|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.65 |
| Max. Negotiated Rate |
$989.21 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Medicare |
$638.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.75
|
| Rate for Payer: ASR ASR |
$485.97
|
| Rate for Payer: ASR Commercial |
$485.97
|
| Rate for Payer: BCBS Complete |
$359.18
|
| Rate for Payer: BCBS MAPPO |
$638.20
|
| Rate for Payer: BCBS Trust/PPO |
$410.27
|
| Rate for Payer: BCN Commercial |
$388.43
|
| Rate for Payer: BCN Medicare Advantage |
$638.20
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$470.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.20
|
| Rate for Payer: Healthscope Commercial |
$501.00
|
| Rate for Payer: Healthscope Whirlpool |
$485.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$638.20
|
| Rate for Payer: Mclaren Commercial |
$450.90
|
| Rate for Payer: Mclaren Medicaid |
$342.08
|
| Rate for Payer: Mclaren Medicare |
$638.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.11
|
| Rate for Payer: Meridian Medicaid |
$359.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.85
|
| Rate for Payer: Nomi Health Commercial |
$410.82
|
| Rate for Payer: PACE Medicare |
$606.29
|
| Rate for Payer: PACE SWMI |
$638.20
|
| Rate for Payer: PHP Commercial |
$702.02
|
| Rate for Payer: PHP Medicaid |
$342.08
|
| Rate for Payer: PHP Medicare Advantage |
$638.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.98
|
| Rate for Payer: Priority Health Medicare |
$638.20
|
| Rate for Payer: Priority Health Narrow Network |
$351.20
|
| Rate for Payer: Railroad Medicare Medicare |
$638.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.20
|
| Rate for Payer: UHC Exchange |
$989.21
|
| Rate for Payer: UHC Medicare Advantage |
$638.20
|
| Rate for Payer: UHCCP DNSP |
$638.20
|
| Rate for Payer: UHCCP Medicaid |
$342.08
|
| Rate for Payer: VA VA |
$638.20
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$333.40 |
| Rate for Payer: Aetna Commercial |
$310.25
|
| Rate for Payer: Aetna Medicare |
$231.53
|
| Rate for Payer: BCBS Complete |
$200.80
|
| Rate for Payer: BCBS MAPPO |
$231.53
|
| Rate for Payer: BCN Medicare Advantage |
$231.53
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$333.40
|
| Rate for Payer: Cofinity Commercial |
$310.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.53
|
| Rate for Payer: Healthscope Commercial |
$277.84
|
| Rate for Payer: Healthscope Whirlpool |
$277.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.11
|
| Rate for Payer: Nomi Health Commercial |
$277.84
|
| Rate for Payer: PACE SWMI |
$231.53
|
| Rate for Payer: PHP Medicare Advantage |
$231.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health Medicare |
$231.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.53
|
| Rate for Payer: UHC Medicare Advantage |
$231.53
|
| Rate for Payer: UHCCP DNSP |
$231.53
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$2.65
|
| Rate for Payer: BCN Medicare Advantage |
$2.65
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Whirlpool |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE SWMI |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$2.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.65
|
| Rate for Payer: UHC Medicare Advantage |
$2.65
|
| Rate for Payer: UHCCP DNSP |
$2.65
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna Medicare |
$40.82
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$40.82
|
| Rate for Payer: BCN Medicare Advantage |
$40.82
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$58.78
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$44.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.86
|
| Rate for Payer: Nomi Health Commercial |
$48.98
|
| Rate for Payer: PACE SWMI |
$40.82
|
| Rate for Payer: PHP Medicare Advantage |
$40.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$40.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.82
|
| Rate for Payer: UHC Medicare Advantage |
$40.82
|
| Rate for Payer: UHCCP DNSP |
$40.82
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$477.93 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$640.43
|
| Rate for Payer: Aetna Medicare |
$477.93
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$477.93
|
| Rate for Payer: BCN Medicare Advantage |
$477.93
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$688.22
|
| Rate for Payer: Cofinity Commercial |
$640.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.93
|
| Rate for Payer: Healthscope Commercial |
$573.52
|
| Rate for Payer: Healthscope Whirlpool |
$573.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.83
|
| Rate for Payer: Nomi Health Commercial |
$573.52
|
| Rate for Payer: PACE SWMI |
$477.93
|
| Rate for Payer: PHP Medicare Advantage |
$477.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$477.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.93
|
| Rate for Payer: UHC Medicare Advantage |
$477.93
|
| Rate for Payer: UHCCP DNSP |
$477.93
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,105.65 |
| Max. Negotiated Rate |
$1,701.00 |
| Rate for Payer: Aetna Commercial |
$1,530.90
|
| Rate for Payer: ASR ASR |
$1,649.97
|
| Rate for Payer: ASR Commercial |
$1,649.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,386.14
|
| Rate for Payer: BCN Commercial |
$1,318.79
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,598.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.80
|
| Rate for Payer: Healthscope Commercial |
$1,701.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,649.97
|
| Rate for Payer: Mclaren Commercial |
$1,530.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,445.85
|
| Rate for Payer: Nomi Health Commercial |
$1,394.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.88
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$477.93 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$640.43
|
| Rate for Payer: Aetna Medicare |
$477.93
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$477.93
|
| Rate for Payer: BCN Medicare Advantage |
$477.93
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$688.22
|
| Rate for Payer: Cofinity Commercial |
$640.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.93
|
| Rate for Payer: Healthscope Commercial |
$573.52
|
| Rate for Payer: Healthscope Whirlpool |
$573.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.83
|
| Rate for Payer: Nomi Health Commercial |
$573.52
|
| Rate for Payer: PACE SWMI |
$477.93
|
| Rate for Payer: PHP Medicare Advantage |
$477.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$477.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.93
|
| Rate for Payer: UHC Medicare Advantage |
$477.93
|
| Rate for Payer: UHCCP DNSP |
$477.93
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,105.65 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,530.90
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$1,649.97
|
| Rate for Payer: ASR Commercial |
$1,649.97
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.95
|
| Rate for Payer: BCN Commercial |
$1,318.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,598.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,701.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,649.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,530.90
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,445.85
|
| Rate for Payer: Nomi Health Commercial |
$1,394.82
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,490.42
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,289.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$600.12 |
| Max. Negotiated Rate |
$1,487.85 |
| Rate for Payer: Aetna Commercial |
$804.16
|
| Rate for Payer: Aetna Medicare |
$600.12
|
| Rate for Payer: BCBS Complete |
$915.60
|
| Rate for Payer: BCBS MAPPO |
$600.12
|
| Rate for Payer: BCN Medicare Advantage |
$600.12
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Commercial |
$804.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.12
|
| Rate for Payer: Healthscope Commercial |
$720.14
|
| Rate for Payer: Healthscope Whirlpool |
$720.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.13
|
| Rate for Payer: Nomi Health Commercial |
$720.14
|
| Rate for Payer: PACE SWMI |
$600.12
|
| Rate for Payer: PHP Medicare Advantage |
$600.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.85
|
| Rate for Payer: Priority Health Medicare |
$600.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.12
|
| Rate for Payer: UHC Medicare Advantage |
$600.12
|
| Rate for Payer: UHCCP DNSP |
$600.12
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$375.60 |
| Max. Negotiated Rate |
$660.31 |
| Rate for Payer: Aetna Commercial |
$614.46
|
| Rate for Payer: Aetna Medicare |
$458.55
|
| Rate for Payer: BCBS Complete |
$375.60
|
| Rate for Payer: BCBS MAPPO |
$458.55
|
| Rate for Payer: BCN Medicare Advantage |
$458.55
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cofinity Commercial |
$660.31
|
| Rate for Payer: Cofinity Commercial |
$614.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.55
|
| Rate for Payer: Healthscope Commercial |
$550.26
|
| Rate for Payer: Healthscope Whirlpool |
$550.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.48
|
| Rate for Payer: Nomi Health Commercial |
$550.26
|
| Rate for Payer: PACE SWMI |
$458.55
|
| Rate for Payer: PHP Medicare Advantage |
$458.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.35
|
| Rate for Payer: Priority Health Medicare |
$458.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.55
|
| Rate for Payer: UHC Medicare Advantage |
$458.55
|
| Rate for Payer: UHCCP DNSP |
$458.55
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$422.40 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$615.57
|
| Rate for Payer: Aetna Medicare |
$459.38
|
| Rate for Payer: BCBS Complete |
$422.40
|
| Rate for Payer: BCBS MAPPO |
$459.38
|
| Rate for Payer: BCN Medicare Advantage |
$459.38
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$661.51
|
| Rate for Payer: Cofinity Commercial |
$615.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.38
|
| Rate for Payer: Healthscope Commercial |
$551.26
|
| Rate for Payer: Healthscope Whirlpool |
$551.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.35
|
| Rate for Payer: Nomi Health Commercial |
$551.26
|
| Rate for Payer: PACE SWMI |
$459.38
|
| Rate for Payer: PHP Medicare Advantage |
$459.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health Medicare |
$459.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.38
|
| Rate for Payer: UHC Medicare Advantage |
$459.38
|
| Rate for Payer: UHCCP DNSP |
$459.38
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$71.73
|
| Rate for Payer: Aetna Medicare |
$53.53
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$53.53
|
| Rate for Payer: BCN Medicare Advantage |
$53.53
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$71.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.53
|
| Rate for Payer: Healthscope Commercial |
$64.24
|
| Rate for Payer: Healthscope Whirlpool |
$64.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.21
|
| Rate for Payer: Nomi Health Commercial |
$64.24
|
| Rate for Payer: PACE SWMI |
$53.53
|
| Rate for Payer: PHP Medicare Advantage |
$53.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.53
|
| Rate for Payer: UHC Medicare Advantage |
$53.53
|
| Rate for Payer: UHCCP DNSP |
$53.53
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$71.73
|
| Rate for Payer: Aetna Medicare |
$53.53
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$53.53
|
| Rate for Payer: BCN Medicare Advantage |
$53.53
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$71.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.53
|
| Rate for Payer: Healthscope Commercial |
$64.24
|
| Rate for Payer: Healthscope Whirlpool |
$64.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.21
|
| Rate for Payer: Nomi Health Commercial |
$64.24
|
| Rate for Payer: PACE SWMI |
$53.53
|
| Rate for Payer: PHP Medicare Advantage |
$53.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.53
|
| Rate for Payer: UHC Medicare Advantage |
$53.53
|
| Rate for Payer: UHCCP DNSP |
$53.53
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,378.21 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Medicare |
$889.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: ASR ASR |
$397.70
|
| Rate for Payer: ASR Commercial |
$397.70
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCBS Trust/PPO |
$335.75
|
| Rate for Payer: BCN Commercial |
$317.87
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$385.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$410.00
|
| Rate for Payer: Healthscope Whirlpool |
$397.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$889.17
|
| Rate for Payer: Mclaren Commercial |
$369.00
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: Nomi Health Commercial |
$336.20
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$978.09
|
| Rate for Payer: PHP Medicaid |
$476.60
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.24
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health Narrow Network |
$287.41
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,378.21
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP DNSP |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: ASR ASR |
$397.70
|
| Rate for Payer: ASR Commercial |
$397.70
|
| Rate for Payer: BCBS Trust/PPO |
$334.11
|
| Rate for Payer: BCN Commercial |
$317.87
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$385.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$410.00
|
| Rate for Payer: Healthscope Whirlpool |
$397.70
|
| Rate for Payer: Mclaren Commercial |
$369.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: Nomi Health Commercial |
$336.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.80
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Aetna Commercial |
$34.40
|
| Rate for Payer: Aetna Medicare |
$25.67
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$25.67
|
| Rate for Payer: BCN Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.67
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Whirlpool |
$30.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.95
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: PACE SWMI |
$25.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.67
|
| Rate for Payer: UHC Medicare Advantage |
$25.67
|
| Rate for Payer: UHCCP DNSP |
$25.67
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$47.78 |
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Medicare |
$33.18
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$33.18
|
| Rate for Payer: BCN Medicare Advantage |
$33.18
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$47.78
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$39.82
|
| Rate for Payer: Healthscope Whirlpool |
$39.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.84
|
| Rate for Payer: Nomi Health Commercial |
$39.82
|
| Rate for Payer: PACE SWMI |
$33.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$33.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.18
|
| Rate for Payer: UHC Medicare Advantage |
$33.18
|
| Rate for Payer: UHCCP DNSP |
$33.18
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$26.09 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$18.12
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$18.12
|
| Rate for Payer: BCN Medicare Advantage |
$18.12
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$26.09
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$21.74
|
| Rate for Payer: Healthscope Whirlpool |
$21.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.03
|
| Rate for Payer: Nomi Health Commercial |
$21.74
|
| Rate for Payer: PACE SWMI |
$18.12
|
| Rate for Payer: PHP Medicare Advantage |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$18.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.12
|
| Rate for Payer: UHC Medicare Advantage |
$18.12
|
| Rate for Payer: UHCCP DNSP |
$18.12
|
|
|
PR CAST SUP LNG ARM SPLINT PLST
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS Q4017
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$15.24
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$11.37
|
| Rate for Payer: BCN Medicare Advantage |
$11.37
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.37
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Whirlpool |
$13.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.94
|
| Rate for Payer: Nomi Health Commercial |
$13.64
|
| Rate for Payer: PACE SWMI |
$11.37
|
| Rate for Payer: PHP Medicare Advantage |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$11.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.37
|
| Rate for Payer: UHC Medicare Advantage |
$11.37
|
| Rate for Payer: UHCCP DNSP |
$11.37
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$10.92
|
| Rate for Payer: Healthscope Whirlpool |
$10.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.55
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$9.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP DNSP |
$9.10
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$112.18
|
| Rate for Payer: Aetna Medicare |
$83.72
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$83.72
|
| Rate for Payer: BCN Medicare Advantage |
$83.72
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$120.56
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$100.46
|
| Rate for Payer: Healthscope Whirlpool |
$100.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.91
|
| Rate for Payer: Nomi Health Commercial |
$100.46
|
| Rate for Payer: PACE SWMI |
$83.72
|
| Rate for Payer: PHP Medicare Advantage |
$83.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Medicare |
$83.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.72
|
| Rate for Payer: UHC Medicare Advantage |
$83.72
|
| Rate for Payer: UHCCP DNSP |
$83.72
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna Commercial |
$56.13
|
| Rate for Payer: Aetna Medicare |
$41.89
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$41.89
|
| Rate for Payer: BCN Medicare Advantage |
$41.89
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$56.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.89
|
| Rate for Payer: Healthscope Commercial |
$50.27
|
| Rate for Payer: Healthscope Whirlpool |
$50.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.98
|
| Rate for Payer: Nomi Health Commercial |
$50.27
|
| Rate for Payer: PACE SWMI |
$41.89
|
| Rate for Payer: PHP Medicare Advantage |
$41.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$41.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.89
|
| Rate for Payer: UHC Medicare Advantage |
$41.89
|
| Rate for Payer: UHCCP DNSP |
$41.89
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$68.41 |
| Rate for Payer: Aetna Commercial |
$63.66
|
| Rate for Payer: Aetna Medicare |
$47.51
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$47.51
|
| Rate for Payer: BCN Medicare Advantage |
$47.51
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$68.41
|
| Rate for Payer: Cofinity Commercial |
$63.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.51
|
| Rate for Payer: Healthscope Commercial |
$57.01
|
| Rate for Payer: Healthscope Whirlpool |
$57.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.89
|
| Rate for Payer: Nomi Health Commercial |
$57.01
|
| Rate for Payer: PACE SWMI |
$47.51
|
| Rate for Payer: PHP Medicare Advantage |
$47.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Medicare |
$47.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.51
|
| Rate for Payer: UHC Medicare Advantage |
$47.51
|
| Rate for Payer: UHCCP DNSP |
$47.51
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Aetna Commercial |
$57.14
|
| Rate for Payer: Aetna Medicare |
$42.64
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$42.64
|
| Rate for Payer: BCN Medicare Advantage |
$42.64
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.64
|
| Rate for Payer: Healthscope Commercial |
$51.17
|
| Rate for Payer: Healthscope Whirlpool |
$51.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.77
|
| Rate for Payer: Nomi Health Commercial |
$51.17
|
| Rate for Payer: PACE SWMI |
$42.64
|
| Rate for Payer: PHP Medicare Advantage |
$42.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$42.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.64
|
| Rate for Payer: UHC Medicare Advantage |
$42.64
|
| Rate for Payer: UHCCP DNSP |
$42.64
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS Q4044
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$30.74 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$21.35
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$21.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$28.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$25.62
|
| Rate for Payer: Healthscope Whirlpool |
$25.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.42
|
| Rate for Payer: Nomi Health Commercial |
$25.62
|
| Rate for Payer: PACE SWMI |
$21.35
|
| Rate for Payer: PHP Medicare Advantage |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$21.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.35
|
| Rate for Payer: UHC Medicare Advantage |
$21.35
|
| Rate for Payer: UHCCP DNSP |
$21.35
|
|
