|
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 TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$773.52 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Aetna Commercial |
$1,036.52
|
| Rate for Payer: Aetna Medicare |
$773.52
|
| Rate for Payer: BCBS Complete |
$894.00
|
| Rate for Payer: BCBS MAPPO |
$773.52
|
| Rate for Payer: BCN Medicare Advantage |
$773.52
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.87
|
| Rate for Payer: Cofinity Commercial |
$1,036.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.52
|
| Rate for Payer: Healthscope Commercial |
$928.22
|
| Rate for Payer: Healthscope Whirlpool |
$928.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.20
|
| Rate for Payer: Nomi Health Commercial |
$928.22
|
| Rate for Payer: PACE SWMI |
$773.52
|
| Rate for Payer: PHP Medicare Advantage |
$773.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.75
|
| Rate for Payer: Priority Health Medicare |
$773.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.52
|
| Rate for Payer: UHC Medicare Advantage |
$773.52
|
| Rate for Payer: UHCCP DNSP |
$773.52
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$296.37 |
| Rate for Payer: Aetna Commercial |
$275.79
|
| Rate for Payer: Aetna Medicare |
$205.81
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$205.81
|
| Rate for Payer: BCN Medicare Advantage |
$205.81
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$296.37
|
| Rate for Payer: Cofinity Commercial |
$275.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.81
|
| Rate for Payer: Healthscope Commercial |
$246.97
|
| Rate for Payer: Healthscope Whirlpool |
$246.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.10
|
| Rate for Payer: Nomi Health Commercial |
$246.97
|
| Rate for Payer: PACE SWMI |
$205.81
|
| Rate for Payer: PHP Medicare Advantage |
$205.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$205.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.81
|
| Rate for Payer: UHC Medicare Advantage |
$205.81
|
| Rate for Payer: UHCCP DNSP |
$205.81
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$772.78 |
| Rate for Payer: Aetna Commercial |
$719.11
|
| Rate for Payer: Aetna Medicare |
$536.65
|
| Rate for Payer: BCBS Complete |
$467.60
|
| Rate for Payer: BCBS MAPPO |
$536.65
|
| Rate for Payer: BCN Medicare Advantage |
$536.65
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cofinity Commercial |
$772.78
|
| Rate for Payer: Cofinity Commercial |
$719.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.65
|
| Rate for Payer: Healthscope Commercial |
$643.98
|
| Rate for Payer: Healthscope Whirlpool |
$643.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.48
|
| Rate for Payer: Nomi Health Commercial |
$643.98
|
| Rate for Payer: PACE SWMI |
$536.65
|
| Rate for Payer: PHP Medicare Advantage |
$536.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.85
|
| Rate for Payer: Priority Health Medicare |
$536.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.65
|
| Rate for Payer: UHC Medicare Advantage |
$536.65
|
| Rate for Payer: UHCCP DNSP |
$536.65
|
|
|
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 |
$628.95 |
| Max. Negotiated Rate |
$1,343.55 |
| Rate for Payer: Aetna Commercial |
$842.79
|
| Rate for Payer: Aetna Medicare |
$628.95
|
| Rate for Payer: BCBS Complete |
$826.80
|
| Rate for Payer: BCBS MAPPO |
$628.95
|
| Rate for Payer: BCN Medicare Advantage |
$628.95
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cofinity Commercial |
$905.69
|
| Rate for Payer: Cofinity Commercial |
$842.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.95
|
| Rate for Payer: Healthscope Commercial |
$754.74
|
| Rate for Payer: Healthscope Whirlpool |
$754.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.40
|
| Rate for Payer: Nomi Health Commercial |
$754.74
|
| Rate for Payer: PACE SWMI |
$628.95
|
| Rate for Payer: PHP Medicare Advantage |
$628.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.55
|
| Rate for Payer: Priority Health Medicare |
$628.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.95
|
| Rate for Payer: UHC Medicare Advantage |
$628.95
|
| Rate for Payer: UHCCP DNSP |
$628.95
|
|
|
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 |
$2,765.22 |
| Rate for Payer: Aetna Commercial |
$1,169.10
|
| Rate for Payer: Aetna Medicare |
$1,784.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: ASR ASR |
$1,260.03
|
| Rate for Payer: ASR Commercial |
$1,260.03
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.75
|
| Rate for Payer: BCN Commercial |
$1,007.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| 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 |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$1,299.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,260.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,784.01
|
| Rate for Payer: Mclaren Commercial |
$1,169.10
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| 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 |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,962.41
|
| Rate for Payer: PHP Medicaid |
$956.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,138.18
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health Narrow Network |
$910.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,143.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$2,765.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP DNSP |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
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/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$851.18 |
| Rate for Payer: Aetna Commercial |
$792.07
|
| Rate for Payer: Aetna Medicare |
$591.10
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$591.10
|
| Rate for Payer: BCN Medicare Advantage |
$591.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$851.18
|
| Rate for Payer: Cofinity Commercial |
$792.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.10
|
| Rate for Payer: Healthscope Commercial |
$709.32
|
| Rate for Payer: Healthscope Whirlpool |
$709.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.65
|
| Rate for Payer: Nomi Health Commercial |
$709.32
|
| Rate for Payer: PACE SWMI |
$591.10
|
| Rate for Payer: PHP Medicare Advantage |
$591.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$591.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.10
|
| Rate for Payer: UHC Medicare Advantage |
$591.10
|
| Rate for Payer: UHCCP DNSP |
$591.10
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$851.18 |
| Rate for Payer: Aetna Commercial |
$792.07
|
| Rate for Payer: Aetna Medicare |
$591.10
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$591.10
|
| Rate for Payer: BCN Medicare Advantage |
$591.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$851.18
|
| Rate for Payer: Cofinity Commercial |
$792.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.10
|
| Rate for Payer: Healthscope Commercial |
$709.32
|
| Rate for Payer: Healthscope Whirlpool |
$709.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.65
|
| Rate for Payer: Nomi Health Commercial |
$709.32
|
| Rate for Payer: PACE SWMI |
$591.10
|
| Rate for Payer: PHP Medicare Advantage |
$591.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$591.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.10
|
| Rate for Payer: UHC Medicare Advantage |
$591.10
|
| Rate for Payer: UHCCP DNSP |
$591.10
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Aetna Medicare |
$57.50
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.75
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$666.25 |
| Rate for Payer: Aetna Commercial |
$580.27
|
| Rate for Payer: Aetna Medicare |
$433.04
|
| Rate for Payer: BCBS Complete |
$410.00
|
| Rate for Payer: BCBS MAPPO |
$433.04
|
| Rate for Payer: BCN Medicare Advantage |
$433.04
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$623.58
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.04
|
| Rate for Payer: Healthscope Commercial |
$519.65
|
| Rate for Payer: Healthscope Whirlpool |
$519.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.69
|
| Rate for Payer: Nomi Health Commercial |
$519.65
|
| Rate for Payer: PACE SWMI |
$433.04
|
| Rate for Payer: PHP Medicare Advantage |
$433.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health Medicare |
$433.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.04
|
| Rate for Payer: UHC Medicare Advantage |
$433.04
|
| Rate for Payer: UHCCP DNSP |
$433.04
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$28.29
|
| Rate for Payer: Aetna Medicare |
$21.11
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$21.11
|
| Rate for Payer: BCN Medicare Advantage |
$21.11
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.11
|
| Rate for Payer: Healthscope Commercial |
$25.33
|
| Rate for Payer: Healthscope Whirlpool |
$25.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.17
|
| Rate for Payer: Nomi Health Commercial |
$25.33
|
| Rate for Payer: PACE SWMI |
$21.11
|
| Rate for Payer: PHP Medicare Advantage |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health Medicare |
$21.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.11
|
| Rate for Payer: UHC Medicare Advantage |
$21.11
|
| Rate for Payer: UHCCP DNSP |
$21.11
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$17.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.96
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Healthscope Whirlpool |
$21.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$21.55
|
| Rate for Payer: PACE SWMI |
$17.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health Medicare |
$17.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.96
|
| Rate for Payer: UHC Medicare Advantage |
$17.96
|
| Rate for Payer: UHCCP DNSP |
$17.96
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,437.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$1,203.22 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Aetna Commercial |
$1,612.31
|
| Rate for Payer: Aetna Medicare |
$1,203.22
|
| Rate for Payer: BCBS Complete |
$1,774.80
|
| Rate for Payer: BCBS MAPPO |
$1,203.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,203.22
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$1,732.64
|
| Rate for Payer: Cofinity Commercial |
$1,612.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,203.22
|
| Rate for Payer: Healthscope Commercial |
$1,443.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,263.38
|
| Rate for Payer: Nomi Health Commercial |
$1,443.86
|
| Rate for Payer: PACE SWMI |
$1,203.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,203.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health Medicare |
$1,203.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,203.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,203.22
|
| Rate for Payer: UHCCP DNSP |
$1,203.22
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$1,042.49 |
| Max. Negotiated Rate |
$2,189.85 |
| Rate for Payer: Aetna Commercial |
$1,396.94
|
| Rate for Payer: Aetna Medicare |
$1,042.49
|
| Rate for Payer: BCBS Complete |
$1,347.60
|
| Rate for Payer: BCBS MAPPO |
$1,042.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.49
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,501.19
|
| Rate for Payer: Cofinity Commercial |
$1,396.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.49
|
| Rate for Payer: Healthscope Commercial |
$1,250.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.61
|
| Rate for Payer: Nomi Health Commercial |
$1,250.99
|
| Rate for Payer: PACE SWMI |
$1,042.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.85
|
| Rate for Payer: Priority Health Medicare |
$1,042.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.49
|
| Rate for Payer: UHCCP DNSP |
$1,042.49
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$96.98 |
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Medicare |
$67.35
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$67.35
|
| Rate for Payer: BCN Medicare Advantage |
$67.35
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$96.98
|
| Rate for Payer: Cofinity Commercial |
$90.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.35
|
| Rate for Payer: Healthscope Commercial |
$74.08
|
| Rate for Payer: Healthscope Whirlpool |
$74.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.72
|
| Rate for Payer: Nomi Health Commercial |
$80.82
|
| Rate for Payer: PACE SWMI |
$67.35
|
| Rate for Payer: PHP Medicare Advantage |
$67.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$67.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.35
|
| Rate for Payer: UHC Medicare Advantage |
$67.35
|
| Rate for Payer: UHCCP DNSP |
$67.35
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$102.48 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$71.17
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$71.17
|
| Rate for Payer: BCN Medicare Advantage |
$71.17
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$95.37
|
| Rate for Payer: Cofinity Commercial |
$102.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.17
|
| Rate for Payer: Healthscope Commercial |
$78.29
|
| Rate for Payer: Healthscope Whirlpool |
$78.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.73
|
| Rate for Payer: Nomi Health Commercial |
$85.40
|
| Rate for Payer: PACE SWMI |
$71.17
|
| Rate for Payer: PHP Medicare Advantage |
$71.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$71.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.17
|
| Rate for Payer: UHC Medicare Advantage |
$71.17
|
| Rate for Payer: UHCCP DNSP |
$71.17
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial |
$97.90
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$73.06
|
| Rate for Payer: BCN Medicare Advantage |
$73.06
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Commercial |
$105.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.06
|
| Rate for Payer: Healthscope Commercial |
$87.67
|
| Rate for Payer: Healthscope Whirlpool |
$87.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.71
|
| Rate for Payer: Nomi Health Commercial |
$87.67
|
| Rate for Payer: PACE SWMI |
$73.06
|
| Rate for Payer: PHP Medicare Advantage |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Medicare |
$73.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.06
|
| Rate for Payer: UHC Medicare Advantage |
$73.06
|
| Rate for Payer: UHCCP DNSP |
$73.06
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna Medicare |
$75.05
|
| Rate for Payer: BCBS Complete |
$67.60
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$108.07
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Healthscope Commercial |
$90.06
|
| Rate for Payer: Healthscope Whirlpool |
$90.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: Nomi Health Commercial |
$90.06
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health Medicare |
$75.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: UHCCP DNSP |
$75.05
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$151.45 |
| Rate for Payer: Aetna Commercial |
$134.91
|
| Rate for Payer: Aetna Medicare |
$100.68
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$100.68
|
| Rate for Payer: BCN Medicare Advantage |
$100.68
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Cofinity Commercial |
$134.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.68
|
| Rate for Payer: Healthscope Commercial |
$120.82
|
| Rate for Payer: Healthscope Whirlpool |
$120.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.71
|
| Rate for Payer: Nomi Health Commercial |
$120.82
|
| Rate for Payer: PACE SWMI |
$100.68
|
| Rate for Payer: PHP Medicare Advantage |
$100.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$100.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.68
|
| Rate for Payer: UHC Medicare Advantage |
$100.68
|
| Rate for Payer: UHCCP DNSP |
$100.68
|
|
