|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$641.88 |
| Rate for Payer: Aetna Commercial |
$160.55
|
| Rate for Payer: Aetna Commercial |
$160.55
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: Aetna Medicare |
$302.00
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS Trust/PPO |
$641.88
|
| Rate for Payer: BCBS Trust/PPO |
$641.88
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.63
|
| Rate for Payer: Priority Health Narrow Network |
$55.63
|
| Rate for Payer: Priority Health Narrow Network |
$55.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.67
|
| Rate for Payer: UHC Exchange |
$128.67
|
| Rate for Payer: UHC Exchange |
$128.67
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
| Rate for Payer: UHCCP Medicaid |
$26.20
|
|
|
PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 97155
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,401.05 |
| Rate for Payer: Aetna Commercial |
$20.80
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.05
|
| Rate for Payer: BCN Commercial |
$25.38
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.23
|
| Rate for Payer: Priority Health Narrow Network |
$45.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.88
|
| Rate for Payer: UHC Exchange |
$37.88
|
|
|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00673
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00674
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$139.09 |
| Max. Negotiated Rate |
$1,152.22 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Medicare |
$189.50
|
| Rate for Payer: BCBS Complete |
$146.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Meridian Medicaid |
$146.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.20
|
| Rate for Payer: Priority Health Narrow Network |
$387.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.35
|
| Rate for Payer: UHC Exchange |
$250.35
|
| Rate for Payer: UHCCP Medicaid |
$139.09
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$151.02 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$297.97
|
| Rate for Payer: Aetna Medicare |
$323.00
|
| Rate for Payer: BCBS Complete |
$158.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Meridian Medicaid |
$158.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.60
|
| Rate for Payer: Priority Health Narrow Network |
$420.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.30
|
| Rate for Payer: UHC Exchange |
$269.30
|
| Rate for Payer: UHCCP Medicaid |
$151.02
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$975.24 |
| Rate for Payer: Aetna Commercial |
$318.51
|
| Rate for Payer: Aetna Medicare |
$303.50
|
| Rate for Payer: BCBS Complete |
$168.41
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$361.13
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Meridian Medicaid |
$168.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.66
|
| Rate for Payer: Priority Health Narrow Network |
$445.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.38
|
| Rate for Payer: UHC Exchange |
$293.38
|
| Rate for Payer: UHCCP Medicaid |
$160.39
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$1,082.49 |
| Rate for Payer: Aetna Commercial |
$254.78
|
| Rate for Payer: Aetna Medicare |
$256.50
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.49
|
| Rate for Payer: BCN Commercial |
$292.23
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Meridian Medicaid |
$136.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.53
|
| Rate for Payer: Priority Health Narrow Network |
$361.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.65
|
| Rate for Payer: UHC Exchange |
$226.65
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.62
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.28
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.42
|
| Rate for Payer: UHC Exchange |
$0.42
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$327.17 |
| Max. Negotiated Rate |
$979.03 |
| Rate for Payer: Aetna Commercial |
$533.56
|
| Rate for Payer: Aetna Medicare |
$520.00
|
| Rate for Payer: BCBS Complete |
$343.53
|
| Rate for Payer: BCBS Trust/PPO |
$979.03
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Meridian Medicaid |
$343.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.31
|
| Rate for Payer: Priority Health Narrow Network |
$686.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.55
|
| Rate for Payer: UHC Exchange |
$528.55
|
| Rate for Payer: UHCCP Medicaid |
$327.17
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$422.17 |
| Max. Negotiated Rate |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$696.49
|
| Rate for Payer: Aetna Medicare |
$677.00
|
| Rate for Payer: BCBS Complete |
$443.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.07
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Meridian Medicaid |
$443.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$880.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$887.68
|
| Rate for Payer: Priority Health Narrow Network |
$887.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.79
|
| Rate for Payer: UHC Exchange |
$698.79
|
| Rate for Payer: UHCCP Medicaid |
$422.17
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$226.01 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Aetna Commercial |
$932.47
|
| Rate for Payer: Aetna Medicare |
$863.50
|
| Rate for Payer: BCBS Complete |
$587.09
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: BCN Commercial |
$1,586.25
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Meridian Medicaid |
$587.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$559.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,176.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.47
|
| Rate for Payer: UHC Exchange |
$971.47
|
| Rate for Payer: UHCCP Medicaid |
$559.13
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$491.18 |
| Max. Negotiated Rate |
$1,457.41 |
| Rate for Payer: Aetna Commercial |
$811.62
|
| Rate for Payer: Aetna Medicare |
$807.50
|
| Rate for Payer: BCBS Complete |
$515.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.41
|
| Rate for Payer: BCN Commercial |
$1,347.28
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Meridian Medicaid |
$515.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,049.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,031.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,031.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.54
|
| Rate for Payer: UHC Exchange |
$841.54
|
| Rate for Payer: UHCCP Medicaid |
$491.18
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$753.63
|
| Rate for Payer: Aetna Medicare |
$739.50
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Meridian Medicaid |
$480.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.38
|
| Rate for Payer: Priority Health Narrow Network |
$960.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$773.26
|
| Rate for Payer: UHC Exchange |
$773.26
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$753.63
|
| Rate for Payer: Aetna Medicare |
$739.50
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Meridian Medicaid |
$480.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.38
|
| Rate for Payer: Priority Health Narrow Network |
$960.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$773.26
|
| Rate for Payer: UHC Exchange |
$773.26
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$961.35 |
| Max. Negotiated Rate |
$1,479.00 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: ASR ASR |
$1,434.63
|
| Rate for Payer: ASR Commercial |
$1,434.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.24
|
| Rate for Payer: BCN Commercial |
$1,146.67
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,390.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Healthscope Commercial |
$1,479.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,434.63
|
| Rate for Payer: Mclaren Commercial |
$1,331.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: Nomi Health Commercial |
$1,212.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.52
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$1,434.63
|
| Rate for Payer: ASR Commercial |
$1,434.63
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.15
|
| Rate for Payer: BCN Commercial |
$1,146.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,390.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,479.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,434.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$1,331.10
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: Nomi Health Commercial |
$1,212.78
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,295.90
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Aetna Commercial |
$870.72
|
| Rate for Payer: Aetna Medicare |
$1,117.50
|
| Rate for Payer: BCBS Complete |
$552.87
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Meridian Medicaid |
$552.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Exchange |
$898.29
|
| Rate for Payer: UHCCP Medicaid |
$526.54
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$312.75 |
| Rate for Payer: Aetna Commercial |
$235.75
|
| Rate for Payer: Aetna Medicare |
$226.00
|
| Rate for Payer: BCBS Complete |
$143.81
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Meridian Medicaid |
$143.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.97
|
| Rate for Payer: Priority Health Narrow Network |
$288.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.04
|
| Rate for Payer: UHC Exchange |
$253.04
|
| Rate for Payer: UHCCP Medicaid |
$136.96
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$1,028.66 |
| Rate for Payer: Aetna Commercial |
$598.90
|
| Rate for Payer: Aetna Medicare |
$584.50
|
| Rate for Payer: BCBS Complete |
$384.90
|
| Rate for Payer: BCBS Trust/PPO |
$48.14
|
| Rate for Payer: BCN Commercial |
$1,028.66
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Meridian Medicaid |
$384.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$366.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.28
|
| Rate for Payer: Priority Health Narrow Network |
$770.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.95
|
| Rate for Payer: UHC Exchange |
$601.95
|
| Rate for Payer: UHCCP Medicaid |
$366.57
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,343.55 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Medicare |
$1,033.50
|
| Rate for Payer: BCBS Complete |
$449.99
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,122.50
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Meridian Medicaid |
$449.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.78
|
| Rate for Payer: Priority Health Narrow Network |
$900.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.50
|
| Rate for Payer: UHC Exchange |
$720.50
|
| Rate for Payer: UHCCP Medicaid |
$428.56
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$844.35 |
| Max. Negotiated Rate |
$1,299.00 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: ASR ASR |
$1,260.03
|
| Rate for Payer: ASR Commercial |
$1,260.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.56
|
| Rate for Payer: BCN Commercial |
$1,007.11
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,221.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.20
|
| Rate for Payer: Healthscope Commercial |
$1,299.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,260.03
|
| Rate for Payer: Mclaren Commercial |
$1,169.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.15
|
| Rate for Payer: Nomi Health Commercial |
$1,065.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,143.12
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$844.35 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$1,260.03
|
| Rate for Payer: ASR Commercial |
$1,260.03
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.75
|
| Rate for Payer: BCN Commercial |
$1,007.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,221.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,299.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,260.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$1,169.10
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.15
|
| Rate for Payer: Nomi Health Commercial |
$1,065.18
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,603.38
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,082.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,143.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$663.21
|
| Rate for Payer: Aetna Medicare |
$649.50
|
| Rate for Payer: BCBS Complete |
$422.70
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Meridian Medicaid |
$422.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.68
|
| Rate for Payer: Priority Health Narrow Network |
$845.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$681.73
|
| Rate for Payer: UHC Exchange |
$681.73
|
| Rate for Payer: UHCCP Medicaid |
$402.57
|
|
