|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 49521
|
| Hospital Charge Code |
49521
|
| Min. Negotiated Rate |
$699.77 |
| Max. Negotiated Rate |
$1,359.80 |
| Rate for Payer: Aetna Commercial |
$937.69
|
| Rate for Payer: Aetna Medicare |
$727.76
|
| Rate for Payer: BCBS Complete |
$836.80
|
| Rate for Payer: BCBS MAPPO |
$699.77
|
| Rate for Payer: BCN Medicare Advantage |
$699.77
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cofinity Commercial |
$937.69
|
| Rate for Payer: Cofinity Commercial |
$1,007.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.76
|
| Rate for Payer: Nomi Health Commercial |
$839.72
|
| Rate for Payer: PACE SWMI |
$699.77
|
| Rate for Payer: PHP Medicare Advantage |
$699.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.80
|
| Rate for Payer: Priority Health Medicare |
$706.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.77
|
| Rate for Payer: UHC Exchange |
$699.77
|
| Rate for Payer: UHC Medicare Advantage |
$699.77
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 49521
|
| Min. Negotiated Rate |
$699.77 |
| Max. Negotiated Rate |
$1,359.80 |
| Rate for Payer: Aetna Commercial |
$937.69
|
| Rate for Payer: Aetna Medicare |
$727.76
|
| Rate for Payer: BCBS Complete |
$836.80
|
| Rate for Payer: BCBS MAPPO |
$699.77
|
| Rate for Payer: BCN Medicare Advantage |
$699.77
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cofinity Commercial |
$937.69
|
| Rate for Payer: Cofinity Commercial |
$1,007.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.76
|
| Rate for Payer: Nomi Health Commercial |
$839.72
|
| Rate for Payer: PACE SWMI |
$699.77
|
| Rate for Payer: PHP Medicare Advantage |
$699.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.80
|
| Rate for Payer: Priority Health Medicare |
$706.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.77
|
| Rate for Payer: UHC Exchange |
$699.77
|
| Rate for Payer: UHC Medicare Advantage |
$699.77
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
49521
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$496.85 |
| Max. Negotiated Rate |
$4,737.22 |
| Rate for Payer: Aetna Commercial |
$1,778.20
|
| Rate for Payer: Aetna Medicare |
$543.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$653.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$653.75
|
| Rate for Payer: BCBS Complete |
$4,737.22
|
| Rate for Payer: BCBS MAPPO |
$523.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.83
|
| Rate for Payer: BCN Commercial |
$1,626.53
|
| Rate for Payer: BCN Medicare Advantage |
$523.00
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cofinity Commercial |
$1,799.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.00
|
| Rate for Payer: Healthscope Commercial |
$1,882.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,569.00
|
| Rate for Payer: Mclaren Medicaid |
$4,511.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$549.15
|
| Rate for Payer: Meridian Medicaid |
$4,737.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.20
|
| Rate for Payer: Nomi Health Commercial |
$1,715.44
|
| Rate for Payer: PACE Senior Care Partners |
$496.85
|
| Rate for Payer: PACE SWMI |
$523.00
|
| Rate for Payer: PHP Commercial |
$1,778.20
|
| Rate for Payer: PHP Medicare Advantage |
$523.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,511.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,820.04
|
| Rate for Payer: Priority Health Medicare |
$528.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,401.64
|
| Rate for Payer: Railroad Medicare Medicare |
$523.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.96
|
| Rate for Payer: UHC Core |
$1,746.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.00
|
| Rate for Payer: UHC Exchange |
$523.00
|
| Rate for Payer: UHC Medicare Advantage |
$523.00
|
| Rate for Payer: UHCCP Medicaid |
$4,511.34
|
| Rate for Payer: VA VA |
$523.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,569.00
|
|
|
PR RPR RECRT INGUN HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
49521
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,359.80 |
| Max. Negotiated Rate |
$1,882.80 |
| Rate for Payer: Aetna Commercial |
$1,778.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,707.70
|
| Rate for Payer: BCN Commercial |
$1,616.70
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cofinity Commercial |
$1,799.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.60
|
| Rate for Payer: Healthscope Commercial |
$1,882.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,569.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.20
|
| Rate for Payer: Nomi Health Commercial |
$1,715.44
|
| Rate for Payer: PHP Commercial |
$1,778.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,820.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,401.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,840.96
|
| Rate for Payer: UHC Core |
$1,746.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,569.00
|
|
|
PR RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT
|
Professional
|
Both
|
$4,469.00
|
|
|
Service Code
|
HCPCS 38115
|
| Min. Negotiated Rate |
$1,256.66 |
| Max. Negotiated Rate |
$2,904.85 |
| Rate for Payer: Aetna Commercial |
$1,683.92
|
| Rate for Payer: Aetna Medicare |
$1,306.93
|
| Rate for Payer: BCBS Complete |
$1,787.60
|
| Rate for Payer: BCBS MAPPO |
$1,256.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,256.66
|
| Rate for Payer: Cash Price |
$3,575.20
|
| Rate for Payer: Cash Price |
$3,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,809.59
|
| Rate for Payer: Cofinity Commercial |
$1,683.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,256.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.49
|
| Rate for Payer: Nomi Health Commercial |
$1,507.99
|
| Rate for Payer: PACE SWMI |
$1,256.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,256.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,904.85
|
| Rate for Payer: Priority Health Medicare |
$1,269.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,256.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,256.66
|
| Rate for Payer: UHC Exchange |
$1,256.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.66
|
|
|
PR RPR SINUS VALSALVA FISTULA
|
Professional
|
Both
|
$3,229.00
|
|
|
Service Code
|
HCPCS 33702
|
| Min. Negotiated Rate |
$1,291.60 |
| Max. Negotiated Rate |
$2,142.56 |
| Rate for Payer: Aetna Commercial |
$1,993.77
|
| Rate for Payer: Aetna Medicare |
$1,547.41
|
| Rate for Payer: BCBS Complete |
$1,291.60
|
| Rate for Payer: BCBS MAPPO |
$1,487.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,487.89
|
| Rate for Payer: Cash Price |
$2,583.20
|
| Rate for Payer: Cash Price |
$2,583.20
|
| Rate for Payer: Cofinity Commercial |
$2,142.56
|
| Rate for Payer: Cofinity Commercial |
$1,993.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,487.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,562.28
|
| Rate for Payer: Nomi Health Commercial |
$1,785.47
|
| Rate for Payer: PACE SWMI |
$1,487.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,487.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,098.85
|
| Rate for Payer: Priority Health Medicare |
$1,502.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,487.89
|
| Rate for Payer: UHC Exchange |
$1,487.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,487.89
|
|
|
PR RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 49600
|
| Min. Negotiated Rate |
$716.18 |
| Max. Negotiated Rate |
$1,281.15 |
| Rate for Payer: Aetna Commercial |
$959.68
|
| Rate for Payer: Aetna Medicare |
$744.83
|
| Rate for Payer: BCBS Complete |
$788.40
|
| Rate for Payer: BCBS MAPPO |
$716.18
|
| Rate for Payer: BCN Medicare Advantage |
$716.18
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cofinity Commercial |
$959.68
|
| Rate for Payer: Cofinity Commercial |
$1,031.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.99
|
| Rate for Payer: Nomi Health Commercial |
$859.42
|
| Rate for Payer: PACE SWMI |
$716.18
|
| Rate for Payer: PHP Medicare Advantage |
$716.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,281.15
|
| Rate for Payer: Priority Health Medicare |
$723.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.18
|
| Rate for Payer: UHC Exchange |
$716.18
|
| Rate for Payer: UHC Medicare Advantage |
$716.18
|
|
|
PR RPR SPIGELIAN HERNIA
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 49590
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,056.90 |
| Rate for Payer: Aetna Medicare |
$813.00
|
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.90
|
|
|
PR RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL
|
Professional
|
Both
|
$7,886.00
|
|
|
Service Code
|
HCPCS 38780
|
| Min. Negotiated Rate |
$1,018.95 |
| Max. Negotiated Rate |
$5,125.90 |
| Rate for Payer: Aetna Commercial |
$1,365.39
|
| Rate for Payer: Aetna Medicare |
$1,059.71
|
| Rate for Payer: BCBS Complete |
$3,154.40
|
| Rate for Payer: BCBS MAPPO |
$1,018.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.95
|
| Rate for Payer: Cash Price |
$6,308.80
|
| Rate for Payer: Cash Price |
$6,308.80
|
| Rate for Payer: Cofinity Commercial |
$1,467.29
|
| Rate for Payer: Cofinity Commercial |
$1,365.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.90
|
| Rate for Payer: Nomi Health Commercial |
$1,222.74
|
| Rate for Payer: PACE SWMI |
$1,018.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,125.90
|
| Rate for Payer: Priority Health Medicare |
$1,029.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,018.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.95
|
| Rate for Payer: UHC Exchange |
$1,018.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.95
|
|
|
PR RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 28200
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$419.29
|
| Rate for Payer: Aetna Medicare |
$325.42
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS MAPPO |
$312.90
|
| Rate for Payer: BCN Medicare Advantage |
$312.90
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$419.29
|
| Rate for Payer: Cofinity Commercial |
$450.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.55
|
| Rate for Payer: Nomi Health Commercial |
$375.48
|
| Rate for Payer: PACE SWMI |
$312.90
|
| Rate for Payer: PHP Medicare Advantage |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health Medicare |
$316.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.90
|
| Rate for Payer: UHC Exchange |
$312.90
|
| Rate for Payer: UHC Medicare Advantage |
$312.90
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS
|
Professional
|
Both
|
$1,254.00
|
|
|
Service Code
|
HCPCS 25263
|
| Min. Negotiated Rate |
$501.60 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna Commercial |
$822.79
|
| Rate for Payer: Aetna Medicare |
$638.58
|
| Rate for Payer: BCBS Complete |
$501.60
|
| Rate for Payer: BCBS MAPPO |
$614.02
|
| Rate for Payer: BCN Medicare Advantage |
$614.02
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cofinity Commercial |
$884.19
|
| Rate for Payer: Cofinity Commercial |
$822.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$644.72
|
| Rate for Payer: Nomi Health Commercial |
$736.82
|
| Rate for Payer: PACE SWMI |
$614.02
|
| Rate for Payer: PHP Medicare Advantage |
$614.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.10
|
| Rate for Payer: Priority Health Medicare |
$620.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.02
|
| Rate for Payer: UHC Exchange |
$614.02
|
| Rate for Payer: UHC Medicare Advantage |
$614.02
|
|
|
PR RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25260
|
| Min. Negotiated Rate |
$614.65 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$823.63
|
| Rate for Payer: Aetna Medicare |
$639.24
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$614.65
|
| Rate for Payer: BCN Medicare Advantage |
$614.65
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$885.10
|
| Rate for Payer: Cofinity Commercial |
$823.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.38
|
| Rate for Payer: Nomi Health Commercial |
$737.58
|
| Rate for Payer: PACE SWMI |
$614.65
|
| Rate for Payer: PHP Medicare Advantage |
$614.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$620.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.65
|
| Rate for Payer: UHC Exchange |
$614.65
|
| Rate for Payer: UHC Medicare Advantage |
$614.65
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$479.04 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Aetna Commercial |
$641.91
|
| Rate for Payer: Aetna Medicare |
$498.20
|
| Rate for Payer: BCBS Complete |
$567.20
|
| Rate for Payer: BCBS MAPPO |
$479.04
|
| Rate for Payer: BCN Medicare Advantage |
$479.04
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$689.82
|
| Rate for Payer: Cofinity Commercial |
$641.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.99
|
| Rate for Payer: Nomi Health Commercial |
$574.85
|
| Rate for Payer: PACE SWMI |
$479.04
|
| Rate for Payer: PHP Medicare Advantage |
$479.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.70
|
| Rate for Payer: Priority Health Medicare |
$483.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.04
|
| Rate for Payer: UHC Exchange |
$479.04
|
| Rate for Payer: UHC Medicare Advantage |
$479.04
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,621.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$542.71 |
| Max. Negotiated Rate |
$1,053.65 |
| Rate for Payer: Aetna Commercial |
$727.23
|
| Rate for Payer: Aetna Medicare |
$564.42
|
| Rate for Payer: BCBS Complete |
$648.40
|
| Rate for Payer: BCBS MAPPO |
$542.71
|
| Rate for Payer: BCN Medicare Advantage |
$542.71
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cofinity Commercial |
$781.50
|
| Rate for Payer: Cofinity Commercial |
$727.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$542.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$569.85
|
| Rate for Payer: Nomi Health Commercial |
$651.25
|
| Rate for Payer: PACE SWMI |
$542.71
|
| Rate for Payer: PHP Medicare Advantage |
$542.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.65
|
| Rate for Payer: Priority Health Medicare |
$548.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$542.71
|
| Rate for Payer: UHC Exchange |
$542.71
|
| Rate for Payer: UHC Medicare Advantage |
$542.71
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN
|
Professional
|
Both
|
$2,302.00
|
|
|
Service Code
|
HCPCS 25274
|
| Min. Negotiated Rate |
$644.31 |
| Max. Negotiated Rate |
$1,496.30 |
| Rate for Payer: Aetna Commercial |
$863.38
|
| Rate for Payer: Aetna Medicare |
$670.08
|
| Rate for Payer: BCBS Complete |
$920.80
|
| Rate for Payer: BCBS MAPPO |
$644.31
|
| Rate for Payer: BCN Medicare Advantage |
$644.31
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cofinity Commercial |
$927.81
|
| Rate for Payer: Cofinity Commercial |
$863.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.53
|
| Rate for Payer: Nomi Health Commercial |
$773.17
|
| Rate for Payer: PACE SWMI |
$644.31
|
| Rate for Payer: PHP Medicare Advantage |
$644.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.30
|
| Rate for Payer: Priority Health Medicare |
$650.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$644.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.31
|
| Rate for Payer: UHC Exchange |
$644.31
|
| Rate for Payer: UHC Medicare Advantage |
$644.31
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$650.90 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$872.21
|
| Rate for Payer: Aetna Medicare |
$676.94
|
| Rate for Payer: BCBS Complete |
$810.00
|
| Rate for Payer: BCBS MAPPO |
$650.90
|
| Rate for Payer: BCN Medicare Advantage |
$650.90
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cofinity Commercial |
$937.30
|
| Rate for Payer: Cofinity Commercial |
$872.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.45
|
| Rate for Payer: Nomi Health Commercial |
$781.08
|
| Rate for Payer: PACE SWMI |
$650.90
|
| Rate for Payer: PHP Medicare Advantage |
$650.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health Medicare |
$657.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$650.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.90
|
| Rate for Payer: UHC Exchange |
$650.90
|
| Rate for Payer: UHC Medicare Advantage |
$650.90
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$539.78
|
| Rate for Payer: Aetna Medicare |
$418.93
|
| Rate for Payer: BCBS Complete |
$378.80
|
| Rate for Payer: BCBS MAPPO |
$402.82
|
| Rate for Payer: BCN Medicare Advantage |
$402.82
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$580.06
|
| Rate for Payer: Cofinity Commercial |
$539.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.96
|
| Rate for Payer: Nomi Health Commercial |
$483.38
|
| Rate for Payer: PACE SWMI |
$402.82
|
| Rate for Payer: PHP Medicare Advantage |
$402.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health Medicare |
$406.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.82
|
| Rate for Payer: UHC Exchange |
$402.82
|
| Rate for Payer: UHC Medicare Advantage |
$402.82
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,690.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$3,459.74 |
| Max. Negotiated Rate |
$5,648.50 |
| Rate for Payer: Aetna Commercial |
$4,636.05
|
| Rate for Payer: Aetna Medicare |
$3,598.13
|
| Rate for Payer: BCBS Complete |
$3,476.00
|
| Rate for Payer: BCBS MAPPO |
$3,459.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,459.74
|
| Rate for Payer: Cash Price |
$6,952.00
|
| Rate for Payer: Cash Price |
$6,952.00
|
| Rate for Payer: Cofinity Commercial |
$4,982.03
|
| Rate for Payer: Cofinity Commercial |
$4,636.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,459.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,632.73
|
| Rate for Payer: Nomi Health Commercial |
$4,151.69
|
| Rate for Payer: PACE SWMI |
$3,459.74
|
| Rate for Payer: PHP Medicare Advantage |
$3,459.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,648.50
|
| Rate for Payer: Priority Health Medicare |
$3,494.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,459.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,459.74
|
| Rate for Payer: UHC Exchange |
$3,459.74
|
| Rate for Payer: UHC Medicare Advantage |
$3,459.74
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Aetna Commercial |
$487.24
|
| Rate for Payer: Aetna Medicare |
$378.15
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS MAPPO |
$363.61
|
| Rate for Payer: BCN Medicare Advantage |
$363.61
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$487.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.79
|
| Rate for Payer: Nomi Health Commercial |
$436.33
|
| Rate for Payer: PACE SWMI |
$363.61
|
| Rate for Payer: PHP Medicare Advantage |
$363.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health Medicare |
$367.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.61
|
| Rate for Payer: UHC Exchange |
$363.61
|
| Rate for Payer: UHC Medicare Advantage |
$363.61
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$291.20 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$32.97
|
| Rate for Payer: BCBS Complete |
$179.20
|
| Rate for Payer: BCBS MAPPO |
$31.70
|
| Rate for Payer: BCN Medicare Advantage |
$31.70
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$45.65
|
| Rate for Payer: Cofinity Commercial |
$42.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.28
|
| Rate for Payer: Nomi Health Commercial |
$38.04
|
| Rate for Payer: PACE SWMI |
$31.70
|
| Rate for Payer: PHP Medicare Advantage |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health Medicare |
$32.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.70
|
| Rate for Payer: UHC Exchange |
$31.70
|
| Rate for Payer: UHC Medicare Advantage |
$31.70
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$824.20 |
| Rate for Payer: Aetna Medicare |
$634.00
|
| Rate for Payer: BCBS Complete |
$507.20
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.20
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,095.25 |
| Rate for Payer: Aetna Medicare |
$842.50
|
| Rate for Payer: BCBS Complete |
$674.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.25
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$8,041.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$2,061.73 |
| Max. Negotiated Rate |
$5,226.65 |
| Rate for Payer: Aetna Commercial |
$2,762.72
|
| Rate for Payer: Aetna Medicare |
$2,144.20
|
| Rate for Payer: BCBS Complete |
$3,216.40
|
| Rate for Payer: BCBS MAPPO |
$2,061.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,061.73
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cofinity Commercial |
$2,762.72
|
| Rate for Payer: Cofinity Commercial |
$2,968.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,061.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,164.82
|
| Rate for Payer: Nomi Health Commercial |
$2,474.08
|
| Rate for Payer: PACE SWMI |
$2,061.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,061.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,226.65
|
| Rate for Payer: Priority Health Medicare |
$2,082.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,061.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,061.73
|
| Rate for Payer: UHC Exchange |
$2,061.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,061.73
|
|
