|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$105.52 |
| Max. Negotiated Rate |
$197.70 |
| Rate for Payer: Aetna Commercial |
$158.17
|
| Rate for Payer: Aetna Medicare |
$118.04
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$118.04
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$118.04
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$169.98
|
| Rate for Payer: Cofinity Commercial |
$158.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.04
|
| Rate for Payer: Healthscope Commercial |
$129.84
|
| Rate for Payer: Healthscope Whirlpool |
$129.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.94
|
| Rate for Payer: Meridian Medicaid |
$110.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$141.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.25
|
| Rate for Payer: PACE SWMI |
$118.04
|
| Rate for Payer: PHP Medicare Advantage |
$118.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$177.84
|
| Rate for Payer: Priority Health Medicare |
$118.04
|
| Rate for Payer: Priority Health Narrow Network |
$177.84
|
| Rate for Payer: Railroad Medicare Medicare |
$118.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.04
|
| Rate for Payer: UHC Exchange |
$181.94
|
| Rate for Payer: UHC Medicaid |
$105.52
|
| Rate for Payer: UHCCP DNSP |
$118.04
|
| Rate for Payer: UHCCP Medicaid |
$105.52
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$127.19 |
| Rate for Payer: Aetna Commercial |
$93.75
|
| Rate for Payer: Aetna Medicare |
$69.96
|
| Rate for Payer: BCBS Complete |
$65.73
|
| Rate for Payer: BCBS MAPPO |
$69.96
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: BCN Medicare Advantage |
$69.96
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$93.75
|
| Rate for Payer: Cofinity Commercial |
$100.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.96
|
| Rate for Payer: Healthscope Commercial |
$76.96
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.46
|
| Rate for Payer: Meridian Medicaid |
$65.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.96
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.50
|
| Rate for Payer: PACE SWMI |
$69.96
|
| Rate for Payer: PHP Medicare Advantage |
$69.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.50
|
| Rate for Payer: Priority Health Medicare |
$69.96
|
| Rate for Payer: Priority Health Narrow Network |
$107.50
|
| Rate for Payer: Railroad Medicare Medicare |
$69.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$69.96
|
| Rate for Payer: UHC Exchange |
$127.19
|
| Rate for Payer: UHC Medicaid |
$62.60
|
| Rate for Payer: UHCCP DNSP |
$69.96
|
| Rate for Payer: UHCCP Medicaid |
$62.60
|
|
|
PR INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 99218
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
|
|
PR INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 99219
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.25
|
|
|
PR INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 99220
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$668.97 |
| Max. Negotiated Rate |
$1,136.89 |
| Rate for Payer: Aetna Commercial |
$896.82
|
| Rate for Payer: Aetna Medicare |
$669.27
|
| Rate for Payer: BCBS Complete |
$702.42
|
| Rate for Payer: BCBS MAPPO |
$669.27
|
| Rate for Payer: BCN Commercial |
$1,136.89
|
| Rate for Payer: BCN Medicare Advantage |
$669.27
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cofinity Commercial |
$963.75
|
| Rate for Payer: Cofinity Commercial |
$896.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.27
|
| Rate for Payer: Healthscope Commercial |
$736.20
|
| Rate for Payer: Healthscope Whirlpool |
$736.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.73
|
| Rate for Payer: Meridian Medicaid |
$702.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$736.20
|
| Rate for Payer: Nomi Health Commercial |
$803.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.25
|
| Rate for Payer: PACE SWMI |
$669.27
|
| Rate for Payer: PHP Medicare Advantage |
$669.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,022.64
|
| Rate for Payer: Priority Health Medicare |
$669.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,022.64
|
| Rate for Payer: Railroad Medicare Medicare |
$669.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,128.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$669.27
|
| Rate for Payer: UHC Exchange |
$1,128.63
|
| Rate for Payer: UHC Medicaid |
$668.97
|
| Rate for Payer: UHCCP DNSP |
$669.27
|
| Rate for Payer: UHCCP Medicaid |
$668.97
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$470.32 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$630.23
|
| Rate for Payer: Aetna Medicare |
$470.32
|
| Rate for Payer: BCBS Complete |
$493.84
|
| Rate for Payer: BCBS MAPPO |
$470.32
|
| Rate for Payer: BCN Commercial |
$826.15
|
| Rate for Payer: BCN Medicare Advantage |
$470.32
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$677.26
|
| Rate for Payer: Cofinity Commercial |
$630.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.32
|
| Rate for Payer: Healthscope Commercial |
$517.35
|
| Rate for Payer: Healthscope Whirlpool |
$517.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.84
|
| Rate for Payer: Meridian Medicaid |
$493.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$517.35
|
| Rate for Payer: Nomi Health Commercial |
$564.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$960.00
|
| Rate for Payer: PACE SWMI |
$470.32
|
| Rate for Payer: PHP Medicare Advantage |
$470.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$743.13
|
| Rate for Payer: Priority Health Medicare |
$470.32
|
| Rate for Payer: Priority Health Narrow Network |
$743.13
|
| Rate for Payer: Railroad Medicare Medicare |
$470.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$470.32
|
| Rate for Payer: UHC Exchange |
$794.39
|
| Rate for Payer: UHC Medicaid |
$470.32
|
| Rate for Payer: UHCCP DNSP |
$470.32
|
| Rate for Payer: UHCCP Medicaid |
$470.32
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Aetna Commercial |
$151.51
|
| Rate for Payer: Aetna Medicare |
$113.07
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS MAPPO |
$113.07
|
| Rate for Payer: BCN Commercial |
$193.71
|
| Rate for Payer: BCN Medicare Advantage |
$113.07
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$151.51
|
| Rate for Payer: Cofinity Commercial |
$162.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.07
|
| Rate for Payer: Healthscope Commercial |
$135.68
|
| Rate for Payer: Healthscope Whirlpool |
$135.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.38
|
| Rate for Payer: Nomi Health Commercial |
$135.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: PACE SWMI |
$113.07
|
| Rate for Payer: PHP Medicare Advantage |
$113.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.42
|
| Rate for Payer: Priority Health Medicare |
$113.07
|
| Rate for Payer: Priority Health Narrow Network |
$169.42
|
| Rate for Payer: Railroad Medicare Medicare |
$113.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$113.07
|
| Rate for Payer: UHC Exchange |
$179.02
|
| Rate for Payer: UHCCP DNSP |
$113.07
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$163.34 |
| Rate for Payer: Aetna Commercial |
$78.23
|
| Rate for Payer: BCBS Complete |
$70.02
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Meridian Medicaid |
$70.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.94
|
| Rate for Payer: Priority Health Narrow Network |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.70
|
| Rate for Payer: UHC Exchange |
$109.70
|
| Rate for Payer: UHC Medicaid |
$66.69
|
| Rate for Payer: UHCCP Medicaid |
$66.69
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$104.46 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$121.06
|
| Rate for Payer: BCBS Complete |
$109.68
|
| Rate for Payer: BCN Commercial |
$163.10
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Meridian Medicaid |
$109.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.64
|
| Rate for Payer: Priority Health Narrow Network |
$147.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.83
|
| Rate for Payer: UHC Exchange |
$170.83
|
| Rate for Payer: UHC Medicaid |
$104.46
|
| Rate for Payer: UHCCP Medicaid |
$104.46
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$112.07 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: BCBS Complete |
$117.67
|
| Rate for Payer: BCN Commercial |
$177.27
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Meridian Medicaid |
$117.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$158.53
|
| Rate for Payer: Priority Health Narrow Network |
$158.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.89
|
| Rate for Payer: UHC Exchange |
$183.89
|
| Rate for Payer: UHC Medicaid |
$112.07
|
| Rate for Payer: UHCCP Medicaid |
$112.07
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$151.50 |
| Rate for Payer: Aetna Commercial |
$103.72
|
| Rate for Payer: BCBS Complete |
$94.33
|
| Rate for Payer: BCN Commercial |
$145.66
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Meridian Medicaid |
$94.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.18
|
| Rate for Payer: Priority Health Narrow Network |
$127.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.79
|
| Rate for Payer: UHC Exchange |
$146.79
|
| Rate for Payer: UHC Medicaid |
$89.84
|
| Rate for Payer: UHCCP Medicaid |
$89.84
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$171.30 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: BCBS Complete |
$74.82
|
| Rate for Payer: BCN Commercial |
$171.30
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$74.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.75
|
| Rate for Payer: Priority Health Narrow Network |
$170.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.21
|
| Rate for Payer: UHC Exchange |
$117.21
|
| Rate for Payer: UHC Medicaid |
$71.26
|
| Rate for Payer: UHCCP Medicaid |
$71.26
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Aetna Commercial |
$99.47
|
| Rate for Payer: BCBS Complete |
$90.49
|
| Rate for Payer: BCN Commercial |
$141.67
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Meridian Medicaid |
$90.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.95
|
| Rate for Payer: Priority Health Narrow Network |
$121.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.78
|
| Rate for Payer: UHC Exchange |
$140.78
|
| Rate for Payer: UHC Medicaid |
$86.18
|
| Rate for Payer: UHCCP Medicaid |
$86.18
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: BCBS Complete |
$79.30
|
| Rate for Payer: BCN Commercial |
$129.68
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Meridian Medicaid |
$79.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.58
|
| Rate for Payer: Priority Health Narrow Network |
$107.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.25
|
| Rate for Payer: UHC Exchange |
$124.25
|
| Rate for Payer: UHC Medicaid |
$75.52
|
| Rate for Payer: UHCCP Medicaid |
$75.52
|
|
|
PR INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 16000
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Medicare |
$42.03
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$42.03
|
| Rate for Payer: BCN Commercial |
$53.80
|
| Rate for Payer: BCN Medicare Advantage |
$42.03
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$60.52
|
| Rate for Payer: Cofinity Commercial |
$56.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.03
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$50.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.13
|
| Rate for Payer: Meridian Medicaid |
$28.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.23
|
| Rate for Payer: Nomi Health Commercial |
$50.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.75
|
| Rate for Payer: PACE SWMI |
$42.03
|
| Rate for Payer: PHP Medicare Advantage |
$42.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.44
|
| Rate for Payer: Priority Health Medicare |
$42.03
|
| Rate for Payer: Priority Health Narrow Network |
$62.44
|
| Rate for Payer: Railroad Medicare Medicare |
$42.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.03
|
| Rate for Payer: UHC Exchange |
$81.80
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP DNSP |
$42.03
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
|
|
PR INIT/SUB PSYCH CARE M 1ST 30
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS G2214
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$76.86 |
| Rate for Payer: Aetna Commercial |
$44.85
|
| Rate for Payer: Aetna Medicare |
$33.47
|
| Rate for Payer: BCBS Complete |
$22.59
|
| Rate for Payer: BCBS MAPPO |
$33.47
|
| Rate for Payer: BCN Commercial |
$48.68
|
| Rate for Payer: BCN Medicare Advantage |
$33.47
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$44.85
|
| Rate for Payer: Cofinity Commercial |
$48.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.47
|
| Rate for Payer: Healthscope Commercial |
$40.16
|
| Rate for Payer: Healthscope Whirlpool |
$40.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.14
|
| Rate for Payer: Meridian Medicaid |
$22.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.82
|
| Rate for Payer: Nomi Health Commercial |
$40.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PACE SWMI |
$33.47
|
| Rate for Payer: PHP Medicare Advantage |
$33.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$33.47
|
| Rate for Payer: Priority Health Narrow Network |
$76.86
|
| Rate for Payer: Railroad Medicare Medicare |
$33.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.47
|
| Rate for Payer: UHC Exchange |
$56.09
|
| Rate for Payer: UHC Medicaid |
$21.51
|
| Rate for Payer: UHCCP DNSP |
$33.47
|
| Rate for Payer: UHCCP Medicaid |
$21.51
|
|
|
PR INJ, DENOSUMAB-BMWO, 1 MG
|
Professional
|
Both
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$37.74 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$26.16
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$31.45
|
| Rate for Payer: Healthscope Whirlpool |
$31.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Nomi Health Commercial |
$31.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Medicare |
$26.21
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.21
|
| Rate for Payer: UHC Exchange |
$28.50
|
| Rate for Payer: UHCCP DNSP |
$26.21
|
|
|
PR INJ DEXAMETHASONE ACETATE
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1094
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
|
|
PR INJ, DUROLANE 1 MG
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS J7318
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$16.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$9.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Healthscope Whirlpool |
$8.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.40
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.50
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Exchange |
$6.52
|
| Rate for Payer: UHCCP DNSP |
$6.73
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
20550
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Aetna Commercial |
$44.58
|
| Rate for Payer: Aetna Medicare |
$33.27
|
| Rate for Payer: BCBS Complete |
$22.36
|
| Rate for Payer: BCBS MAPPO |
$33.27
|
| Rate for Payer: BCN Commercial |
$45.95
|
| Rate for Payer: BCN Medicare Advantage |
$33.27
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.27
|
| Rate for Payer: Healthscope Commercial |
$39.92
|
| Rate for Payer: Healthscope Whirlpool |
$39.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.93
|
| Rate for Payer: Meridian Medicaid |
$22.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.60
|
| Rate for Payer: Nomi Health Commercial |
$39.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
| Rate for Payer: PACE SWMI |
$33.27
|
| Rate for Payer: PHP Medicare Advantage |
$33.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.29
|
| Rate for Payer: Priority Health Medicare |
$33.27
|
| Rate for Payer: Priority Health Narrow Network |
$62.29
|
| Rate for Payer: Railroad Medicare Medicare |
$33.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.27
|
| Rate for Payer: UHC Exchange |
$69.41
|
| Rate for Payer: UHC Medicaid |
$21.30
|
| Rate for Payer: UHCCP DNSP |
$33.27
|
| Rate for Payer: UHCCP Medicaid |
$21.30
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Aetna Commercial |
$44.58
|
| Rate for Payer: Aetna Medicare |
$33.27
|
| Rate for Payer: BCBS Complete |
$22.36
|
| Rate for Payer: BCBS MAPPO |
$33.27
|
| Rate for Payer: BCN Commercial |
$45.95
|
| Rate for Payer: BCN Medicare Advantage |
$33.27
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Cofinity Commercial |
$44.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.27
|
| Rate for Payer: Healthscope Commercial |
$39.92
|
| Rate for Payer: Healthscope Whirlpool |
$39.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.93
|
| Rate for Payer: Meridian Medicaid |
$22.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.60
|
| Rate for Payer: Nomi Health Commercial |
$39.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
| Rate for Payer: PACE SWMI |
$33.27
|
| Rate for Payer: PHP Medicare Advantage |
$33.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.29
|
| Rate for Payer: Priority Health Medicare |
$33.27
|
| Rate for Payer: Priority Health Narrow Network |
$62.29
|
| Rate for Payer: Railroad Medicare Medicare |
$33.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.27
|
| Rate for Payer: UHC Exchange |
$69.41
|
| Rate for Payer: UHC Medicaid |
$21.30
|
| Rate for Payer: UHCCP DNSP |
$33.27
|
| Rate for Payer: UHCCP Medicaid |
$21.30
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna Commercial |
$134.10
|
| Rate for Payer: ASR ASR |
$144.53
|
| Rate for Payer: BCBS Trust/PPO |
$122.36
|
| Rate for Payer: BCN Commercial |
$122.36
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$140.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.20
|
| Rate for Payer: Healthscope Commercial |
$144.53
|
| Rate for Payer: Healthscope Whirlpool |
$149.00
|
| Rate for Payer: Mclaren Commercial |
$134.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.65
|
| Rate for Payer: Nomi Health Commercial |
$122.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$445.48 |
| Rate for Payer: Aetna Commercial |
$134.10
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$144.53
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$122.85
|
| Rate for Payer: BCN Commercial |
$122.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$140.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$144.53
|
| Rate for Payer: Healthscope Whirlpool |
$149.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$134.10
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.65
|
| Rate for Payer: Nomi Health Commercial |
$122.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$445.48
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$356.39
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
HCPCS 64417
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Medicare |
$60.77
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS MAPPO |
$60.77
|
| Rate for Payer: BCN Commercial |
$96.11
|
| Rate for Payer: BCN Medicare Advantage |
$60.77
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cash Price |
$238.40
|
| Rate for Payer: Cofinity Commercial |
$87.51
|
| Rate for Payer: Cofinity Commercial |
$81.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.77
|
| Rate for Payer: Healthscope Commercial |
$72.92
|
| Rate for Payer: Healthscope Whirlpool |
$72.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.81
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.85
|
| Rate for Payer: Nomi Health Commercial |
$72.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.50
|
| Rate for Payer: PACE SWMI |
$60.77
|
| Rate for Payer: PHP Medicare Advantage |
$60.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$111.63
|
| Rate for Payer: Priority Health Medicare |
$60.77
|
| Rate for Payer: Priority Health Narrow Network |
$111.63
|
| Rate for Payer: Railroad Medicare Medicare |
$60.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.77
|
| Rate for Payer: UHC Exchange |
$107.91
|
| Rate for Payer: UHC Medicaid |
$39.19
|
| Rate for Payer: UHCCP DNSP |
$60.77
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
