|
PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC
|
Professional
|
Both
|
$3,348.00
|
|
|
Service Code
|
HCPCS 32820
|
| Min. Negotiated Rate |
$1,337.73 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Aetna Commercial |
$1,792.56
|
| Rate for Payer: Aetna Medicare |
$1,337.73
|
| Rate for Payer: BCBS Complete |
$1,339.20
|
| Rate for Payer: BCBS MAPPO |
$1,337.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,337.73
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,926.33
|
| Rate for Payer: Cofinity Commercial |
$1,792.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,337.73
|
| Rate for Payer: Healthscope Commercial |
$1,605.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,605.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,404.62
|
| Rate for Payer: Nomi Health Commercial |
$1,605.28
|
| Rate for Payer: PACE SWMI |
$1,337.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,337.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.20
|
| Rate for Payer: Priority Health Medicare |
$1,337.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,337.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,337.73
|
| Rate for Payer: UHCCP DNSP |
$1,337.73
|
|
|
PR MAKENA, 10 MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1726
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR MAMMAPLASTY AUGMENTATION - GEL
|
Professional
|
Both
|
$4,937.00
|
|
|
Service Code
|
HCPCS 00261
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,974.80 |
| Max. Negotiated Rate |
$3,209.05 |
| Rate for Payer: Aetna Medicare |
$2,468.50
|
| Rate for Payer: BCBS Complete |
$1,974.80
|
| Rate for Payer: Cash Price |
$3,949.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,209.05
|
|
|
PR MAMMAPLASTY AUGMENTATION - SALINE
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 00262
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$2,453.10 |
| Rate for Payer: Aetna Medicare |
$1,887.00
|
| Rate for Payer: BCBS Complete |
$1,509.60
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,453.10
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$74.40
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$74.40
|
| Rate for Payer: BCN Medicare Advantage |
$74.40
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$89.28
|
| Rate for Payer: Healthscope Whirlpool |
$89.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.12
|
| Rate for Payer: Nomi Health Commercial |
$89.28
|
| Rate for Payer: PACE SWMI |
$74.40
|
| Rate for Payer: PHP Medicare Advantage |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$74.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.40
|
| Rate for Payer: UHC Medicare Advantage |
$74.40
|
| Rate for Payer: UHCCP DNSP |
$74.40
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$157.39 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Medicare |
$157.39
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS MAPPO |
$157.39
|
| Rate for Payer: BCN Medicare Advantage |
$157.39
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$210.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.39
|
| Rate for Payer: Healthscope Commercial |
$188.87
|
| Rate for Payer: Healthscope Whirlpool |
$188.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.26
|
| Rate for Payer: Nomi Health Commercial |
$188.87
|
| Rate for Payer: PACE SWMI |
$157.39
|
| Rate for Payer: PHP Medicare Advantage |
$157.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health Medicare |
$157.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.39
|
| Rate for Payer: UHC Medicare Advantage |
$157.39
|
| Rate for Payer: UHCCP DNSP |
$157.39
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$609.67 |
| Rate for Payer: Aetna Commercial |
$567.33
|
| Rate for Payer: Aetna Medicare |
$423.38
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$423.38
|
| Rate for Payer: BCN Medicare Advantage |
$423.38
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$609.67
|
| Rate for Payer: Cofinity Commercial |
$567.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.38
|
| Rate for Payer: Healthscope Commercial |
$508.06
|
| Rate for Payer: Healthscope Whirlpool |
$508.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.55
|
| Rate for Payer: Nomi Health Commercial |
$508.06
|
| Rate for Payer: PACE SWMI |
$423.38
|
| Rate for Payer: PHP Medicare Advantage |
$423.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$423.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.38
|
| Rate for Payer: UHC Medicare Advantage |
$423.38
|
| Rate for Payer: UHCCP DNSP |
$423.38
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$494.48 |
| Rate for Payer: Aetna Commercial |
$460.14
|
| Rate for Payer: Aetna Medicare |
$343.39
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$343.39
|
| Rate for Payer: BCN Medicare Advantage |
$343.39
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$494.48
|
| Rate for Payer: Cofinity Commercial |
$460.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.39
|
| Rate for Payer: Healthscope Commercial |
$412.07
|
| Rate for Payer: Healthscope Whirlpool |
$412.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.56
|
| Rate for Payer: Nomi Health Commercial |
$412.07
|
| Rate for Payer: PACE SWMI |
$343.39
|
| Rate for Payer: PHP Medicare Advantage |
$343.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$343.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.39
|
| Rate for Payer: UHC Medicare Advantage |
$343.39
|
| Rate for Payer: UHCCP DNSP |
$343.39
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$178.04 |
| Max. Negotiated Rate |
$655.20 |
| Rate for Payer: Aetna Commercial |
$238.57
|
| Rate for Payer: Aetna Medicare |
$178.04
|
| Rate for Payer: BCBS Complete |
$403.20
|
| Rate for Payer: BCBS MAPPO |
$178.04
|
| Rate for Payer: BCN Medicare Advantage |
$178.04
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cofinity Commercial |
$256.38
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.04
|
| Rate for Payer: Healthscope Commercial |
$213.65
|
| Rate for Payer: Healthscope Whirlpool |
$213.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.94
|
| Rate for Payer: Nomi Health Commercial |
$213.65
|
| Rate for Payer: PACE SWMI |
$178.04
|
| Rate for Payer: PHP Medicare Advantage |
$178.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.20
|
| Rate for Payer: Priority Health Medicare |
$178.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.04
|
| Rate for Payer: UHC Medicare Advantage |
$178.04
|
| Rate for Payer: UHCCP DNSP |
$178.04
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$434.85 |
| Max. Negotiated Rate |
$2,419.32 |
| Rate for Payer: Aetna Commercial |
$602.10
|
| Rate for Payer: Aetna Medicare |
$1,560.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: ASR ASR |
$648.93
|
| Rate for Payer: ASR Commercial |
$648.93
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCBS Trust/PPO |
$547.84
|
| Rate for Payer: BCN Commercial |
$518.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$628.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$669.00
|
| Rate for Payer: Healthscope Whirlpool |
$648.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,560.85
|
| Rate for Payer: Mclaren Commercial |
$602.10
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$548.58
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$1,716.93
|
| Rate for Payer: PHP Medicaid |
$836.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.18
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health Narrow Network |
$468.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,419.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP DNSP |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$434.85 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: Aetna Commercial |
$602.10
|
| Rate for Payer: ASR ASR |
$648.93
|
| Rate for Payer: ASR Commercial |
$648.93
|
| Rate for Payer: BCBS Trust/PPO |
$545.17
|
| Rate for Payer: BCN Commercial |
$518.68
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$628.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.20
|
| Rate for Payer: Healthscope Commercial |
$669.00
|
| Rate for Payer: Healthscope Whirlpool |
$648.93
|
| Rate for Payer: Mclaren Commercial |
$602.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.65
|
| Rate for Payer: Nomi Health Commercial |
$548.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.72
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$434.85 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$148.93
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$148.93
|
| Rate for Payer: BCN Medicare Advantage |
$148.93
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$214.46
|
| Rate for Payer: Cofinity Commercial |
$199.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.93
|
| Rate for Payer: Healthscope Commercial |
$178.72
|
| Rate for Payer: Healthscope Whirlpool |
$178.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.38
|
| Rate for Payer: Nomi Health Commercial |
$178.72
|
| Rate for Payer: PACE SWMI |
$148.93
|
| Rate for Payer: PHP Medicare Advantage |
$148.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$148.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.93
|
| Rate for Payer: UHCCP DNSP |
$148.93
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$434.85 |
| Rate for Payer: Aetna Commercial |
$199.57
|
| Rate for Payer: Aetna Medicare |
$148.93
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$148.93
|
| Rate for Payer: BCN Medicare Advantage |
$148.93
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$214.46
|
| Rate for Payer: Cofinity Commercial |
$199.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.93
|
| Rate for Payer: Healthscope Commercial |
$178.72
|
| Rate for Payer: Healthscope Whirlpool |
$178.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.38
|
| Rate for Payer: Nomi Health Commercial |
$178.72
|
| Rate for Payer: PACE SWMI |
$148.93
|
| Rate for Payer: PHP Medicare Advantage |
$148.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$148.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.93
|
| Rate for Payer: UHC Medicare Advantage |
$148.93
|
| Rate for Payer: UHCCP DNSP |
$148.93
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$146.87 |
| Max. Negotiated Rate |
$316.55 |
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: Aetna Medicare |
$146.87
|
| Rate for Payer: BCBS Complete |
$194.80
|
| Rate for Payer: BCBS MAPPO |
$146.87
|
| Rate for Payer: BCN Medicare Advantage |
$146.87
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$211.49
|
| Rate for Payer: Cofinity Commercial |
$196.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.87
|
| Rate for Payer: Healthscope Commercial |
$176.24
|
| Rate for Payer: Healthscope Whirlpool |
$176.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.21
|
| Rate for Payer: Nomi Health Commercial |
$176.24
|
| Rate for Payer: PACE SWMI |
$146.87
|
| Rate for Payer: PHP Medicare Advantage |
$146.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.55
|
| Rate for Payer: Priority Health Medicare |
$146.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.87
|
| Rate for Payer: UHC Medicare Advantage |
$146.87
|
| Rate for Payer: UHCCP DNSP |
$146.87
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$579.96 |
| Rate for Payer: Aetna Commercial |
$539.68
|
| Rate for Payer: Aetna Medicare |
$402.75
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$402.75
|
| Rate for Payer: BCN Medicare Advantage |
$402.75
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$579.96
|
| Rate for Payer: Cofinity Commercial |
$539.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.75
|
| Rate for Payer: Healthscope Commercial |
$483.30
|
| Rate for Payer: Healthscope Whirlpool |
$483.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.89
|
| Rate for Payer: Nomi Health Commercial |
$483.30
|
| Rate for Payer: PACE SWMI |
$402.75
|
| Rate for Payer: PHP Medicare Advantage |
$402.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$402.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.75
|
| Rate for Payer: UHC Medicare Advantage |
$402.75
|
| Rate for Payer: UHCCP DNSP |
$402.75
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$116.15 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$80.66
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$80.66
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$96.79
|
| Rate for Payer: Healthscope Whirlpool |
$96.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.69
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$80.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
| Rate for Payer: UHCCP DNSP |
$80.66
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$198.09 |
| Rate for Payer: Aetna Commercial |
$184.33
|
| Rate for Payer: Aetna Medicare |
$137.56
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$137.56
|
| Rate for Payer: BCN Medicare Advantage |
$137.56
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$198.09
|
| Rate for Payer: Cofinity Commercial |
$184.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.56
|
| Rate for Payer: Healthscope Commercial |
$165.07
|
| Rate for Payer: Healthscope Whirlpool |
$165.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.44
|
| Rate for Payer: Nomi Health Commercial |
$165.07
|
| Rate for Payer: PACE SWMI |
$137.56
|
| Rate for Payer: PHP Medicare Advantage |
$137.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$137.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.56
|
| Rate for Payer: UHC Medicare Advantage |
$137.56
|
| Rate for Payer: UHCCP DNSP |
$137.56
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna Commercial |
$34.95
|
| Rate for Payer: Aetna Medicare |
$26.08
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$26.08
|
| Rate for Payer: BCN Medicare Advantage |
$26.08
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Cofinity Commercial |
$34.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.08
|
| Rate for Payer: Healthscope Commercial |
$31.30
|
| Rate for Payer: Healthscope Whirlpool |
$31.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.38
|
| Rate for Payer: Nomi Health Commercial |
$31.30
|
| Rate for Payer: PACE SWMI |
$26.08
|
| Rate for Payer: PHP Medicare Advantage |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$26.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.08
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
| Rate for Payer: UHCCP DNSP |
$26.08
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$174.63 |
| Max. Negotiated Rate |
$510.25 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Medicare |
$174.63
|
| Rate for Payer: BCBS Complete |
$314.00
|
| Rate for Payer: BCBS MAPPO |
$174.63
|
| Rate for Payer: BCN Medicare Advantage |
$174.63
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$251.47
|
| Rate for Payer: Cofinity Commercial |
$234.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.63
|
| Rate for Payer: Healthscope Commercial |
$209.56
|
| Rate for Payer: Healthscope Whirlpool |
$209.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.36
|
| Rate for Payer: Nomi Health Commercial |
$209.56
|
| Rate for Payer: PACE SWMI |
$174.63
|
| Rate for Payer: PHP Medicare Advantage |
$174.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health Medicare |
$174.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.63
|
| Rate for Payer: UHC Medicare Advantage |
$174.63
|
| Rate for Payer: UHCCP DNSP |
$174.63
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$936.80 |
| Max. Negotiated Rate |
$1,583.04 |
| Rate for Payer: Aetna Commercial |
$1,473.10
|
| Rate for Payer: Aetna Medicare |
$1,099.33
|
| Rate for Payer: BCBS Complete |
$936.80
|
| Rate for Payer: BCBS MAPPO |
$1,099.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.33
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cofinity Commercial |
$1,583.04
|
| Rate for Payer: Cofinity Commercial |
$1,473.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.33
|
| Rate for Payer: Healthscope Commercial |
$1,319.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,319.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.30
|
| Rate for Payer: Nomi Health Commercial |
$1,319.20
|
| Rate for Payer: PACE SWMI |
$1,099.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health Medicare |
$1,099.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.33
|
| Rate for Payer: UHCCP DNSP |
$1,099.33
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$221.83 |
| Max. Negotiated Rate |
$452.40 |
| Rate for Payer: Aetna Commercial |
$297.25
|
| Rate for Payer: Aetna Medicare |
$221.83
|
| Rate for Payer: BCBS Complete |
$278.40
|
| Rate for Payer: BCBS MAPPO |
$221.83
|
| Rate for Payer: BCN Medicare Advantage |
$221.83
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cofinity Commercial |
$319.44
|
| Rate for Payer: Cofinity Commercial |
$297.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.83
|
| Rate for Payer: Healthscope Commercial |
$266.20
|
| Rate for Payer: Healthscope Whirlpool |
$266.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.92
|
| Rate for Payer: Nomi Health Commercial |
$266.20
|
| Rate for Payer: PACE SWMI |
$221.83
|
| Rate for Payer: PHP Medicare Advantage |
$221.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health Medicare |
$221.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.83
|
| Rate for Payer: UHC Medicare Advantage |
$221.83
|
| Rate for Payer: UHCCP DNSP |
$221.83
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$415.27 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Aetna Commercial |
$556.46
|
| Rate for Payer: Aetna Medicare |
$415.27
|
| Rate for Payer: BCBS Complete |
$652.80
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| Rate for Payer: BCN Medicare Advantage |
$415.27
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$597.99
|
| Rate for Payer: Cofinity Commercial |
$556.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.27
|
| Rate for Payer: Healthscope Commercial |
$498.32
|
| Rate for Payer: Healthscope Whirlpool |
$498.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| Rate for Payer: Nomi Health Commercial |
$498.32
|
| Rate for Payer: PACE SWMI |
$415.27
|
| Rate for Payer: PHP Medicare Advantage |
$415.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health Medicare |
$415.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
| Rate for Payer: UHCCP DNSP |
$415.27
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$5,788.66 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Aetna Medicare |
$3,734.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: ASR ASR |
$1,583.04
|
| Rate for Payer: ASR Commercial |
$1,583.04
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.44
|
| Rate for Payer: BCN Commercial |
$1,265.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,534.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,734.62
|
| Rate for Payer: Mclaren Commercial |
$1,468.80
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$1,338.24
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,108.08
|
| Rate for Payer: PHP Medicaid |
$2,001.76
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,429.96
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.03
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,436.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$5,788.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP DNSP |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$415.27 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Aetna Commercial |
$556.46
|
| Rate for Payer: Aetna Medicare |
$415.27
|
| Rate for Payer: BCBS Complete |
$652.80
|
| Rate for Payer: BCBS MAPPO |
$415.27
|
| Rate for Payer: BCN Medicare Advantage |
$415.27
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$597.99
|
| Rate for Payer: Cofinity Commercial |
$556.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.27
|
| Rate for Payer: Healthscope Commercial |
$498.32
|
| Rate for Payer: Healthscope Whirlpool |
$498.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.03
|
| Rate for Payer: Nomi Health Commercial |
$498.32
|
| Rate for Payer: PACE SWMI |
$415.27
|
| Rate for Payer: PHP Medicare Advantage |
$415.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: Priority Health Medicare |
$415.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.27
|
| Rate for Payer: UHC Medicare Advantage |
$415.27
|
| Rate for Payer: UHCCP DNSP |
$415.27
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: ASR ASR |
$1,583.04
|
| Rate for Payer: ASR Commercial |
$1,583.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,329.92
|
| Rate for Payer: BCN Commercial |
$1,265.29
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$1,534.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,305.60
|
| Rate for Payer: Healthscope Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.04
|
| Rate for Payer: Mclaren Commercial |
$1,468.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,387.20
|
| Rate for Payer: Nomi Health Commercial |
$1,338.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,436.16
|
|
