|
PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
46250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$4,145.63 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: Aetna Medicare |
$2,674.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: ASR ASR |
$1,095.13
|
| Rate for Payer: ASR Commercial |
$1,095.13
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCBS Trust/PPO |
$924.54
|
| Rate for Payer: BCN Commercial |
$875.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$1,061.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Healthscope Commercial |
$1,129.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,674.60
|
| Rate for Payer: Mclaren Commercial |
$1,016.10
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Commercial |
$2,942.06
|
| Rate for Payer: PHP Medicaid |
$1,433.59
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$989.23
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Priority Health Narrow Network |
$791.43
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$4,145.63
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP DNSP |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
PR HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 46257
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$572.43 |
| Rate for Payer: Aetna Commercial |
$532.68
|
| Rate for Payer: Aetna Medicare |
$397.52
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$397.52
|
| Rate for Payer: BCN Medicare Advantage |
$397.52
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$572.43
|
| Rate for Payer: Cofinity Commercial |
$532.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.52
|
| Rate for Payer: Healthscope Commercial |
$477.02
|
| Rate for Payer: Healthscope Whirlpool |
$477.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.40
|
| Rate for Payer: Nomi Health Commercial |
$477.02
|
| Rate for Payer: PACE SWMI |
$397.52
|
| Rate for Payer: PHP Medicare Advantage |
$397.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$397.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.52
|
| Rate for Payer: UHC Medicare Advantage |
$397.52
|
| Rate for Payer: UHCCP DNSP |
$397.52
|
|
|
PR HEMORRHOIDOPEXY STAPLING
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 46947
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$538.93 |
| Rate for Payer: Aetna Commercial |
$501.51
|
| Rate for Payer: Aetna Medicare |
$374.26
|
| Rate for Payer: BCBS Complete |
$258.40
|
| Rate for Payer: BCBS MAPPO |
$374.26
|
| Rate for Payer: BCN Medicare Advantage |
$374.26
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cofinity Commercial |
$538.93
|
| Rate for Payer: Cofinity Commercial |
$501.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.26
|
| Rate for Payer: Healthscope Commercial |
$449.11
|
| Rate for Payer: Healthscope Whirlpool |
$449.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.97
|
| Rate for Payer: Nomi Health Commercial |
$449.11
|
| Rate for Payer: PACE SWMI |
$374.26
|
| Rate for Payer: PHP Medicare Advantage |
$374.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health Medicare |
$374.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.26
|
| Rate for Payer: UHC Medicare Advantage |
$374.26
|
| Rate for Payer: UHCCP DNSP |
$374.26
|
|
|
PR HEPATECTOMY RESCJ PARTIAL LOBECTOMY
|
Professional
|
Both
|
$4,633.00
|
|
|
Service Code
|
HCPCS 47120
|
| Min. Negotiated Rate |
$1,853.20 |
| Max. Negotiated Rate |
$3,257.09 |
| Rate for Payer: Aetna Commercial |
$3,030.91
|
| Rate for Payer: Aetna Medicare |
$2,261.87
|
| Rate for Payer: BCBS Complete |
$1,853.20
|
| Rate for Payer: BCBS MAPPO |
$2,261.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,261.87
|
| Rate for Payer: Cash Price |
$3,706.40
|
| Rate for Payer: Cash Price |
$3,706.40
|
| Rate for Payer: Cofinity Commercial |
$3,257.09
|
| Rate for Payer: Cofinity Commercial |
$3,030.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,261.87
|
| Rate for Payer: Healthscope Commercial |
$2,714.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,714.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,374.96
|
| Rate for Payer: Nomi Health Commercial |
$2,714.24
|
| Rate for Payer: PACE SWMI |
$2,261.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,261.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,011.45
|
| Rate for Payer: Priority Health Medicare |
$2,261.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,261.87
|
| Rate for Payer: UHC Medicare Advantage |
$2,261.87
|
| Rate for Payer: UHCCP DNSP |
$2,261.87
|
|
|
PR HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY
|
Professional
|
Both
|
$6,159.00
|
|
|
Service Code
|
HCPCS 47130
|
| Min. Negotiated Rate |
$2,463.60 |
| Max. Negotiated Rate |
$4,612.87 |
| Rate for Payer: Aetna Commercial |
$4,292.53
|
| Rate for Payer: Aetna Medicare |
$3,203.38
|
| Rate for Payer: BCBS Complete |
$2,463.60
|
| Rate for Payer: BCBS MAPPO |
$3,203.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,203.38
|
| Rate for Payer: Cash Price |
$4,927.20
|
| Rate for Payer: Cash Price |
$4,927.20
|
| Rate for Payer: Cofinity Commercial |
$4,612.87
|
| Rate for Payer: Cofinity Commercial |
$4,292.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,203.38
|
| Rate for Payer: Healthscope Commercial |
$3,844.06
|
| Rate for Payer: Healthscope Whirlpool |
$3,844.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,363.55
|
| Rate for Payer: Nomi Health Commercial |
$3,844.06
|
| Rate for Payer: PACE SWMI |
$3,203.38
|
| Rate for Payer: PHP Medicare Advantage |
$3,203.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,003.35
|
| Rate for Payer: Priority Health Medicare |
$3,203.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,203.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,203.38
|
| Rate for Payer: UHCCP DNSP |
$3,203.38
|
|
|
PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90636
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 90371
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$179.81
|
| Rate for Payer: Aetna Medicare |
$134.19
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$134.19
|
| Rate for Payer: BCN Medicare Advantage |
$134.19
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$193.23
|
| Rate for Payer: Cofinity Commercial |
$179.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.19
|
| Rate for Payer: Healthscope Commercial |
$161.03
|
| Rate for Payer: Healthscope Whirlpool |
$161.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.90
|
| Rate for Payer: Nomi Health Commercial |
$161.03
|
| Rate for Payer: PACE SWMI |
$134.19
|
| Rate for Payer: PHP Medicare Advantage |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$134.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.19
|
| Rate for Payer: UHC Medicare Advantage |
$134.19
|
| Rate for Payer: UHCCP DNSP |
$134.19
|
|
|
PR HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 47010
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Aetna Commercial |
$1,576.36
|
| Rate for Payer: Aetna Medicare |
$1,176.39
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: BCBS MAPPO |
$1,176.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,176.39
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cofinity Commercial |
$1,694.00
|
| Rate for Payer: Cofinity Commercial |
$1,576.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,176.39
|
| Rate for Payer: Healthscope Commercial |
$1,411.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,411.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,235.21
|
| Rate for Payer: Nomi Health Commercial |
$1,411.67
|
| Rate for Payer: PACE SWMI |
$1,176.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,176.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
| Rate for Payer: Priority Health Medicare |
$1,176.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,176.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,176.39
|
| Rate for Payer: UHCCP DNSP |
$1,176.39
|
|
|
PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 90633
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna Medicare |
$73.79
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$73.79
|
| Rate for Payer: BCN Medicare Advantage |
$73.79
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.79
|
| Rate for Payer: Healthscope Commercial |
$88.55
|
| Rate for Payer: Healthscope Whirlpool |
$88.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.48
|
| Rate for Payer: Nomi Health Commercial |
$88.55
|
| Rate for Payer: PACE SWMI |
$73.79
|
| Rate for Payer: PHP Medicare Advantage |
$73.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$73.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.79
|
| Rate for Payer: UHC Medicare Advantage |
$73.79
|
| Rate for Payer: UHCCP DNSP |
$73.79
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$108.22 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Medicare |
$75.15
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$75.15
|
| Rate for Payer: BCN Medicare Advantage |
$75.15
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$108.22
|
| Rate for Payer: Cofinity Commercial |
$100.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.15
|
| Rate for Payer: Healthscope Commercial |
$90.18
|
| Rate for Payer: Healthscope Whirlpool |
$90.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.91
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: PACE SWMI |
$75.15
|
| Rate for Payer: PHP Medicare Advantage |
$75.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$75.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.15
|
| Rate for Payer: UHC Medicare Advantage |
$75.15
|
| Rate for Payer: UHCCP DNSP |
$75.15
|
|
|
PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 90739
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$255.69 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Aetna Medicare |
$177.56
|
| Rate for Payer: BCBS Complete |
$130.40
|
| Rate for Payer: BCBS MAPPO |
$177.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.56
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cofinity Commercial |
$255.69
|
| Rate for Payer: Cofinity Commercial |
$237.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.56
|
| Rate for Payer: Healthscope Commercial |
$213.07
|
| Rate for Payer: Healthscope Whirlpool |
$213.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.44
|
| Rate for Payer: Nomi Health Commercial |
$213.07
|
| Rate for Payer: PACE SWMI |
$177.56
|
| Rate for Payer: PHP Medicare Advantage |
$177.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.90
|
| Rate for Payer: Priority Health Medicare |
$177.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.56
|
| Rate for Payer: UHC Medicare Advantage |
$177.56
|
| Rate for Payer: UHCCP DNSP |
$177.56
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$101.35 |
| Rate for Payer: Aetna Commercial |
$94.31
|
| Rate for Payer: Aetna Medicare |
$70.38
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$70.38
|
| Rate for Payer: BCN Medicare Advantage |
$70.38
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Cofinity Commercial |
$101.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.38
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Healthscope Whirlpool |
$84.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.90
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: PACE SWMI |
$70.38
|
| Rate for Payer: PHP Medicare Advantage |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$70.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.38
|
| Rate for Payer: UHC Medicare Advantage |
$70.38
|
| Rate for Payer: UHCCP DNSP |
$70.38
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$42.44
|
| Rate for Payer: Aetna Medicare |
$31.67
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$31.67
|
| Rate for Payer: BCN Medicare Advantage |
$31.67
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.67
|
| Rate for Payer: Healthscope Commercial |
$38.00
|
| Rate for Payer: Healthscope Whirlpool |
$38.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.25
|
| Rate for Payer: Nomi Health Commercial |
$38.00
|
| Rate for Payer: PACE SWMI |
$31.67
|
| Rate for Payer: PHP Medicare Advantage |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$31.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.67
|
| Rate for Payer: UHC Medicare Advantage |
$31.67
|
| Rate for Payer: UHCCP DNSP |
$31.67
|
|
|
PR HFO FLEXION GLOVE PRE OTS
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS L3912
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$166.36 |
| Rate for Payer: Aetna Commercial |
$154.81
|
| Rate for Payer: Aetna Medicare |
$115.53
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS MAPPO |
$115.53
|
| Rate for Payer: BCN Medicare Advantage |
$115.53
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$166.36
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.53
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Healthscope Whirlpool |
$138.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.31
|
| Rate for Payer: Nomi Health Commercial |
$138.64
|
| Rate for Payer: PACE SWMI |
$115.53
|
| Rate for Payer: PHP Medicare Advantage |
$115.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$115.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.53
|
| Rate for Payer: UHC Medicare Advantage |
$115.53
|
| Rate for Payer: UHCCP DNSP |
$115.53
|
|
|
PR HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS L3929
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$144.23 |
| Rate for Payer: Aetna Commercial |
$134.21
|
| Rate for Payer: Aetna Medicare |
$100.16
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS MAPPO |
$100.16
|
| Rate for Payer: BCN Medicare Advantage |
$100.16
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$144.23
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.16
|
| Rate for Payer: Healthscope Commercial |
$120.19
|
| Rate for Payer: Healthscope Whirlpool |
$120.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.17
|
| Rate for Payer: Nomi Health Commercial |
$120.19
|
| Rate for Payer: PACE SWMI |
$100.16
|
| Rate for Payer: PHP Medicare Advantage |
$100.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health Medicare |
$100.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.16
|
| Rate for Payer: UHC Medicare Advantage |
$100.16
|
| Rate for Payer: UHCCP DNSP |
$100.16
|
|
|
PR HFO W/JOINT(S) CF
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS L3921
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$507.23 |
| Rate for Payer: Aetna Commercial |
$472.00
|
| Rate for Payer: Aetna Medicare |
$352.24
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$352.24
|
| Rate for Payer: BCN Medicare Advantage |
$352.24
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$507.23
|
| Rate for Payer: Cofinity Commercial |
$472.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.24
|
| Rate for Payer: Healthscope Commercial |
$422.69
|
| Rate for Payer: Healthscope Whirlpool |
$422.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.85
|
| Rate for Payer: Nomi Health Commercial |
$422.69
|
| Rate for Payer: PACE SWMI |
$352.24
|
| Rate for Payer: PHP Medicare Advantage |
$352.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health Medicare |
$352.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.24
|
| Rate for Payer: UHC Medicare Advantage |
$352.24
|
| Rate for Payer: UHCCP DNSP |
$352.24
|
|
|
PR HFO W/O JOINTS CF
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS L3913
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$427.62 |
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna Medicare |
$296.96
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS MAPPO |
$296.96
|
| Rate for Payer: BCN Medicare Advantage |
$296.96
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$427.62
|
| Rate for Payer: Cofinity Commercial |
$397.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.96
|
| Rate for Payer: Healthscope Commercial |
$356.35
|
| Rate for Payer: Healthscope Whirlpool |
$356.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.81
|
| Rate for Payer: Nomi Health Commercial |
$356.35
|
| Rate for Payer: PACE SWMI |
$296.96
|
| Rate for Payer: PHP Medicare Advantage |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health Medicare |
$296.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.96
|
| Rate for Payer: UHC Medicare Advantage |
$296.96
|
| Rate for Payer: UHCCP DNSP |
$296.96
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90647
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90648
|
| 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 HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90645
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR HIB VACCINE, PRP-D, IM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90646
|
| 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 HINGE EXTENSION/FLEX WRIST/F
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS L3900
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$2,557.90 |
| Rate for Payer: Aetna Commercial |
$2,380.27
|
| Rate for Payer: Aetna Medicare |
$1,776.32
|
| Rate for Payer: BCBS Complete |
$604.80
|
| Rate for Payer: BCBS MAPPO |
$1,776.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,776.32
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cofinity Commercial |
$2,557.90
|
| Rate for Payer: Cofinity Commercial |
$2,380.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,776.32
|
| Rate for Payer: Healthscope Commercial |
$2,131.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,131.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,865.14
|
| Rate for Payer: Nomi Health Commercial |
$2,131.58
|
| Rate for Payer: PACE SWMI |
$1,776.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,776.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.80
|
| Rate for Payer: Priority Health Medicare |
$1,776.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,776.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,776.32
|
| Rate for Payer: UHCCP DNSP |
$1,776.32
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$142.85 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$99.20
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$99.20
|
| Rate for Payer: BCN Medicare Advantage |
$99.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$132.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$119.04
|
| Rate for Payer: Healthscope Whirlpool |
$119.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.16
|
| Rate for Payer: Nomi Health Commercial |
$119.04
|
| Rate for Payer: PACE SWMI |
$99.20
|
| Rate for Payer: PHP Medicare Advantage |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$99.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.20
|
| Rate for Payer: UHC Medicare Advantage |
$99.20
|
| Rate for Payer: UHCCP DNSP |
$99.20
|
|
