payer: BCBS Trust/PPO |
$557.36
|
| Rate for Payer: BCN Commercial |
$1,274.47
|
| Rate for Payer: BCN Medicare Advantage |
$833.94
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cofinity Commercial |
$1,200.87
|
| Rate for Payer: Cofinity Commercial |
$1,117.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$833.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.64
|
| Rate for Payer: Nomi Health Commercial |
$1,000.73
|
| Rate for Payer: PACE SWMI |
$833.94
|
| Rate for Payer: PHP Medicare Advantage |
$833.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,337.80
|
| Rate for Payer: Priority Health Medicare |
$842.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,337.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$833.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$833.94
|
| Rate for Payer: UHC Exchange |
$833.94
|
| Rate for Payer: UHC Medicare Advantage |
$833.94
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$185.93 |
| Max. Negotiated Rate |
$1,563.72 |
| Rate for Payer: Aetna Commercial |
$1,313.63
|
| Rate for Payer: Aetna Medicare |
$1,019.53
|
| Rate for Payer: BCBS Complete |
$836.00
|
| Rate for Payer: BCBS MAPPO |
$980.32
|
| Rate for Payer: BCBS Trust/PPO |
$185.93
|
| Rate for Payer: BCN Commercial |
$1,490.47
|
| Rate for Payer: BCN Medicare Advantage |
$980.32
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cofinity Commercial |
$1,411.66
|
| Rate for Payer: Cofinity Commercial |
$1,313.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,029.34
|
| Rate for Payer: Nomi Health Commercial |
$1,176.38
|
| Rate for Payer: PACE SWMI |
$980.32
|
| Rate for Payer: PHP Medicare Advantage |
$980.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,358.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,563.72
|
| Rate for Payer: Priority Health Medicare |
$990.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,563.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$980.32
|
| Rate for Payer: UHC Exchange |
$980.32
|
| Rate for Payer: UHC Medicare Advantage |
$980.32
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS
|
Professional
|
Both
|
$2,251.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$695.73 |
| Max. Negotiated Rate |
$3,253.04 |
| Rate for Payer: Aetna Commercial |
$932.28
|
| Rate for Payer: Aetna Medicare |
$723.56
|
| Rate for Payer: BCBS Complete |
$900.40
|
| Rate for Payer: BCBS MAPPO |
$695.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.04
|
| Rate for Payer: BCN Commercial |
$1,060.92
|
| Rate for Payer: BCN Medicare Advantage |
$695.73
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cofinity Commercial |
$932.28
|
| Rate for Payer: Cofinity Commercial |
$1,001.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.52
|
| Rate for Payer: Nomi Health Commercial |
$834.88
|
| Rate for Payer: PACE SWMI |
$695.73
|
| Rate for Payer: PHP Medicare Advantage |
$695.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,114.92
|
| Rate for Payer: Priority Health Medicare |
$702.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.73
|
| Rate for Payer: UHC Exchange |
$695.73
|
| Rate for Payer: UHC Medicare Advantage |
$695.73
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$1,420.07 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.07
|
| Rate for Payer: BCN Commercial |
$33.72
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$11.66
|
| Rate for Payer: Priority Health Medicare |
$8.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Exchange |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,657.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$1,119.32 |
| Max. Negotiated Rate |
$2,781.23 |
| Rate for Payer: Aetna Commercial |
$2,247.33
|
| Rate for Payer: Aetna Medicare |
$1,744.19
|
| Rate for Payer: BCBS Complete |
$1,175.29
|
| Rate for Payer: BCBS MAPPO |
$1,677.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.22
|
| Rate for Payer: BCN Commercial |
$2,526.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,677.11
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cofinity Commercial |
$2,415.04
|
| Rate for Payer: Cofinity Commercial |
$2,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,677.11
|
| Rate for Payer: Mclaren Medicaid |
$1,119.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,760.97
|
| Rate for Payer: Meridian Medicaid |
$1,175.29
|
| Rate for Payer: Nomi Health Commercial |
$2,012.53
|
| Rate for Payer: PACE SWMI |
$1,677.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,677.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,119.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,377.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,781.23
|
| Rate for Payer: Priority Health Medicare |
$1,693.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,781.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,677.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,677.11
|
| Rate for Payer: UHC Exchange |
$1,677.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,677.11
|
| Rate for Payer: UHCCP Medicaid |
$1,119.32
|
|
|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$549.75 |
| Max. Negotiated Rate |
$2,171.65 |
| Rate for Payer: Aetna Commercial |
$1,101.02
|
| Rate for Payer: Aetna Medicare |
$854.53
|
| Rate for Payer: BCBS Complete |
$577.24
|
| Rate for Payer: BCBS MAPPO |
$821.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.03
|
| Rate for Payer: BCN Commercial |
$1,240.27
|
| Rate for Payer: BCN Medicare Advantage |
$821.66
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,101.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.66
|
| Rate for Payer: Mclaren Medicaid |
$549.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.74
|
| Rate for Payer: Meridian Medicaid |
$577.24
|
| Rate for Payer: Nomi Health Commercial |
$985.99
|
| Rate for Payer: PACE SWMI |
$821.66
|
| Rate for Payer: PHP Medicare Advantage |
$821.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,366.11
|
| Rate for Payer: Priority Health Medicare |
$829.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,366.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.66
|
| Rate for Payer: UHC Exchange |
$821.66
|
| Rate for Payer: UHC Medicare Advantage |
$821.66
|
| Rate for Payer: UHCCP Medicaid |
$549.75
|
|
