|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Mclaren Medicaid |
$444.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO |
$935.99
|
| Rate for Payer: Priority Health Medicare |
$664.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$935.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Exchange |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,041.30 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.71
|
| Rate for Payer: BCN Commercial |
$1,238.03
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$1,313.64
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,393.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,073.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,409.76
|
| Rate for Payer: UHC Core |
$1,337.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Mclaren Medicaid |
$444.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO |
$935.99
|
| Rate for Payer: Priority Health Medicare |
$664.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$935.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Exchange |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$167.66
|
| Rate for Payer: Aetna Medicare |
$130.12
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS MAPPO |
$125.12
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: BCN Medicare Advantage |
$125.12
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$180.17
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.12
|
| Rate for Payer: Mclaren Medicaid |
$83.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Nomi Health Commercial |
$150.14
|
| Rate for Payer: PACE SWMI |
$125.12
|
| Rate for Payer: PHP Medicare Advantage |
$125.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health HMO/PPO |
$177.00
|
| Rate for Payer: Priority Health Medicare |
$126.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.12
|
| Rate for Payer: UHC Exchange |
$125.12
|
| Rate for Payer: UHC Medicare Advantage |
$125.12
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Mclaren Medicaid |
$461.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO |
$971.21
|
| Rate for Payer: Priority Health Medicare |
$690.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Exchange |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Mclaren Medicaid |
$461.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO |
$971.21
|
| Rate for Payer: Priority Health Medicare |
$690.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$971.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Exchange |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,398.80 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,756.68
|
| Rate for Payer: BCN Commercial |
$1,663.07
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$1,764.64
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,872.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,441.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,893.76
|
| Rate for Payer: UHC Core |
$1,796.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.00
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$511.10 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: Aetna Medicare |
$559.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$672.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$672.50
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$538.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.16
|
| Rate for Payer: BCN Commercial |
$1,673.18
|
| Rate for Payer: BCN Medicare Advantage |
$538.00
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.00
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.00
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.90
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$1,764.64
|
| Rate for Payer: PACE Senior Care Partners |
$511.10
|
| Rate for Payer: PACE SWMI |
$538.00
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: PHP Medicare Advantage |
$538.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,872.24
|
| Rate for Payer: Priority Health Medicare |
$543.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,441.84
|
| Rate for Payer: Railroad Medicare Medicare |
$538.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,893.76
|
| Rate for Payer: UHC Core |
$1,796.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$538.00
|
| Rate for Payer: UHC Exchange |
$538.00
|
| Rate for Payer: UHC Medicare Advantage |
$538.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$538.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.00
|
|
|
PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$896.35 |
| Rate for Payer: Aetna Commercial |
$141.76
|
| Rate for Payer: Aetna Medicare |
$110.02
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$105.79
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$105.79
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$141.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.79
|
| Rate for Payer: Mclaren Medicaid |
$70.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.08
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Nomi Health Commercial |
$126.95
|
| Rate for Payer: PACE SWMI |
$105.79
|
| Rate for Payer: PHP Medicare Advantage |
$105.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.35
|
| Rate for Payer: Priority Health HMO/PPO |
$149.00
|
| Rate for Payer: Priority Health Medicare |
$106.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.79
|
| Rate for Payer: UHC Exchange |
$105.79
|
| Rate for Payer: UHC Medicare Advantage |
$105.79
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$1,259.47 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| 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 |
$24.82
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Mclaren Medicaid |
$5.11
|
| Rate for Payer: Mclaren Medicaid |
$5.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Nomi Health Commercial |
$29.78
|
| Rate for Payer: Nomi Health Commercial |
$29.78
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$25.07
|
| Rate for Payer: Priority Health Medicare |
$25.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Exchange |
$24.82
|
| Rate for Payer: UHC Exchange |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.82
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$1,875.99 |
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna Medicare |
$24.36
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$23.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.99
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$23.42
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.42
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.59
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$28.10
|
| Rate for Payer: PACE SWMI |
$23.42
|
| Rate for Payer: PHP Medicare Advantage |
$23.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$28.05
|
| Rate for Payer: Priority Health Medicare |
$23.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.42
|
| Rate for Payer: UHC Exchange |
$23.42
|
| Rate for Payer: UHC Medicare Advantage |
$23.42
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
|
|
PR SPORTS PHYSICAL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$789.10 |
| Rate for Payer: Aetna Commercial |
$344.98
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: BCBS Complete |
$178.03
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$463.85
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cofinity Commercial |
$370.73
|
| Rate for Payer: Cofinity Commercial |
$344.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Mclaren Medicaid |
$169.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$178.03
|
| Rate for Payer: Nomi Health Commercial |
$308.94
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.10
|
| Rate for Payer: Priority Health HMO/PPO |
$424.39
|
| Rate for Payer: Priority Health Medicare |
$260.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$424.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Exchange |
$257.45
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$169.55
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$426.47
|
| Rate for Payer: Aetna Medicare |
$330.99
|
| Rate for Payer: BCBS Complete |
$219.63
|
| Rate for Payer: BCBS MAPPO |
$318.26
|
| Rate for Payer: BCBS Trust/PPO |
$327.02
|
| Rate for Payer: BCN Commercial |
$725.69
|
| Rate for Payer: BCN Medicare Advantage |
$318.26
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$458.29
|
| Rate for Payer: Cofinity Commercial |
$426.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.26
|
| Rate for Payer: Mclaren Medicaid |
$209.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.17
|
| Rate for Payer: Meridian Medicaid |
$219.63
|
| Rate for Payer: Nomi Health Commercial |
$381.91
|
| Rate for Payer: PACE SWMI |
$318.26
|
| Rate for Payer: PHP Medicare Advantage |
$318.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health HMO/PPO |
$520.12
|
| Rate for Payer: Priority Health Medicare |
$321.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$520.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.26
|
| Rate for Payer: UHC Exchange |
$318.26
|
| Rate for Payer: UHC Medicare Advantage |
$318.26
|
| Rate for Payer: UHCCP Medicaid |
$209.17
|
|
|
PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA
|
Professional
|
Both
|
$1,743.00
|
|
|
Service Code
|
HCPCS 49220
|
| Min. Negotiated Rate |
$697.20 |
| Max. Negotiated Rate |
$1,132.95 |
| Rate for Payer: Aetna Medicare |
$871.50
|
| Rate for Payer: BCBS Complete |
$697.20
|
| Rate for Payer: Cash Price |
$1,394.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.95
|
|
|
PR STANDARDIZED COGNITIVE PERFORMANCE TESTING
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 96125
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$128.75
|
| Rate for Payer: Aetna Medicare |
$99.92
|
| Rate for Payer: BCBS Complete |
$74.80
|
| Rate for Payer: BCBS MAPPO |
$96.08
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$149.05
|
| Rate for Payer: BCN Medicare Advantage |
$96.08
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.88
|
| Rate for Payer: Nomi Health Commercial |
$115.30
|
| Rate for Payer: PACE SWMI |
$96.08
|
| Rate for Payer: PHP Medicare Advantage |
$96.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
| Rate for Payer: Priority Health HMO/PPO |
$138.86
|
| Rate for Payer: Priority Health Medicare |
$97.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.08
|
| Rate for Payer: UHC Exchange |
$96.08
|
| Rate for Payer: UHC Medicare Advantage |
$96.08
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$590.44 |
| Max. Negotiated Rate |
$1,545.81 |
| Rate for Payer: Aetna Commercial |
$1,160.86
|
| Rate for Payer: Aetna Medicare |
$900.96
|
| Rate for Payer: BCBS Complete |
$619.96
|
| Rate for Payer: BCBS MAPPO |
$866.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.81
|
| Rate for Payer: BCN Commercial |
$1,365.86
|
| Rate for Payer: BCN Medicare Advantage |
$866.31
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,247.49
|
| Rate for Payer: Cofinity Commercial |
$1,160.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.31
|
| Rate for Payer: Mclaren Medicaid |
$590.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.63
|
| Rate for Payer: Meridian Medicaid |
$619.96
|
| Rate for Payer: Nomi Health Commercial |
$1,039.57
|
| Rate for Payer: PACE SWMI |
$866.31
|
| Rate for Payer: PHP Medicare Advantage |
$866.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,356.02
|
| Rate for Payer: Priority Health Medicare |
$874.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,356.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$866.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.31
|
| Rate for Payer: UHC Exchange |
$866.31
|
| Rate for Payer: UHC Medicare Advantage |
$866.31
|
| Rate for Payer: UHCCP Medicaid |
$590.44
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT
|
Professional
|
Both
|
$2,433.00
|
|
|
Service Code
|
HCPCS 69661
|
| Min. Negotiated Rate |
$768.93 |
| Max. Negotiated Rate |
$1,935.16 |
| Rate for Payer: Aetna Commercial |
$1,513.11
|
| Rate for Payer: Aetna Medicare |
$1,174.36
|
| Rate for Payer: BCBS Complete |
$807.38
|
| Rate for Payer: BCBS MAPPO |
$1,129.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.16
|
| Rate for Payer: BCN Commercial |
$1,778.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,129.19
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cofinity Commercial |
$1,626.03
|
| Rate for Payer: Cofinity Commercial |
$1,513.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,129.19
|
| Rate for Payer: Mclaren Medicaid |
$768.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.65
|
| Rate for Payer: Meridian Medicaid |
$807.38
|
| Rate for Payer: Nomi Health Commercial |
$1,355.03
|
| Rate for Payer: PACE SWMI |
$1,129.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,129.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$768.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,581.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,766.03
|
| Rate for Payer: Priority Health Medicare |
$1,140.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,766.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,129.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,129.19
|
| Rate for Payer: UHC Exchange |
$1,129.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,129.19
|
| Rate for Payer: UHCCP Medicaid |
$768.93
|
|
|
PR STAPES MOBILIZATION
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 69650
|
| Min. Negotiated Rate |
$512.90 |
| Max. Negotiated Rate |
$1,315.47 |
| Rate for Payer: Aetna Commercial |
$1,004.77
|
| Rate for Payer: Aetna Medicare |
$779.82
|
| Rate for Payer: BCBS Complete |
$538.54
|
| Rate for Payer: BCBS MAPPO |
$749.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.47
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$749.83
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,079.76
|
| Rate for Payer: Cofinity Commercial |
$1,004.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.83
|
| Rate for Payer: Mclaren Medicaid |
$512.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$787.32
|
| Rate for Payer: Meridian Medicaid |
$538.54
|
| Rate for Payer: Nomi Health Commercial |
$899.80
|
| Rate for Payer: PACE SWMI |
$749.83
|
| Rate for Payer: PHP Medicare Advantage |
$749.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,180.43
|
| Rate for Payer: Priority Health Medicare |
$757.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,180.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$749.83
|
| Rate for Payer: UHC Exchange |
$749.83
|
| Rate for Payer: UHC Medicare Advantage |
$749.83
|
| Rate for Payer: UHCCP Medicaid |
$512.90
|
|
|
PR STENGER TEST PURE TONE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92565
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$1,644.60 |
| Rate for Payer: Aetna Commercial |
$26.17
|
| Rate for Payer: Aetna Medicare |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.60
|
| Rate for Payer: BCN Commercial |
$29.32
|
| Rate for Payer: BCN Medicare Advantage |
$19.53
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.51
|
| Rate for Payer: Nomi Health Commercial |
$23.44
|
| Rate for Payer: PACE SWMI |
$19.53
|
| Rate for Payer: PHP Medicare Advantage |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health HMO/PPO |
$28.49
|
| Rate for Payer: Priority Health Medicare |
$19.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.53
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$19.53
|
|
|
PR STENGER TEST SPEECH
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92577
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$27.36
|
| Rate for Payer: Aetna Medicare |
$21.24
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$20.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$20.42
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$27.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.44
|
| Rate for Payer: Nomi Health Commercial |
$24.50
|
| Rate for Payer: PACE SWMI |
$20.42
|
| Rate for Payer: PHP Medicare Advantage |
$20.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO |
$29.85
|
| Rate for Payer: Priority Health Medicare |
$20.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.42
|
| Rate for Payer: UHC Exchange |
$20.42
|
| Rate for Payer: UHC Medicare Advantage |
$20.42
|
|
|
PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 36908
|
| Min. Negotiated Rate |
$129.29 |
| Max. Negotiated Rate |
$2,085.19 |
| Rate for Payer: Aetna Commercial |
$264.14
|
| Rate for Payer: Aetna Medicare |
$205.00
|
| Rate for Payer: BCBS Complete |
$135.75
|
| Rate for Payer: BCBS MAPPO |
$197.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.07
|
| Rate for Payer: BCN Commercial |
$2,085.19
|
| Rate for Payer: BCN Medicare Advantage |
$197.12
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$283.85
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.12
|
| Rate for Payer: Mclaren Medicaid |
$129.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.98
|
| Rate for Payer: Meridian Medicaid |
$135.75
|
| Rate for Payer: Nomi Health Commercial |
$236.54
|
| Rate for Payer: PACE SWMI |
$197.12
|
| Rate for Payer: PHP Medicare Advantage |
$197.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health HMO/PPO |
$320.68
|
| Rate for Payer: Priority Health Medicare |
$199.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.12
|
| Rate for Payer: UHC Exchange |
$197.12
|
| Rate for Payer: UHC Medicare Advantage |
$197.12
|
| Rate for Payer: UHCCP Medicaid |
$129.29
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS G6002
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$68.27
|
| Rate for Payer: BCBS MAPPO |
$68.27
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$108.97
|
| Rate for Payer: BCN Commercial |
$108.97
|
| Rate for Payer: BCN Medicare Advantage |
$68.27
|
| Rate for Payer: BCN Medicare Advantage |
$68.27
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$98.31
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Cofinity Commercial |
$98.31
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.27
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.68
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$81.92
|
| Rate for Payer: Nomi Health Commercial |
$81.92
|
| Rate for Payer: PACE SWMI |
$68.27
|
| Rate for Payer: PACE SWMI |
$68.27
|
| Rate for Payer: PHP Medicare Advantage |
$68.27
|
| Rate for Payer: PHP Medicare Advantage |
$68.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO |
$31.32
|
| Rate for Payer: Priority Health Medicare |
$68.95
|
| Rate for Payer: Priority Health Medicare |
$68.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.27
|
| Rate for Payer: UHC Exchange |
$68.27
|
| Rate for Payer: UHC Exchange |
$68.27
|
| Rate for Payer: UHC Medicare Advantage |
$68.27
|
| Rate for Payer: UHC Medicare Advantage |
$68.27
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
|
|
PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES
|
Professional
|
Both
|
$2,976.00
|
|
|
Service Code
|
HCPCS 61750
|
| Min. Negotiated Rate |
$662.49 |
| Max. Negotiated Rate |
$2,885.28 |
| Rate for Payer: Aetna Commercial |
$1,876.23
|
| Rate for Payer: Aetna Medicare |
$1,456.18
|
| Rate for Payer: BCBS Complete |
$967.06
|
| Rate for Payer: BCBS MAPPO |
$1,400.17
|
| Rate for Payer: BCBS Trust/PPO |
$662.49
|
| Rate for Payer: BCN Commercial |
$2,885.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,400.17
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cofinity Commercial |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$1,876.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,400.17
|
| Rate for Payer: Mclaren Medicaid |
$921.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,470.18
|
| Rate for Payer: Meridian Medicaid |
$967.06
|
| Rate for Payer: Nomi Health Commercial |
$1,680.20
|
| Rate for Payer: PACE SWMI |
$1,400.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,400.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$921.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,934.40
|
| Rate for Payer: Priority Health HMO/PPO |
$2,443.20
|
| Rate for Payer: Priority Health Medicare |
$1,414.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,443.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,400.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,400.17
|
| Rate for Payer: UHC Exchange |
$1,400.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,400.17
|
| Rate for Payer: UHCCP Medicaid |
$921.01
|
|
|
PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61783
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$707.92 |
| Rate for Payer: Aetna Commercial |
$304.90
|
| Rate for Payer: Aetna Medicare |
$236.64
|
| Rate for Payer: BCBS Complete |
$155.88
|
| Rate for Payer: BCBS MAPPO |
$227.54
|
| Rate for Payer: BCBS Trust/PPO |
$707.92
|
| Rate for Payer: BCN Commercial |
$337.68
|
| Rate for Payer: BCN Medicare Advantage |
$227.54
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$327.66
|
| Rate for Payer: Cofinity Commercial |
$304.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.54
|
| Rate for Payer: Mclaren Medicaid |
$148.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.92
|
| Rate for Payer: Meridian Medicaid |
$155.88
|
| Rate for Payer: Nomi Health Commercial |
$273.05
|
| Rate for Payer: PACE SWMI |
$227.54
|
| Rate for Payer: PHP Medicare Advantage |
$227.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health HMO/PPO |
$394.12
|
| Rate for Payer: Priority Health Medicare |
$229.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$394.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.54
|
| Rate for Payer: UHC Exchange |
$227.54
|
| Rate for Payer: UHC Medicare Advantage |
$227.54
|
| Rate for Payer: UHCCP Medicaid |
$148.46
|
|
