|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$274.83
|
| Rate for Payer: Aetna Medicare |
$205.10
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: BCBS MAPPO |
$205.10
|
| Rate for Payer: BCN Commercial |
$353.07
|
| Rate for Payer: BCN Medicare Advantage |
$205.10
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$295.34
|
| Rate for Payer: Cofinity Commercial |
$274.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.10
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Healthscope Whirlpool |
$246.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.35
|
| Rate for Payer: Meridian Medicaid |
$142.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.61
|
| Rate for Payer: Nomi Health Commercial |
$246.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.75
|
| Rate for Payer: PACE SWMI |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$205.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.20
|
| Rate for Payer: Priority Health Medicare |
$205.10
|
| Rate for Payer: Priority Health Narrow Network |
$430.20
|
| Rate for Payer: Railroad Medicare Medicare |
$205.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$205.10
|
| Rate for Payer: UHC Exchange |
$387.08
|
| Rate for Payer: UHC Medicaid |
$135.68
|
| Rate for Payer: UHCCP DNSP |
$205.10
|
| Rate for Payer: UHCCP Medicaid |
$135.68
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$142.07 |
| Max. Negotiated Rate |
$468.75 |
| Rate for Payer: Aetna Commercial |
$289.39
|
| Rate for Payer: Aetna Medicare |
$215.96
|
| Rate for Payer: BCBS Complete |
$149.17
|
| Rate for Payer: BCBS MAPPO |
$215.96
|
| Rate for Payer: BCN Commercial |
$374.98
|
| Rate for Payer: BCN Medicare Advantage |
$215.96
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$310.98
|
| Rate for Payer: Cofinity Commercial |
$289.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.96
|
| Rate for Payer: Healthscope Commercial |
$259.15
|
| Rate for Payer: Healthscope Whirlpool |
$259.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.76
|
| Rate for Payer: Meridian Medicaid |
$149.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.56
|
| Rate for Payer: Nomi Health Commercial |
$259.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.75
|
| Rate for Payer: PACE SWMI |
$215.96
|
| Rate for Payer: PHP Medicare Advantage |
$215.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$456.89
|
| Rate for Payer: Priority Health Medicare |
$215.96
|
| Rate for Payer: Priority Health Narrow Network |
$456.89
|
| Rate for Payer: Railroad Medicare Medicare |
$215.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.96
|
| Rate for Payer: UHC Exchange |
$415.62
|
| Rate for Payer: UHC Medicaid |
$142.07
|
| Rate for Payer: UHCCP DNSP |
$215.96
|
| Rate for Payer: UHCCP Medicaid |
$142.07
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$236.75
|
| Rate for Payer: Aetna Medicare |
$176.68
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$176.68
|
| Rate for Payer: BCN Commercial |
$303.27
|
| Rate for Payer: BCN Medicare Advantage |
$176.68
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$254.42
|
| Rate for Payer: Cofinity Commercial |
$236.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.68
|
| Rate for Payer: Healthscope Commercial |
$212.02
|
| Rate for Payer: Healthscope Whirlpool |
$212.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.51
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.35
|
| Rate for Payer: Nomi Health Commercial |
$212.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.00
|
| Rate for Payer: PACE SWMI |
$176.68
|
| Rate for Payer: PHP Medicare Advantage |
$176.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$369.51
|
| Rate for Payer: Priority Health Medicare |
$176.68
|
| Rate for Payer: Priority Health Narrow Network |
$369.51
|
| Rate for Payer: Railroad Medicare Medicare |
$176.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.68
|
| Rate for Payer: UHC Exchange |
$330.98
|
| Rate for Payer: UHC Medicaid |
$116.94
|
| Rate for Payer: UHCCP DNSP |
$176.68
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.64
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.18
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.69
|
| Rate for Payer: Cofinity Commercial |
$0.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$0.58
|
| Rate for Payer: Healthscope Whirlpool |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.53
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHCCP DNSP |
$0.48
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.25
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$296.71 |
| Max. Negotiated Rate |
$861.09 |
| Rate for Payer: Aetna Commercial |
$603.95
|
| Rate for Payer: Aetna Medicare |
$450.71
|
| Rate for Payer: BCBS Complete |
$311.55
|
| Rate for Payer: BCBS MAPPO |
$450.71
|
| Rate for Payer: BCN Commercial |
$764.90
|
| Rate for Payer: BCN Medicare Advantage |
$450.71
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Cofinity Commercial |
$649.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.71
|
| Rate for Payer: Healthscope Commercial |
$540.85
|
| Rate for Payer: Healthscope Whirlpool |
$540.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.25
|
| Rate for Payer: Meridian Medicaid |
$311.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$495.78
|
| Rate for Payer: Nomi Health Commercial |
$540.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.25
|
| Rate for Payer: PACE SWMI |
$450.71
|
| Rate for Payer: PHP Medicare Advantage |
$450.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$700.08
|
| Rate for Payer: Priority Health Medicare |
$450.71
|
| Rate for Payer: Priority Health Narrow Network |
$700.08
|
| Rate for Payer: Railroad Medicare Medicare |
$450.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$861.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$450.71
|
| Rate for Payer: UHC Exchange |
$861.09
|
| Rate for Payer: UHC Medicaid |
$296.71
|
| Rate for Payer: UHCCP DNSP |
$450.71
|
| Rate for Payer: UHCCP Medicaid |
$296.71
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$383.83 |
| Max. Negotiated Rate |
$1,123.19 |
| Rate for Payer: Aetna Commercial |
$785.44
|
| Rate for Payer: Aetna Medicare |
$586.15
|
| Rate for Payer: BCBS Complete |
$403.02
|
| Rate for Payer: BCBS MAPPO |
$586.15
|
| Rate for Payer: BCN Commercial |
$987.00
|
| Rate for Payer: BCN Medicare Advantage |
$586.15
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$844.06
|
| Rate for Payer: Cofinity Commercial |
$785.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.15
|
| Rate for Payer: Healthscope Commercial |
$703.38
|
| Rate for Payer: Healthscope Whirlpool |
$703.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.46
|
| Rate for Payer: Meridian Medicaid |
$403.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$644.76
|
| Rate for Payer: Nomi Health Commercial |
$703.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,046.25
|
| Rate for Payer: PACE SWMI |
$586.15
|
| Rate for Payer: PHP Medicare Advantage |
$586.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$903.36
|
| Rate for Payer: Priority Health Medicare |
$586.15
|
| Rate for Payer: Priority Health Narrow Network |
$903.36
|
| Rate for Payer: Railroad Medicare Medicare |
$586.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$586.15
|
| Rate for Payer: UHC Exchange |
$1,123.19
|
| Rate for Payer: UHC Medicaid |
$383.83
|
| Rate for Payer: UHCCP DNSP |
$586.15
|
| Rate for Payer: UHCCP Medicaid |
$383.83
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,779.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$1,514.36 |
| Rate for Payer: Aetna Commercial |
$1,007.59
|
| Rate for Payer: Aetna Medicare |
$751.93
|
| Rate for Payer: BCBS Complete |
$514.39
|
| Rate for Payer: BCBS MAPPO |
$751.93
|
| Rate for Payer: BCN Commercial |
$1,307.20
|
| Rate for Payer: BCN Medicare Advantage |
$751.93
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cofinity Commercial |
$1,082.78
|
| Rate for Payer: Cofinity Commercial |
$1,007.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.93
|
| Rate for Payer: Healthscope Commercial |
$902.32
|
| Rate for Payer: Healthscope Whirlpool |
$902.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.53
|
| Rate for Payer: Meridian Medicaid |
$514.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$827.12
|
| Rate for Payer: Nomi Health Commercial |
$902.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,334.25
|
| Rate for Payer: PACE SWMI |
$751.93
|
| Rate for Payer: PHP Medicare Advantage |
$751.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,196.43
|
| Rate for Payer: Priority Health Medicare |
$751.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,196.43
|
| Rate for Payer: Railroad Medicare Medicare |
$751.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,514.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.93
|
| Rate for Payer: UHC Exchange |
$1,514.36
|
| Rate for Payer: UHC Medicaid |
$489.90
|
| Rate for Payer: UHCCP DNSP |
$751.93
|
| Rate for Payer: UHCCP Medicaid |
$489.90
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$416.20 |
| Max. Negotiated Rate |
$1,320.28 |
| Rate for Payer: Aetna Commercial |
$851.96
|
| Rate for Payer: Aetna Medicare |
$635.79
|
| Rate for Payer: BCBS Complete |
$437.01
|
| Rate for Payer: BCBS MAPPO |
$635.79
|
| Rate for Payer: BCN Commercial |
$1,148.35
|
| Rate for Payer: BCN Medicare Advantage |
$635.79
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cofinity Commercial |
$915.54
|
| Rate for Payer: Cofinity Commercial |
$851.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.79
|
| Rate for Payer: Healthscope Commercial |
$762.95
|
| Rate for Payer: Healthscope Whirlpool |
$762.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.58
|
| Rate for Payer: Meridian Medicaid |
$437.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$699.37
|
| Rate for Payer: Nomi Health Commercial |
$762.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,247.25
|
| Rate for Payer: PACE SWMI |
$635.79
|
| Rate for Payer: PHP Medicare Advantage |
$635.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$416.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,051.03
|
| Rate for Payer: Priority Health Medicare |
$635.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,051.03
|
| Rate for Payer: Railroad Medicare Medicare |
$635.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,320.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$635.79
|
| Rate for Payer: UHC Exchange |
$1,320.28
|
| Rate for Payer: UHC Medicaid |
$416.20
|
| Rate for Payer: UHCCP DNSP |
$635.79
|
| Rate for Payer: UHCCP Medicaid |
$416.20
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,142.25 |
| Max. Negotiated Rate |
$1,523.00 |
| Rate for Payer: Aetna Commercial |
$1,370.70
|
| Rate for Payer: ASR ASR |
$1,477.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,250.69
|
| Rate for Payer: BCN Commercial |
$1,250.69
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$1,431.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.40
|
| Rate for Payer: Healthscope Commercial |
$1,477.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,523.00
|
| Rate for Payer: Mclaren Commercial |
$1,370.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.55
|
| Rate for Payer: Nomi Health Commercial |
$1,248.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,067.62 |
| Max. Negotiated Rate |
$2,569.82 |
| Rate for Payer: Aetna Commercial |
$1,370.70
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$1,477.31
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.71
|
| Rate for Payer: BCN Commercial |
$1,255.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$1,431.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,477.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,523.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$1,370.70
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.55
|
| Rate for Payer: Nomi Health Commercial |
$1,248.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,334.45
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,067.62
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,224.25 |
| Rate for Payer: Aetna Commercial |
$808.41
|
| Rate for Payer: Aetna Medicare |
$603.29
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$603.29
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$603.29
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$868.74
|
| Rate for Payer: Cofinity Commercial |
$808.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.29
|
| Rate for Payer: Healthscope Commercial |
$723.95
|
| Rate for Payer: Healthscope Whirlpool |
$723.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.62
|
| Rate for Payer: Nomi Health Commercial |
$723.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE SWMI |
$603.29
|
| Rate for Payer: PHP Medicare Advantage |
$603.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$979.01
|
| Rate for Payer: Priority Health Medicare |
$603.29
|
| Rate for Payer: Priority Health Narrow Network |
$979.01
|
| Rate for Payer: Railroad Medicare Medicare |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,224.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.29
|
| Rate for Payer: UHC Exchange |
$1,224.25
|
| Rate for Payer: UHC Medicaid |
$395.54
|
| Rate for Payer: UHCCP DNSP |
$603.29
|
| Rate for Payer: UHCCP Medicaid |
$395.54
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,224.25 |
| Rate for Payer: Aetna Commercial |
$808.41
|
| Rate for Payer: Aetna Medicare |
$603.29
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$603.29
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$603.29
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$868.74
|
| Rate for Payer: Cofinity Commercial |
$808.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.29
|
| Rate for Payer: Healthscope Commercial |
$723.95
|
| Rate for Payer: Healthscope Whirlpool |
$723.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.62
|
| Rate for Payer: Nomi Health Commercial |
$723.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE SWMI |
$603.29
|
| Rate for Payer: PHP Medicare Advantage |
$603.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$979.01
|
| Rate for Payer: Priority Health Medicare |
$603.29
|
| Rate for Payer: Priority Health Narrow Network |
$979.01
|
| Rate for Payer: Railroad Medicare Medicare |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,224.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.29
|
| Rate for Payer: UHC Exchange |
$1,224.25
|
| Rate for Payer: UHC Medicaid |
$395.54
|
| Rate for Payer: UHCCP DNSP |
$603.29
|
| Rate for Payer: UHCCP Medicaid |
$395.54
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,302.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$1,726.50 |
| Rate for Payer: Aetna Commercial |
$911.29
|
| Rate for Payer: Aetna Medicare |
$680.07
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS MAPPO |
$680.07
|
| Rate for Payer: BCN Commercial |
$1,231.01
|
| Rate for Payer: BCN Medicare Advantage |
$680.07
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cofinity Commercial |
$979.30
|
| Rate for Payer: Cofinity Commercial |
$911.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.07
|
| Rate for Payer: Healthscope Commercial |
$816.08
|
| Rate for Payer: Healthscope Whirlpool |
$816.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.07
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$748.08
|
| Rate for Payer: Nomi Health Commercial |
$816.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,726.50
|
| Rate for Payer: PACE SWMI |
$680.07
|
| Rate for Payer: PHP Medicare Advantage |
$680.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,126.70
|
| Rate for Payer: Priority Health Medicare |
$680.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.70
|
| Rate for Payer: Railroad Medicare Medicare |
$680.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,413.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$680.07
|
| Rate for Payer: UHC Exchange |
$1,413.07
|
| Rate for Payer: UHC Medicaid |
$445.60
|
| Rate for Payer: UHCCP DNSP |
$680.07
|
| Rate for Payer: UHCCP Medicaid |
$445.60
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$116.51 |
| Max. Negotiated Rate |
$385.74 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Aetna Medicare |
$182.15
|
| Rate for Payer: BCBS Complete |
$122.34
|
| Rate for Payer: BCBS MAPPO |
$182.15
|
| Rate for Payer: BCN Commercial |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$182.15
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Commercial |
$244.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.15
|
| Rate for Payer: Healthscope Commercial |
$218.58
|
| Rate for Payer: Healthscope Whirlpool |
$218.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.26
|
| Rate for Payer: Meridian Medicaid |
$122.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.37
|
| Rate for Payer: Nomi Health Commercial |
$218.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: PACE SWMI |
$182.15
|
| Rate for Payer: PHP Medicare Advantage |
$182.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.07
|
| Rate for Payer: Priority Health Medicare |
$182.15
|
| Rate for Payer: Priority Health Narrow Network |
$293.07
|
| Rate for Payer: Railroad Medicare Medicare |
$182.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.15
|
| Rate for Payer: UHC Exchange |
$385.74
|
| Rate for Payer: UHC Medicaid |
$116.51
|
| Rate for Payer: UHCCP DNSP |
$182.15
|
| Rate for Payer: UHCCP Medicaid |
$116.51
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$965.65 |
| Rate for Payer: Aetna Commercial |
$654.52
|
| Rate for Payer: Aetna Medicare |
$488.45
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$488.45
|
| Rate for Payer: BCN Commercial |
$857.02
|
| Rate for Payer: BCN Medicare Advantage |
$488.45
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$703.37
|
| Rate for Payer: Cofinity Commercial |
$654.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.45
|
| Rate for Payer: Healthscope Commercial |
$586.14
|
| Rate for Payer: Healthscope Whirlpool |
$586.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.87
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$537.29
|
| Rate for Payer: Nomi Health Commercial |
$586.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.00
|
| Rate for Payer: PACE SWMI |
$488.45
|
| Rate for Payer: PHP Medicare Advantage |
$488.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$784.40
|
| Rate for Payer: Priority Health Medicare |
$488.45
|
| Rate for Payer: Priority Health Narrow Network |
$784.40
|
| Rate for Payer: Railroad Medicare Medicare |
$488.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$488.45
|
| Rate for Payer: UHC Exchange |
$965.65
|
| Rate for Payer: UHC Medicaid |
$321.84
|
| Rate for Payer: UHCCP DNSP |
$488.45
|
| Rate for Payer: UHCCP Medicaid |
$321.84
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,129.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$365.72 |
| Max. Negotiated Rate |
$1,596.75 |
| Rate for Payer: Aetna Commercial |
$747.01
|
| Rate for Payer: Aetna Medicare |
$557.47
|
| Rate for Payer: BCBS Complete |
$384.01
|
| Rate for Payer: BCBS MAPPO |
$557.47
|
| Rate for Payer: BCN Commercial |
$1,001.94
|
| Rate for Payer: BCN Medicare Advantage |
$557.47
|
| Rate for Payer: Cash Price |
$1,703.20
|
| Rate for Payer: Cash Price |
$1,703.20
|
| Rate for Payer: Cofinity Commercial |
$802.76
|
| Rate for Payer: Cofinity Commercial |
$747.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.47
|
| Rate for Payer: Healthscope Commercial |
$668.96
|
| Rate for Payer: Healthscope Whirlpool |
$668.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.34
|
| Rate for Payer: Meridian Medicaid |
$384.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$613.22
|
| Rate for Payer: Nomi Health Commercial |
$668.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.75
|
| Rate for Payer: PACE SWMI |
$557.47
|
| Rate for Payer: PHP Medicare Advantage |
$557.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$917.03
|
| Rate for Payer: Priority Health Medicare |
$557.47
|
| Rate for Payer: Priority Health Narrow Network |
$917.03
|
| Rate for Payer: Railroad Medicare Medicare |
$557.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,146.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$557.47
|
| Rate for Payer: UHC Exchange |
$1,146.45
|
| Rate for Payer: UHC Medicaid |
$365.72
|
| Rate for Payer: UHCCP DNSP |
$557.47
|
| Rate for Payer: UHCCP Medicaid |
$365.72
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,003.50 |
| Max. Negotiated Rate |
$2,870.23 |
| Rate for Payer: Aetna Commercial |
$1,204.20
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$1,297.86
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.18
|
| Rate for Payer: BCN Commercial |
$1,103.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$1,257.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,297.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$1,204.20
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.30
|
| Rate for Payer: Nomi Health Commercial |
$1,097.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,870.23
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,296.18
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,003.50 |
| Max. Negotiated Rate |
$1,338.00 |
| Rate for Payer: Aetna Commercial |
$1,204.20
|
| Rate for Payer: ASR ASR |
$1,297.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.77
|
| Rate for Payer: BCN Commercial |
$1,098.77
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$1,257.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.40
|
| Rate for Payer: Healthscope Commercial |
$1,297.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.00
|
| Rate for Payer: Mclaren Commercial |
$1,204.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.30
|
| Rate for Payer: Nomi Health Commercial |
$1,097.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,075.72 |
| Rate for Payer: Aetna Commercial |
$711.12
|
| Rate for Payer: Aetna Medicare |
$530.69
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$530.69
|
| Rate for Payer: BCN Commercial |
$941.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$711.12
|
| Rate for Payer: Cofinity Commercial |
$764.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.69
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Healthscope Whirlpool |
$636.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.22
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$583.76
|
| Rate for Payer: Nomi Health Commercial |
$636.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE SWMI |
$530.69
|
| Rate for Payer: PHP Medicare Advantage |
$530.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$861.43
|
| Rate for Payer: Priority Health Medicare |
$530.69
|
| Rate for Payer: Priority Health Narrow Network |
$861.43
|
| Rate for Payer: Railroad Medicare Medicare |
$530.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,075.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$530.69
|
| Rate for Payer: UHC Exchange |
$1,075.72
|
| Rate for Payer: UHC Medicaid |
$348.26
|
| Rate for Payer: UHCCP DNSP |
$530.69
|
| Rate for Payer: UHCCP Medicaid |
$348.26
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,075.72 |
| Rate for Payer: Aetna Commercial |
$711.12
|
| Rate for Payer: Aetna Medicare |
$530.69
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$530.69
|
| Rate for Payer: BCN Commercial |
$941.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$764.19
|
| Rate for Payer: Cofinity Commercial |
$711.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.69
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Healthscope Whirlpool |
$636.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.22
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$583.76
|
| Rate for Payer: Nomi Health Commercial |
$636.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE SWMI |
$530.69
|
| Rate for Payer: PHP Medicare Advantage |
$530.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$861.43
|
| Rate for Payer: Priority Health Medicare |
$530.69
|
| Rate for Payer: Priority Health Narrow Network |
$861.43
|
| Rate for Payer: Railroad Medicare Medicare |
$530.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,075.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$530.69
|
| Rate for Payer: UHC Exchange |
$1,075.72
|
| Rate for Payer: UHC Medicaid |
$348.26
|
| Rate for Payer: UHCCP DNSP |
$530.69
|
| Rate for Payer: UHCCP Medicaid |
$348.26
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$109.78 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: BCN Commercial |
$109.78
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$559.07
|
| Rate for Payer: Aetna Medicare |
$417.22
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$417.22
|
| Rate for Payer: BCN Commercial |
$687.71
|
| Rate for Payer: BCN Medicare Advantage |
$417.22
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.22
|
| Rate for Payer: Healthscope Commercial |
$500.66
|
| Rate for Payer: Healthscope Whirlpool |
$500.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.08
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.94
|
| Rate for Payer: Nomi Health Commercial |
$500.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$792.00
|
| Rate for Payer: PACE SWMI |
$417.22
|
| Rate for Payer: PHP Medicare Advantage |
$417.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$735.15
|
| Rate for Payer: Priority Health Medicare |
$417.22
|
| Rate for Payer: Priority Health Narrow Network |
$735.15
|
| Rate for Payer: Railroad Medicare Medicare |
$417.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$417.22
|
| Rate for Payer: UHC Exchange |
$770.63
|
| Rate for Payer: UHC Medicaid |
$274.13
|
| Rate for Payer: UHCCP DNSP |
$417.22
|
| Rate for Payer: UHCCP Medicaid |
$274.13
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.76
|
| Rate for Payer: Priority Health Narrow Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.76
|
| Rate for Payer: Priority Health Narrow Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
