|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$33.32
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.98
|
| Rate for Payer: BCN Commercial |
$147.98
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$31.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$33.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Exchange |
$45.00
|
| Rate for Payer: UHC Medicaid |
$31.73
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$31.73
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 11200
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$79.26
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Mclaren Medicaid |
$44.09
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.20
|
| Rate for Payer: UHC Medicaid |
$44.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
|
Professional
|
Both
|
$4,060.00
|
|
|
Service Code
|
HCPCS 63662
|
| Min. Negotiated Rate |
$541.87 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Aetna Commercial |
$1,089.28
|
| Rate for Payer: Aetna Medicare |
$2,030.00
|
| Rate for Payer: BCBS Complete |
$568.96
|
| Rate for Payer: BCN Commercial |
$1,301.22
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Mclaren Medicaid |
$541.87
|
| Rate for Payer: Meridian Medicaid |
$568.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,045.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,511.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,511.34
|
| Rate for Payer: UHC Medicaid |
$541.87
|
| Rate for Payer: UHCCP Medicaid |
$541.87
|
|
|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,876.00
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$197.03 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$419.58
|
| Rate for Payer: Aetna Medicare |
$938.00
|
| Rate for Payer: BCBS Complete |
$206.88
|
| Rate for Payer: BCN Commercial |
$498.48
|
| Rate for Payer: Cash Price |
$1,500.80
|
| Rate for Payer: Cash Price |
$1,500.80
|
| Rate for Payer: Mclaren Medicaid |
$197.03
|
| Rate for Payer: Meridian Medicaid |
$206.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,407.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$578.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.98
|
| Rate for Payer: UHC Medicaid |
$197.03
|
| Rate for Payer: UHCCP Medicaid |
$197.03
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$188.72 |
| Max. Negotiated Rate |
$1,170.75 |
| Rate for Payer: Aetna Commercial |
$379.91
|
| Rate for Payer: Aetna Medicare |
$780.50
|
| Rate for Payer: BCBS Complete |
$198.16
|
| Rate for Payer: BCN Commercial |
$453.66
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Mclaren Medicaid |
$188.72
|
| Rate for Payer: Meridian Medicaid |
$198.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,170.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$526.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.92
|
| Rate for Payer: UHC Medicaid |
$188.72
|
| Rate for Payer: UHCCP Medicaid |
$188.72
|
|
|
PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 26392
|
| Min. Negotiated Rate |
$620.26 |
| Max. Negotiated Rate |
$1,608.69 |
| Rate for Payer: Aetna Commercial |
$1,339.43
|
| Rate for Payer: Aetna Medicare |
$838.50
|
| Rate for Payer: BCBS Complete |
$651.27
|
| Rate for Payer: BCN Commercial |
$1,504.90
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Mclaren Medicaid |
$620.26
|
| Rate for Payer: Meridian Medicaid |
$651.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,257.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$620.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,608.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,608.69
|
| Rate for Payer: UHC Medicaid |
$620.26
|
| Rate for Payer: UHCCP Medicaid |
$620.26
|
|
|
PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
HCPCS 46754
|
| Min. Negotiated Rate |
$152.93 |
| Max. Negotiated Rate |
$447.79 |
| Rate for Payer: Aetna Commercial |
$312.54
|
| Rate for Payer: Aetna Medicare |
$243.00
|
| Rate for Payer: BCBS Complete |
$160.58
|
| Rate for Payer: BCN Commercial |
$367.51
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Mclaren Medicaid |
$152.93
|
| Rate for Payer: Meridian Medicaid |
$160.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$447.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.79
|
| Rate for Payer: UHC Medicaid |
$152.93
|
| Rate for Payer: UHCCP Medicaid |
$152.93
|
|
|
PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR
|
Professional
|
Both
|
$1,728.00
|
|
|
Service Code
|
HCPCS 33234
|
| Min. Negotiated Rate |
$273.71 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$652.14
|
| Rate for Payer: Aetna Medicare |
$864.00
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCN Commercial |
$714.11
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Mclaren Medicaid |
$273.71
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,296.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$767.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$767.93
|
| Rate for Payer: UHC Medicaid |
$273.71
|
| Rate for Payer: UHCCP Medicaid |
$273.71
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$1,025.25 |
| Rate for Payer: Aetna Commercial |
$854.53
|
| Rate for Payer: Aetna Medicare |
$683.50
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCN Commercial |
$938.20
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Mclaren Medicaid |
$362.10
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,008.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.91
|
| Rate for Payer: UHC Medicaid |
$362.10
|
| Rate for Payer: UHCCP Medicaid |
$362.10
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
36590
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Aetna Commercial |
$252.86
|
| Rate for Payer: Aetna Medicare |
$368.50
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCN Commercial |
$281.36
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Mclaren Medicaid |
$110.12
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.57
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Aetna Commercial |
$252.86
|
| Rate for Payer: Aetna Medicare |
$368.50
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCN Commercial |
$281.36
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Mclaren Medicaid |
$110.12
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.57
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$512.95 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna Commercial |
$626.45
|
| Rate for Payer: BCBS Trust/PPO |
$608.69
|
| Rate for Payer: BCN Commercial |
$608.69
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Healthscope Commercial |
$663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PHP Commercial |
$626.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$641.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.95
|
| Rate for Payer: UHC Core |
$615.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Aetna Commercial |
$626.45
|
| Rate for Payer: Aetna Medicare |
$191.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.31
|
| Rate for Payer: BCBS Complete |
$136.42
|
| Rate for Payer: BCBS MAPPO |
$184.25
|
| Rate for Payer: BCBS Trust/PPO |
$605.89
|
| Rate for Payer: BCN Commercial |
$605.89
|
| Rate for Payer: BCN Medicare Advantage |
$184.25
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.25
|
| Rate for Payer: Healthscope Commercial |
$663.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.75
|
| Rate for Payer: Mclaren Medicaid |
$129.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.46
|
| Rate for Payer: Meridian Medicaid |
$136.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PACE Senior Care Partners |
$175.04
|
| Rate for Payer: PACE SWMI |
$184.25
|
| Rate for Payer: PHP Commercial |
$626.45
|
| Rate for Payer: PHP Medicare Advantage |
$184.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$641.19
|
| Rate for Payer: Priority Health Medicare |
$186.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.95
|
| Rate for Payer: Railroad Medicare Medicare |
$184.25
|
| Rate for Payer: UHC Core |
$615.39
|
| Rate for Payer: UHC Exchange |
$184.25
|
| Rate for Payer: UHC Medicaid |
$129.93
|
| Rate for Payer: UHC Medicare Advantage |
$184.25
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
| Rate for Payer: VA VA |
$184.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.75
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$79.88 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Commercial |
$183.56
|
| Rate for Payer: Aetna Medicare |
$221.00
|
| Rate for Payer: BCBS Complete |
$83.87
|
| Rate for Payer: BCN Commercial |
$202.18
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Mclaren Medicaid |
$79.88
|
| Rate for Payer: Meridian Medicaid |
$83.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$217.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.42
|
| Rate for Payer: UHC Medicaid |
$79.88
|
| Rate for Payer: UHCCP Medicaid |
$79.88
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$310.50 |
| Rate for Payer: Aetna Commercial |
$113.66
|
| Rate for Payer: Aetna Medicare |
$207.00
|
| Rate for Payer: BCBS Complete |
$59.49
|
| Rate for Payer: BCN Commercial |
$154.38
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Mclaren Medicaid |
$56.66
|
| Rate for Payer: Meridian Medicaid |
$59.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$141.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.29
|
| Rate for Payer: UHC Medicaid |
$56.66
|
| Rate for Payer: UHCCP Medicaid |
$56.66
|
|
|
PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 50575
|
| Min. Negotiated Rate |
$396.61 |
| Max. Negotiated Rate |
$1,145.13 |
| Rate for Payer: Aetna Commercial |
$915.90
|
| Rate for Payer: Aetna Medicare |
$714.00
|
| Rate for Payer: BCBS Complete |
$416.44
|
| Rate for Payer: BCN Commercial |
$1,051.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Mclaren Medicaid |
$396.61
|
| Rate for Payer: Meridian Medicaid |
$416.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,145.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,145.13
|
| Rate for Payer: UHC Medicaid |
$396.61
|
| Rate for Payer: UHCCP Medicaid |
$396.61
|
|
|
PR ROBOTIC SURGICAL SYSTEM
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS S2900
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCN Commercial |
$51.06
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
|
|
PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 95852
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Aetna Commercial |
$6.11
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$3.36
|
| Rate for Payer: BCN Commercial |
$8.46
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Mclaren Medicaid |
$3.20
|
| Rate for Payer: Meridian Medicaid |
$3.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.81
|
| Rate for Payer: UHC Medicaid |
$3.20
|
| Rate for Payer: UHCCP Medicaid |
$3.20
|
|
|
PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 35700
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Aetna Commercial |
$205.39
|
| Rate for Payer: Aetna Medicare |
$297.50
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCN Commercial |
$220.60
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Mclaren Medicaid |
$87.12
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.23
|
| Rate for Payer: UHC Medicaid |
$87.12
|
| Rate for Payer: UHCCP Medicaid |
$87.12
|
|
|
PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 33530
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Aetna Commercial |
$707.24
|
| Rate for Payer: Aetna Medicare |
$877.00
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCN Commercial |
$764.90
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Mclaren Medicaid |
$304.38
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,315.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.55
|
| Rate for Payer: UHC Medicaid |
$304.38
|
| Rate for Payer: UHCCP Medicaid |
$304.38
|
|
|
PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 35390
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$249.54 |
| Rate for Payer: Aetna Commercial |
$214.00
|
| Rate for Payer: Aetna Medicare |
$162.50
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCN Commercial |
$232.06
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Mclaren Medicaid |
$91.38
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.54
|
| Rate for Payer: UHC Medicaid |
$91.38
|
| Rate for Payer: UHCCP Medicaid |
$91.38
|
|
|
PR ROUT FOOT CARE PER VISIT
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS S0390
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$25.38
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
|
|
PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB
|
Professional
|
Both
|
$4,149.00
|
|
|
Service Code
|
HCPCS 59610
|
| Min. Negotiated Rate |
$2,074.50 |
| Max. Negotiated Rate |
$3,585.89 |
| Rate for Payer: Aetna Commercial |
$2,150.00
|
| Rate for Payer: Aetna Medicare |
$2,074.50
|
| Rate for Payer: BCBS Complete |
$2,324.35
|
| Rate for Payer: BCN Commercial |
$3,440.73
|
| Rate for Payer: Cash Price |
$3,319.20
|
| Rate for Payer: Cash Price |
$3,319.20
|
| Rate for Payer: Mclaren Medicaid |
$2,213.67
|
| Rate for Payer: Meridian Medicaid |
$2,324.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,111.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,213.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,585.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,585.89
|
| Rate for Payer: UHC Medicaid |
$2,213.67
|
| Rate for Payer: UHCCP Medicaid |
$2,213.67
|
|
|
PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC
|
Professional
|
Both
|
$4,453.00
|
|
|
Service Code
|
HCPCS 59618
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$3,843.04 |
| Rate for Payer: Aetna Commercial |
$2,150.00
|
| Rate for Payer: Aetna Medicare |
$2,226.50
|
| Rate for Payer: BCBS Complete |
$2,493.41
|
| Rate for Payer: BCN Commercial |
$3,440.73
|
| Rate for Payer: Cash Price |
$3,562.40
|
| Rate for Payer: Cash Price |
$3,562.40
|
| Rate for Payer: Mclaren Medicaid |
$2,374.68
|
| Rate for Payer: Meridian Medicaid |
$2,493.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,339.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,374.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,843.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,843.04
|
| Rate for Payer: UHC Medicaid |
$2,374.68
|
| Rate for Payer: UHCCP Medicaid |
$2,374.68
|
|
|
PR RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST
|
Professional
|
Both
|
$2,615.00
|
|
|
Service Code
|
HCPCS 50840
|
| Min. Negotiated Rate |
$703.75 |
| Max. Negotiated Rate |
$2,001.14 |
| Rate for Payer: Aetna Commercial |
$1,579.43
|
| Rate for Payer: Aetna Medicare |
$1,307.50
|
| Rate for Payer: BCBS Complete |
$738.94
|
| Rate for Payer: BCN Commercial |
$1,837.05
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Mclaren Medicaid |
$703.75
|
| Rate for Payer: Meridian Medicaid |
$738.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,961.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,001.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,001.14
|
| Rate for Payer: UHC Medicaid |
$703.75
|
| Rate for Payer: UHCCP Medicaid |
$703.75
|
|
