|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,333.45 |
| Rate for Payer: Aetna Commercial |
$1,240.85
|
| Rate for Payer: Aetna Medicare |
$963.05
|
| Rate for Payer: BCBS Complete |
$602.00
|
| Rate for Payer: BCBS MAPPO |
$926.01
|
| Rate for Payer: BCN Medicare Advantage |
$926.01
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.45
|
| Rate for Payer: Cofinity Commercial |
$1,240.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.31
|
| Rate for Payer: Nomi Health Commercial |
$1,111.21
|
| Rate for Payer: PACE SWMI |
$926.01
|
| Rate for Payer: PHP Medicare Advantage |
$926.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health Medicare |
$935.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$926.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$926.01
|
| Rate for Payer: UHC Exchange |
$926.01
|
| Rate for Payer: UHC Medicare Advantage |
$926.01
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$1,146.64 |
| Rate for Payer: Aetna Commercial |
$1,067.02
|
| Rate for Payer: Aetna Medicare |
$828.13
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$796.28
|
| Rate for Payer: BCN Medicare Advantage |
$796.28
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$1,146.64
|
| Rate for Payer: Cofinity Commercial |
$1,067.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.09
|
| Rate for Payer: Nomi Health Commercial |
$955.54
|
| Rate for Payer: PACE SWMI |
$796.28
|
| Rate for Payer: PHP Medicare Advantage |
$796.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$804.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.28
|
| Rate for Payer: UHC Exchange |
$796.28
|
| Rate for Payer: UHC Medicare Advantage |
$796.28
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$726.80 |
| Max. Negotiated Rate |
$1,265.80 |
| Rate for Payer: Aetna Commercial |
$1,177.90
|
| Rate for Payer: Aetna Medicare |
$914.19
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$879.03
|
| Rate for Payer: BCN Medicare Advantage |
$879.03
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,265.80
|
| Rate for Payer: Cofinity Commercial |
$1,177.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$879.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.98
|
| Rate for Payer: Nomi Health Commercial |
$1,054.84
|
| Rate for Payer: PACE SWMI |
$879.03
|
| Rate for Payer: PHP Medicare Advantage |
$879.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health Medicare |
$887.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$879.03
|
| Rate for Payer: UHC Exchange |
$879.03
|
| Rate for Payer: UHC Medicare Advantage |
$879.03
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,147.61 |
| Rate for Payer: Aetna Commercial |
$1,067.91
|
| Rate for Payer: Aetna Medicare |
$828.83
|
| Rate for Payer: BCBS Complete |
$586.80
|
| Rate for Payer: BCBS MAPPO |
$796.95
|
| Rate for Payer: BCN Medicare Advantage |
$796.95
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,147.61
|
| Rate for Payer: Cofinity Commercial |
$1,067.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.80
|
| Rate for Payer: Nomi Health Commercial |
$956.34
|
| Rate for Payer: PACE SWMI |
$796.95
|
| Rate for Payer: PHP Medicare Advantage |
$796.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health Medicare |
$804.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.95
|
| Rate for Payer: UHC Exchange |
$796.95
|
| Rate for Payer: UHC Medicare Advantage |
$796.95
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,514.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$828.71 |
| Max. Negotiated Rate |
$2,284.10 |
| Rate for Payer: Aetna Commercial |
$1,110.47
|
| Rate for Payer: Aetna Medicare |
$861.86
|
| Rate for Payer: BCBS Complete |
$1,405.60
|
| Rate for Payer: BCBS MAPPO |
$828.71
|
| Rate for Payer: BCN Medicare Advantage |
$828.71
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,193.34
|
| Rate for Payer: Cofinity Commercial |
$1,110.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$870.15
|
| Rate for Payer: Nomi Health Commercial |
$994.45
|
| Rate for Payer: PACE SWMI |
$828.71
|
| Rate for Payer: PHP Medicare Advantage |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,284.10
|
| Rate for Payer: Priority Health Medicare |
$837.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$828.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$828.71
|
| Rate for Payer: UHC Exchange |
$828.71
|
| Rate for Payer: UHC Medicare Advantage |
$828.71
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$299.07 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$400.75
|
| Rate for Payer: Aetna Medicare |
$311.03
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$299.07
|
| Rate for Payer: BCN Medicare Advantage |
$299.07
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$430.66
|
| Rate for Payer: Cofinity Commercial |
$400.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.02
|
| Rate for Payer: Nomi Health Commercial |
$358.88
|
| Rate for Payer: PACE SWMI |
$299.07
|
| Rate for Payer: PHP Medicare Advantage |
$299.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$302.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.07
|
| Rate for Payer: UHC Exchange |
$299.07
|
| Rate for Payer: UHC Medicare Advantage |
$299.07
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$1,181.03 |
| Max. Negotiated Rate |
$2,668.90 |
| Rate for Payer: Aetna Commercial |
$1,582.58
|
| Rate for Payer: Aetna Medicare |
$1,228.27
|
| Rate for Payer: BCBS Complete |
$1,642.40
|
| Rate for Payer: BCBS MAPPO |
$1,181.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,181.03
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cofinity Commercial |
$1,700.68
|
| Rate for Payer: Cofinity Commercial |
$1,582.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,181.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,240.08
|
| Rate for Payer: Nomi Health Commercial |
$1,417.24
|
| Rate for Payer: PACE SWMI |
$1,181.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,181.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,668.90
|
| Rate for Payer: Priority Health Medicare |
$1,192.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,181.03
|
| Rate for Payer: UHC Exchange |
$1,181.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,181.03
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$1,182.67 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$1,584.78
|
| Rate for Payer: Aetna Medicare |
$1,229.98
|
| Rate for Payer: BCBS Complete |
$1,388.40
|
| Rate for Payer: BCBS MAPPO |
$1,182.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.67
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$1,703.04
|
| Rate for Payer: Cofinity Commercial |
$1,584.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.80
|
| Rate for Payer: Nomi Health Commercial |
$1,419.20
|
| Rate for Payer: PACE SWMI |
$1,182.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health Medicare |
$1,194.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.67
|
| Rate for Payer: UHC Exchange |
$1,182.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.67
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$535.75 |
| Rate for Payer: Aetna Commercial |
$498.55
|
| Rate for Payer: Aetna Medicare |
$386.93
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$372.05
|
| Rate for Payer: BCN Medicare Advantage |
$372.05
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$535.75
|
| Rate for Payer: Cofinity Commercial |
$498.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.65
|
| Rate for Payer: Nomi Health Commercial |
$446.46
|
| Rate for Payer: PACE SWMI |
$372.05
|
| Rate for Payer: PHP Medicare Advantage |
$372.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$375.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.05
|
| Rate for Payer: UHC Exchange |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$489.76
|
| Rate for Payer: Aetna Medicare |
$380.11
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$365.49
|
| Rate for Payer: BCN Medicare Advantage |
$365.49
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Cofinity Commercial |
$489.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$383.76
|
| Rate for Payer: Nomi Health Commercial |
$438.59
|
| Rate for Payer: PACE SWMI |
$365.49
|
| Rate for Payer: PHP Medicare Advantage |
$365.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$369.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$365.49
|
| Rate for Payer: UHC Exchange |
$365.49
|
| Rate for Payer: UHC Medicare Advantage |
$365.49
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$229.53 |
| Max. Negotiated Rate |
$412.75 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$238.71
|
| Rate for Payer: BCBS Complete |
$254.00
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health Medicare |
$231.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Exchange |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$284.39
|
| Rate for Payer: BCBS Complete |
$248.40
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.65
|
| Rate for Payer: Priority Health Medicare |
$276.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.45
|
| Rate for Payer: UHC Exchange |
$273.45
|
| Rate for Payer: UHC Medicare Advantage |
$273.45
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$602.02
|
| Rate for Payer: Aetna Medicare |
$467.24
|
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: BCBS MAPPO |
$449.27
|
| Rate for Payer: BCN Medicare Advantage |
$449.27
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$646.95
|
| Rate for Payer: Cofinity Commercial |
$602.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.73
|
| Rate for Payer: Nomi Health Commercial |
$539.12
|
| Rate for Payer: PACE SWMI |
$449.27
|
| Rate for Payer: PHP Medicare Advantage |
$449.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health Medicare |
$453.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.27
|
| Rate for Payer: UHC Exchange |
$449.27
|
| Rate for Payer: UHC Medicare Advantage |
$449.27
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,455.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$890.05 |
| Max. Negotiated Rate |
$4,195.75 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: BCBS Complete |
$2,582.00
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,195.75
|
| Rate for Payer: Priority Health Medicare |
$898.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$890.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Exchange |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$349.04 |
| Max. Negotiated Rate |
$567.45 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: BCBS Complete |
$349.20
|
| Rate for Payer: BCBS MAPPO |
$349.04
|
| Rate for Payer: BCN Medicare Advantage |
$349.04
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$502.62
|
| Rate for Payer: Cofinity Commercial |
$467.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.49
|
| Rate for Payer: Nomi Health Commercial |
$418.85
|
| Rate for Payer: PACE SWMI |
$349.04
|
| Rate for Payer: PHP Medicare Advantage |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health Medicare |
$352.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.04
|
| Rate for Payer: UHC Exchange |
$349.04
|
| Rate for Payer: UHC Medicare Advantage |
$349.04
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.62 |
| Max. Negotiated Rate |
$464.73 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$386.39
|
| Rate for Payer: BCN Commercial |
$365.43
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: PACE Senior Care Partners |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO |
$408.90
|
| Rate for Payer: Priority Health Medicare |
$118.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.90
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.60
|
| Rate for Payer: UHC Core |
$392.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.50
|
| Rate for Payer: UHC Exchange |
$117.50
|
| Rate for Payer: UHC Medicare Advantage |
$117.50
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
| Rate for Payer: VA VA |
$117.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: BCBS Trust/PPO |
$383.66
|
| Rate for Payer: BCN Commercial |
$363.22
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO |
$408.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.60
|
| Rate for Payer: UHC Core |
$392.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$187.09
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$181.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Exchange |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$187.09
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$181.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Exchange |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$226.85 |
| Rate for Payer: Aetna Commercial |
$178.51
|
| Rate for Payer: Aetna Medicare |
$138.55
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$133.22
|
| Rate for Payer: BCN Medicare Advantage |
$133.22
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$191.84
|
| Rate for Payer: Cofinity Commercial |
$178.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.88
|
| Rate for Payer: Nomi Health Commercial |
$159.86
|
| Rate for Payer: PACE SWMI |
$133.22
|
| Rate for Payer: PHP Medicare Advantage |
$133.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$134.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.22
|
| Rate for Payer: UHC Exchange |
$133.22
|
| Rate for Payer: UHC Medicare Advantage |
$133.22
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$220.37 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$295.30
|
| Rate for Payer: Aetna Medicare |
$229.18
|
| Rate for Payer: BCBS Complete |
$323.20
|
| Rate for Payer: BCBS MAPPO |
$220.37
|
| Rate for Payer: BCN Medicare Advantage |
$220.37
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$317.33
|
| Rate for Payer: Cofinity Commercial |
$295.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.39
|
| Rate for Payer: Nomi Health Commercial |
$264.44
|
| Rate for Payer: PACE SWMI |
$220.37
|
| Rate for Payer: PHP Medicare Advantage |
$220.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health Medicare |
$222.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.37
|
| Rate for Payer: UHC Exchange |
$220.37
|
| Rate for Payer: UHC Medicare Advantage |
$220.37
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$185.02 |
| Max. Negotiated Rate |
$378.95 |
| Rate for Payer: Aetna Commercial |
$247.93
|
| Rate for Payer: Aetna Medicare |
$192.42
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$185.02
|
| Rate for Payer: BCN Medicare Advantage |
$185.02
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$266.43
|
| Rate for Payer: Cofinity Commercial |
$247.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.27
|
| Rate for Payer: Nomi Health Commercial |
$222.02
|
| Rate for Payer: PACE SWMI |
$185.02
|
| Rate for Payer: PHP Medicare Advantage |
$185.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$186.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.02
|
| Rate for Payer: UHC Exchange |
$185.02
|
| Rate for Payer: UHC Medicare Advantage |
$185.02
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$2,772.25 |
| Rate for Payer: Aetna Commercial |
$1,288.91
|
| Rate for Payer: Aetna Medicare |
$1,000.34
|
| Rate for Payer: BCBS Complete |
$1,706.00
|
| Rate for Payer: BCBS MAPPO |
$961.87
|
| Rate for Payer: BCN Medicare Advantage |
$961.87
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cofinity Commercial |
$1,385.09
|
| Rate for Payer: Cofinity Commercial |
$1,288.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,009.96
|
| Rate for Payer: Nomi Health Commercial |
$1,154.24
|
| Rate for Payer: PACE SWMI |
$961.87
|
| Rate for Payer: PHP Medicare Advantage |
$961.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,772.25
|
| Rate for Payer: Priority Health Medicare |
$971.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$961.87
|
| Rate for Payer: UHC Exchange |
$961.87
|
| Rate for Payer: UHC Medicare Advantage |
$961.87
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$267.20 |
| Max. Negotiated Rate |
$434.20 |
| Rate for Payer: Aetna Commercial |
$366.87
|
| Rate for Payer: Aetna Medicare |
$284.73
|
| Rate for Payer: BCBS Complete |
$267.20
|
| Rate for Payer: BCBS MAPPO |
$273.78
|
| Rate for Payer: BCN Medicare Advantage |
$273.78
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cofinity Commercial |
$394.24
|
| Rate for Payer: Cofinity Commercial |
$366.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.47
|
| Rate for Payer: Nomi Health Commercial |
$328.54
|
| Rate for Payer: PACE SWMI |
$273.78
|
| Rate for Payer: PHP Medicare Advantage |
$273.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.20
|
| Rate for Payer: Priority Health Medicare |
$276.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.78
|
| Rate for Payer: UHC Exchange |
$273.78
|
| Rate for Payer: UHC Medicare Advantage |
$273.78
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.09
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Nomi Health Commercial |
$12.11
|
| Rate for Payer: PACE SWMI |
$10.09
|
| Rate for Payer: PHP Medicare Advantage |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$10.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.09
|
| Rate for Payer: UHC Exchange |
$10.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.09
|
|
