|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
92960
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$125.09
|
| Rate for Payer: Aetna Medicare |
$93.35
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$93.35
|
| Rate for Payer: BCN Commercial |
$175.61
|
| Rate for Payer: BCN Medicare Advantage |
$93.35
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$134.42
|
| Rate for Payer: Cofinity Commercial |
$125.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$112.02
|
| Rate for Payer: Healthscope Whirlpool |
$112.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.02
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.69
|
| Rate for Payer: Nomi Health Commercial |
$112.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PACE SWMI |
$93.35
|
| Rate for Payer: PHP Medicare Advantage |
$93.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.93
|
| Rate for Payer: Priority Health Medicare |
$93.35
|
| Rate for Payer: Priority Health Narrow Network |
$151.93
|
| Rate for Payer: Railroad Medicare Medicare |
$93.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.35
|
| Rate for Payer: UHC Exchange |
$176.39
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHCCP DNSP |
$93.35
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$407.17 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Aetna Medicare |
$216.06
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$216.06
|
| Rate for Payer: BCN Commercial |
$356.55
|
| Rate for Payer: BCN Medicare Advantage |
$216.06
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$311.13
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.06
|
| Rate for Payer: Healthscope Commercial |
$259.27
|
| Rate for Payer: Healthscope Whirlpool |
$259.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.86
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.67
|
| Rate for Payer: Nomi Health Commercial |
$259.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: PACE SWMI |
$216.06
|
| Rate for Payer: PHP Medicare Advantage |
$216.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$338.89
|
| Rate for Payer: Priority Health Medicare |
$216.06
|
| Rate for Payer: Priority Health Narrow Network |
$338.89
|
| Rate for Payer: Railroad Medicare Medicare |
$216.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.06
|
| Rate for Payer: UHC Exchange |
$407.17
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP DNSP |
$216.06
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Healthscope Whirlpool |
$3.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.35
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.43
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: Priority Health Narrow Network |
$5.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.05
|
| Rate for Payer: UHC Exchange |
$3.72
|
| Rate for Payer: UHCCP DNSP |
$3.05
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare |
$38.51
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.51
|
| Rate for Payer: BCN Commercial |
$39.56
|
| Rate for Payer: BCN Medicare Advantage |
$38.51
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$55.45
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.51
|
| Rate for Payer: Healthscope Commercial |
$42.36
|
| Rate for Payer: Healthscope Whirlpool |
$42.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.44
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.36
|
| Rate for Payer: Nomi Health Commercial |
$46.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PACE SWMI |
$38.51
|
| Rate for Payer: PHP Medicare Advantage |
$38.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.33
|
| Rate for Payer: Priority Health Medicare |
$38.51
|
| Rate for Payer: Priority Health Narrow Network |
$57.33
|
| Rate for Payer: Railroad Medicare Medicare |
$38.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.51
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UHC Medicaid |
$24.71
|
| Rate for Payer: UHCCP DNSP |
$38.51
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,576.80
|
| Rate for Payer: ASR ASR |
$1,699.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.74
|
| Rate for Payer: BCN Commercial |
$1,438.74
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$1,646.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.60
|
| Rate for Payer: Healthscope Commercial |
$1,699.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,752.00
|
| Rate for Payer: Mclaren Commercial |
$1,576.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.20
|
| Rate for Payer: Nomi Health Commercial |
$1,436.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,541.76
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$297.99 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$606.04
|
| Rate for Payer: Aetna Medicare |
$452.27
|
| Rate for Payer: BCBS Complete |
$312.89
|
| Rate for Payer: BCBS MAPPO |
$452.27
|
| Rate for Payer: BCN Commercial |
$761.42
|
| Rate for Payer: BCN Medicare Advantage |
$452.27
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$651.27
|
| Rate for Payer: Cofinity Commercial |
$606.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.27
|
| Rate for Payer: Healthscope Commercial |
$542.72
|
| Rate for Payer: Healthscope Whirlpool |
$542.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.88
|
| Rate for Payer: Meridian Medicaid |
$312.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$497.50
|
| Rate for Payer: Nomi Health Commercial |
$542.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$452.27
|
| Rate for Payer: PHP Medicare Advantage |
$452.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$813.93
|
| Rate for Payer: Priority Health Medicare |
$452.27
|
| Rate for Payer: Priority Health Narrow Network |
$813.93
|
| Rate for Payer: Railroad Medicare Medicare |
$452.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$452.27
|
| Rate for Payer: UHC Exchange |
$849.68
|
| Rate for Payer: UHC Medicaid |
$297.99
|
| Rate for Payer: UHCCP DNSP |
$452.27
|
| Rate for Payer: UHCCP Medicaid |
$297.99
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$297.99 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$606.04
|
| Rate for Payer: Aetna Medicare |
$452.27
|
| Rate for Payer: BCBS Complete |
$312.89
|
| Rate for Payer: BCBS MAPPO |
$452.27
|
| Rate for Payer: BCN Commercial |
$761.42
|
| Rate for Payer: BCN Medicare Advantage |
$452.27
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$651.27
|
| Rate for Payer: Cofinity Commercial |
$606.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.27
|
| Rate for Payer: Healthscope Commercial |
$542.72
|
| Rate for Payer: Healthscope Whirlpool |
$542.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.88
|
| Rate for Payer: Meridian Medicaid |
$312.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$497.50
|
| Rate for Payer: Nomi Health Commercial |
$542.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$452.27
|
| Rate for Payer: PHP Medicare Advantage |
$452.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$813.93
|
| Rate for Payer: Priority Health Medicare |
$452.27
|
| Rate for Payer: Priority Health Narrow Network |
$813.93
|
| Rate for Payer: Railroad Medicare Medicare |
$452.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$452.27
|
| Rate for Payer: UHC Exchange |
$849.68
|
| Rate for Payer: UHC Medicaid |
$297.99
|
| Rate for Payer: UHCCP DNSP |
$452.27
|
| Rate for Payer: UHCCP Medicaid |
$297.99
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,228.15 |
| Max. Negotiated Rate |
$5,053.36 |
| Rate for Payer: Aetna Commercial |
$1,576.80
|
| Rate for Payer: Aetna Medicare |
$3,260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: ASR ASR |
$1,699.44
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.52
|
| Rate for Payer: BCN Commercial |
$1,444.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$1,646.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$1,699.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,752.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$1,576.80
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$1,790.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.20
|
| Rate for Payer: Nomi Health Commercial |
$1,436.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,586.25
|
| Rate for Payer: PHP Medicaid |
$1,747.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,535.10
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,228.15
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,541.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$5,053.36
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP DNSP |
$3,260.23
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,358.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$368.49 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Aetna Commercial |
$752.45
|
| Rate for Payer: Aetna Medicare |
$561.53
|
| Rate for Payer: BCBS Complete |
$386.91
|
| Rate for Payer: BCBS MAPPO |
$561.53
|
| Rate for Payer: BCN Commercial |
$952.63
|
| Rate for Payer: BCN Medicare Advantage |
$561.53
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cofinity Commercial |
$808.60
|
| Rate for Payer: Cofinity Commercial |
$752.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.53
|
| Rate for Payer: Healthscope Commercial |
$673.84
|
| Rate for Payer: Healthscope Whirlpool |
$673.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.61
|
| Rate for Payer: Meridian Medicaid |
$386.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$617.68
|
| Rate for Payer: Nomi Health Commercial |
$673.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.50
|
| Rate for Payer: PACE SWMI |
$561.53
|
| Rate for Payer: PHP Medicare Advantage |
$561.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,018.35
|
| Rate for Payer: Priority Health Medicare |
$561.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.35
|
| Rate for Payer: Railroad Medicare Medicare |
$561.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,074.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$561.53
|
| Rate for Payer: UHC Exchange |
$1,074.43
|
| Rate for Payer: UHC Medicaid |
$368.49
|
| Rate for Payer: UHCCP DNSP |
$561.53
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$810.96 |
| Rate for Payer: Aetna Commercial |
$599.70
|
| Rate for Payer: Aetna Medicare |
$447.54
|
| Rate for Payer: BCBS Complete |
$310.65
|
| Rate for Payer: BCBS MAPPO |
$447.54
|
| Rate for Payer: BCN Commercial |
$731.53
|
| Rate for Payer: BCN Medicare Advantage |
$447.54
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$644.46
|
| Rate for Payer: Cofinity Commercial |
$599.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.54
|
| Rate for Payer: Healthscope Commercial |
$537.05
|
| Rate for Payer: Healthscope Whirlpool |
$537.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.92
|
| Rate for Payer: Meridian Medicaid |
$310.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.29
|
| Rate for Payer: Nomi Health Commercial |
$537.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.25
|
| Rate for Payer: PACE SWMI |
$447.54
|
| Rate for Payer: PHP Medicare Advantage |
$447.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$781.99
|
| Rate for Payer: Priority Health Medicare |
$447.54
|
| Rate for Payer: Priority Health Narrow Network |
$781.99
|
| Rate for Payer: Railroad Medicare Medicare |
$447.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$810.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.54
|
| Rate for Payer: UHC Exchange |
$810.96
|
| Rate for Payer: UHC Medicaid |
$295.86
|
| Rate for Payer: UHCCP DNSP |
$447.54
|
| Rate for Payer: UHCCP Medicaid |
$295.86
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$277.54 |
| Max. Negotiated Rate |
$823.12 |
| Rate for Payer: Aetna Commercial |
$566.95
|
| Rate for Payer: Aetna Medicare |
$423.10
|
| Rate for Payer: BCBS Complete |
$291.42
|
| Rate for Payer: BCBS MAPPO |
$423.10
|
| Rate for Payer: BCN Commercial |
$730.04
|
| Rate for Payer: BCN Medicare Advantage |
$423.10
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$609.26
|
| Rate for Payer: Cofinity Commercial |
$566.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.10
|
| Rate for Payer: Healthscope Commercial |
$507.72
|
| Rate for Payer: Healthscope Whirlpool |
$507.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.25
|
| Rate for Payer: Meridian Medicaid |
$291.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$465.41
|
| Rate for Payer: Nomi Health Commercial |
$507.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PACE SWMI |
$423.10
|
| Rate for Payer: PHP Medicare Advantage |
$423.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$780.39
|
| Rate for Payer: Priority Health Medicare |
$423.10
|
| Rate for Payer: Priority Health Narrow Network |
$780.39
|
| Rate for Payer: Railroad Medicare Medicare |
$423.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$823.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$423.10
|
| Rate for Payer: UHC Exchange |
$823.12
|
| Rate for Payer: UHC Medicaid |
$277.54
|
| Rate for Payer: UHCCP DNSP |
$423.10
|
| Rate for Payer: UHCCP Medicaid |
$277.54
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$295.82 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Aetna Commercial |
$379.80
|
| Rate for Payer: Aetna Medicare |
$926.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: ASR ASR |
$409.34
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$347.94
|
| Rate for Payer: BCN Commercial |
$347.94
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$396.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$409.34
|
| Rate for Payer: Healthscope Whirlpool |
$422.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$926.61
|
| Rate for Payer: Mclaren Commercial |
$379.80
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$508.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.70
|
| Rate for Payer: Nomi Health Commercial |
$346.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$1,019.27
|
| Rate for Payer: PHP Medicaid |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$369.76
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Narrow Network |
$295.82
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$1,436.25
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP DNSP |
$926.61
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Medicare |
$51.97
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$84.65
|
| Rate for Payer: BCN Medicare Advantage |
$51.97
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$74.84
|
| Rate for Payer: Cofinity Commercial |
$69.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.97
|
| Rate for Payer: Healthscope Commercial |
$62.36
|
| Rate for Payer: Healthscope Whirlpool |
$62.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.57
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.17
|
| Rate for Payer: Nomi Health Commercial |
$62.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$51.97
|
| Rate for Payer: PHP Medicare Advantage |
$51.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.15
|
| Rate for Payer: Priority Health Medicare |
$51.97
|
| Rate for Payer: Priority Health Narrow Network |
$103.15
|
| Rate for Payer: Railroad Medicare Medicare |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.97
|
| Rate for Payer: UHC Exchange |
$97.58
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP DNSP |
$51.97
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Medicare |
$51.97
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$84.65
|
| Rate for Payer: BCN Medicare Advantage |
$51.97
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$74.84
|
| Rate for Payer: Cofinity Commercial |
$69.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.97
|
| Rate for Payer: Healthscope Commercial |
$62.36
|
| Rate for Payer: Healthscope Whirlpool |
$62.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.57
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.17
|
| Rate for Payer: Nomi Health Commercial |
$62.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$51.97
|
| Rate for Payer: PHP Medicare Advantage |
$51.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.15
|
| Rate for Payer: Priority Health Medicare |
$51.97
|
| Rate for Payer: Priority Health Narrow Network |
$103.15
|
| Rate for Payer: Railroad Medicare Medicare |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.97
|
| Rate for Payer: UHC Exchange |
$97.58
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP DNSP |
$51.97
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna Commercial |
$379.80
|
| Rate for Payer: ASR ASR |
$409.34
|
| Rate for Payer: BCBS Trust/PPO |
$346.55
|
| Rate for Payer: BCN Commercial |
$346.55
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$396.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.60
|
| Rate for Payer: Healthscope Commercial |
$409.34
|
| Rate for Payer: Healthscope Whirlpool |
$422.00
|
| Rate for Payer: Mclaren Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.70
|
| Rate for Payer: Nomi Health Commercial |
$346.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.36
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$32.63
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.35
|
| Rate for Payer: BCN Commercial |
$40.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$32.63
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Whirlpool |
$29.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.57
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.79
|
| Rate for Payer: Nomi Health Commercial |
$29.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PACE SWMI |
$24.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.28
|
| Rate for Payer: Priority Health Medicare |
$24.35
|
| Rate for Payer: Priority Health Narrow Network |
$36.28
|
| Rate for Payer: Railroad Medicare Medicare |
$24.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.35
|
| Rate for Payer: UHC Exchange |
$45.68
|
| Rate for Payer: UHC Medicaid |
$15.76
|
| Rate for Payer: UHCCP DNSP |
$24.35
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$48.73 |
| Rate for Payer: Aetna Commercial |
$45.35
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: BCBS MAPPO |
$33.84
|
| Rate for Payer: BCN Commercial |
$32.40
|
| Rate for Payer: BCN Medicare Advantage |
$33.84
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$48.73
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$40.61
|
| Rate for Payer: Healthscope Whirlpool |
$40.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.22
|
| Rate for Payer: Nomi Health Commercial |
$40.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: PACE SWMI |
$33.84
|
| Rate for Payer: PHP Medicare Advantage |
$33.84
|
| Rate for Payer: Priority Health Medicare |
$33.84
|
| Rate for Payer: Railroad Medicare Medicare |
$33.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.84
|
| Rate for Payer: UHC Exchange |
$11.03
|
| Rate for Payer: UHCCP DNSP |
$33.84
|
|
|
PR CAST SUP GAUNTLET PLASTER
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4013
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Medicare |
$20.07
|
| Rate for Payer: BCBS MAPPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Medicare Advantage |
$20.07
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$28.90
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$24.08
|
| Rate for Payer: Healthscope Whirlpool |
$24.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.08
|
| Rate for Payer: Nomi Health Commercial |
$24.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE SWMI |
$20.07
|
| Rate for Payer: PHP Medicare Advantage |
$20.07
|
| Rate for Payer: Priority Health Medicare |
$20.07
|
| Rate for Payer: Railroad Medicare Medicare |
$20.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.07
|
| Rate for Payer: UHC Exchange |
$6.54
|
| Rate for Payer: UHCCP DNSP |
$20.07
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$26.61 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$18.48
|
| Rate for Payer: BCBS MAPPO |
$18.48
|
| Rate for Payer: BCN Commercial |
$17.70
|
| Rate for Payer: BCN Medicare Advantage |
$18.48
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$26.61
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.48
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Whirlpool |
$22.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: PACE SWMI |
$18.48
|
| Rate for Payer: PHP Medicare Advantage |
$18.48
|
| Rate for Payer: Priority Health Medicare |
$18.48
|
| Rate for Payer: Railroad Medicare Medicare |
$18.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.48
|
| Rate for Payer: UHC Exchange |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$18.48
|
|
|
PR CAST SUP LNG ARM SPLINT PLST
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS Q4017
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$15.54
|
| Rate for Payer: Aetna Medicare |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$11.60
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$11.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.60
|
| Rate for Payer: Healthscope Commercial |
$13.92
|
| Rate for Payer: Healthscope Whirlpool |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.76
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$11.60
|
| Rate for Payer: PHP Medicare Advantage |
$11.60
|
| Rate for Payer: Priority Health Medicare |
$11.60
|
| Rate for Payer: Railroad Medicare Medicare |
$11.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.60
|
| Rate for Payer: UHC Exchange |
$3.78
|
| Rate for Payer: UHCCP DNSP |
$11.60
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$12.44
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: BCBS MAPPO |
$9.28
|
| Rate for Payer: BCN Commercial |
$8.89
|
| Rate for Payer: BCN Medicare Advantage |
$9.28
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$11.14
|
| Rate for Payer: Healthscope Whirlpool |
$11.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Nomi Health Commercial |
$11.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: PACE SWMI |
$9.28
|
| Rate for Payer: PHP Medicare Advantage |
$9.28
|
| Rate for Payer: Priority Health Medicare |
$9.28
|
| Rate for Payer: Railroad Medicare Medicare |
$9.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.28
|
| Rate for Payer: UHC Exchange |
$3.02
|
| Rate for Payer: UHCCP DNSP |
$9.28
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$122.96 |
| Rate for Payer: Aetna Commercial |
$114.42
|
| Rate for Payer: Aetna Medicare |
$85.39
|
| Rate for Payer: BCBS MAPPO |
$85.39
|
| Rate for Payer: BCN Commercial |
$81.76
|
| Rate for Payer: BCN Medicare Advantage |
$85.39
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$122.96
|
| Rate for Payer: Cofinity Commercial |
$114.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.39
|
| Rate for Payer: Healthscope Commercial |
$102.47
|
| Rate for Payer: Healthscope Whirlpool |
$102.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.93
|
| Rate for Payer: Nomi Health Commercial |
$102.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.25
|
| Rate for Payer: PACE SWMI |
$85.39
|
| Rate for Payer: PHP Medicare Advantage |
$85.39
|
| Rate for Payer: Priority Health Medicare |
$85.39
|
| Rate for Payer: Railroad Medicare Medicare |
$85.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$85.39
|
| Rate for Payer: UHC Exchange |
$27.84
|
| Rate for Payer: UHCCP DNSP |
$85.39
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$61.53 |
| Rate for Payer: Aetna Commercial |
$57.26
|
| Rate for Payer: Aetna Medicare |
$42.73
|
| Rate for Payer: BCBS MAPPO |
$42.73
|
| Rate for Payer: BCN Commercial |
$40.91
|
| Rate for Payer: BCN Medicare Advantage |
$42.73
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$57.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.73
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Healthscope Whirlpool |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.00
|
| Rate for Payer: Nomi Health Commercial |
$51.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: PACE SWMI |
$42.73
|
| Rate for Payer: PHP Medicare Advantage |
$42.73
|
| Rate for Payer: Priority Health Medicare |
$42.73
|
| Rate for Payer: Railroad Medicare Medicare |
$42.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.73
|
| Rate for Payer: UHC Exchange |
$13.93
|
| Rate for Payer: UHCCP DNSP |
$42.73
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Aetna Commercial |
$64.94
|
| Rate for Payer: Aetna Medicare |
$48.46
|
| Rate for Payer: BCBS MAPPO |
$48.46
|
| Rate for Payer: BCN Commercial |
$46.40
|
| Rate for Payer: BCN Medicare Advantage |
$48.46
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$64.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.46
|
| Rate for Payer: Healthscope Commercial |
$58.15
|
| Rate for Payer: Healthscope Whirlpool |
$58.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.31
|
| Rate for Payer: Nomi Health Commercial |
$58.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.25
|
| Rate for Payer: PACE SWMI |
$48.46
|
| Rate for Payer: PHP Medicare Advantage |
$48.46
|
| Rate for Payer: Priority Health Medicare |
$48.46
|
| Rate for Payer: Railroad Medicare Medicare |
$48.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.46
|
| Rate for Payer: UHC Exchange |
$15.80
|
| Rate for Payer: UHCCP DNSP |
$48.46
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$62.63 |
| Rate for Payer: Aetna Commercial |
$58.28
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: BCBS MAPPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$41.64
|
| Rate for Payer: BCN Medicare Advantage |
$43.49
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$58.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.49
|
| Rate for Payer: Healthscope Commercial |
$52.19
|
| Rate for Payer: Healthscope Whirlpool |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.84
|
| Rate for Payer: Nomi Health Commercial |
$52.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
| Rate for Payer: PACE SWMI |
$43.49
|
| Rate for Payer: PHP Medicare Advantage |
$43.49
|
| Rate for Payer: Priority Health Medicare |
$43.49
|
| Rate for Payer: Railroad Medicare Medicare |
$43.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43.49
|
| Rate for Payer: UHC Exchange |
$14.18
|
| Rate for Payer: UHCCP DNSP |
$43.49
|
|
