|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$931.63 |
| Max. Negotiated Rate |
$1,451.62 |
| Rate for Payer: Aetna Commercial |
$1,248.38
|
| Rate for Payer: Aetna Commercial |
$1,248.38
|
| Rate for Payer: Aetna Medicare |
$931.63
|
| Rate for Payer: Aetna Medicare |
$931.63
|
| Rate for Payer: BCBS MAPPO |
$931.63
|
| Rate for Payer: BCBS MAPPO |
$931.63
|
| Rate for Payer: BCN Commercial |
$1,451.62
|
| Rate for Payer: BCN Commercial |
$1,451.62
|
| Rate for Payer: BCN Medicare Advantage |
$931.63
|
| Rate for Payer: BCN Medicare Advantage |
$931.63
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$1,248.38
|
| Rate for Payer: Cofinity Commercial |
$1,341.55
|
| Rate for Payer: Cofinity Commercial |
$1,248.38
|
| Rate for Payer: Cofinity Commercial |
$1,341.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.63
|
| Rate for Payer: Healthscope Commercial |
$1,117.96
|
| Rate for Payer: Healthscope Commercial |
$1,117.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,024.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,024.79
|
| Rate for Payer: Nomi Health Commercial |
$1,117.96
|
| Rate for Payer: Nomi Health Commercial |
$1,117.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,341.00
|
| Rate for Payer: PACE SWMI |
$931.63
|
| Rate for Payer: PACE SWMI |
$931.63
|
| Rate for Payer: PHP Medicare Advantage |
$931.63
|
| Rate for Payer: PHP Medicare Advantage |
$931.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,338.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,338.70
|
| Rate for Payer: Priority Health Medicare |
$931.63
|
| Rate for Payer: Priority Health Medicare |
$931.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,338.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,338.70
|
| Rate for Payer: Railroad Medicare Medicare |
$931.63
|
| Rate for Payer: Railroad Medicare Medicare |
$931.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$931.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$931.63
|
| Rate for Payer: UHC Exchange |
$1,369.40
|
| Rate for Payer: UHC Exchange |
$1,369.40
|
| Rate for Payer: UHCCP DNSP |
$931.63
|
| Rate for Payer: UHCCP DNSP |
$931.63
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$655.59 |
| Max. Negotiated Rate |
$969.74 |
| Rate for Payer: Aetna Commercial |
$878.49
|
| Rate for Payer: Aetna Commercial |
$878.49
|
| Rate for Payer: Aetna Medicare |
$655.59
|
| Rate for Payer: Aetna Medicare |
$655.59
|
| Rate for Payer: BCBS MAPPO |
$655.59
|
| Rate for Payer: BCBS MAPPO |
$655.59
|
| Rate for Payer: BCN Commercial |
$773.62
|
| Rate for Payer: BCN Commercial |
$773.62
|
| Rate for Payer: BCN Medicare Advantage |
$655.59
|
| Rate for Payer: BCN Medicare Advantage |
$655.59
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$878.49
|
| Rate for Payer: Cofinity Commercial |
$944.05
|
| Rate for Payer: Cofinity Commercial |
$878.49
|
| Rate for Payer: Cofinity Commercial |
$944.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.59
|
| Rate for Payer: Healthscope Commercial |
$786.71
|
| Rate for Payer: Healthscope Commercial |
$786.71
|
| Rate for Payer: Healthscope Whirlpool |
$786.71
|
| Rate for Payer: Healthscope Whirlpool |
$786.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$721.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$721.15
|
| Rate for Payer: Nomi Health Commercial |
$786.71
|
| Rate for Payer: Nomi Health Commercial |
$786.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$962.25
|
| Rate for Payer: PACE SWMI |
$655.59
|
| Rate for Payer: PACE SWMI |
$655.59
|
| Rate for Payer: PHP Medicare Advantage |
$655.59
|
| Rate for Payer: PHP Medicare Advantage |
$655.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$904.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$904.72
|
| Rate for Payer: Priority Health Medicare |
$655.59
|
| Rate for Payer: Priority Health Medicare |
$655.59
|
| Rate for Payer: Priority Health Narrow Network |
$904.72
|
| Rate for Payer: Priority Health Narrow Network |
$904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$655.59
|
| Rate for Payer: Railroad Medicare Medicare |
$655.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.59
|
| Rate for Payer: UHC Exchange |
$969.74
|
| Rate for Payer: UHC Exchange |
$969.74
|
| Rate for Payer: UHCCP DNSP |
$655.59
|
| Rate for Payer: UHCCP DNSP |
$655.59
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$1,909.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$986.69 |
| Max. Negotiated Rate |
$1,538.26 |
| Rate for Payer: Aetna Commercial |
$1,322.16
|
| Rate for Payer: Aetna Commercial |
$1,322.16
|
| Rate for Payer: Aetna Medicare |
$986.69
|
| Rate for Payer: Aetna Medicare |
$986.69
|
| Rate for Payer: BCBS MAPPO |
$986.69
|
| Rate for Payer: BCBS MAPPO |
$986.69
|
| Rate for Payer: BCN Commercial |
$1,538.26
|
| Rate for Payer: BCN Commercial |
$1,538.26
|
| Rate for Payer: BCN Medicare Advantage |
$986.69
|
| Rate for Payer: BCN Medicare Advantage |
$986.69
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$1,322.16
|
| Rate for Payer: Cofinity Commercial |
$1,420.83
|
| Rate for Payer: Cofinity Commercial |
$1,322.16
|
| Rate for Payer: Cofinity Commercial |
$1,420.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$986.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$986.69
|
| Rate for Payer: Healthscope Commercial |
$1,184.03
|
| Rate for Payer: Healthscope Commercial |
$1,184.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,184.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,184.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,085.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,085.36
|
| Rate for Payer: Nomi Health Commercial |
$1,184.03
|
| Rate for Payer: Nomi Health Commercial |
$1,184.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,431.75
|
| Rate for Payer: PACE SWMI |
$986.69
|
| Rate for Payer: PACE SWMI |
$986.69
|
| Rate for Payer: PHP Medicare Advantage |
$986.69
|
| Rate for Payer: PHP Medicare Advantage |
$986.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,418.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,418.60
|
| Rate for Payer: Priority Health Medicare |
$986.69
|
| Rate for Payer: Priority Health Medicare |
$986.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.60
|
| Rate for Payer: Railroad Medicare Medicare |
$986.69
|
| Rate for Payer: Railroad Medicare Medicare |
$986.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,456.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,456.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$986.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$986.69
|
| Rate for Payer: UHC Exchange |
$1,456.28
|
| Rate for Payer: UHC Exchange |
$1,456.28
|
| Rate for Payer: UHCCP DNSP |
$986.69
|
| Rate for Payer: UHCCP DNSP |
$986.69
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$1,792.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$474.18 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Medicare |
$474.18
|
| Rate for Payer: Aetna Medicare |
$474.18
|
| Rate for Payer: BCBS MAPPO |
$474.18
|
| Rate for Payer: BCBS MAPPO |
$474.18
|
| Rate for Payer: BCN Commercial |
$578.05
|
| Rate for Payer: BCN Commercial |
$578.05
|
| Rate for Payer: BCN Medicare Advantage |
$474.18
|
| Rate for Payer: BCN Medicare Advantage |
$474.18
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$635.40
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Commercial |
$635.40
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.18
|
| Rate for Payer: Healthscope Commercial |
$569.02
|
| Rate for Payer: Healthscope Commercial |
$569.02
|
| Rate for Payer: Healthscope Whirlpool |
$569.02
|
| Rate for Payer: Healthscope Whirlpool |
$569.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.60
|
| Rate for Payer: Nomi Health Commercial |
$569.02
|
| Rate for Payer: Nomi Health Commercial |
$569.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.00
|
| Rate for Payer: PACE SWMI |
$474.18
|
| Rate for Payer: PACE SWMI |
$474.18
|
| Rate for Payer: PHP Medicare Advantage |
$474.18
|
| Rate for Payer: PHP Medicare Advantage |
$474.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$676.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$676.01
|
| Rate for Payer: Priority Health Medicare |
$474.18
|
| Rate for Payer: Priority Health Medicare |
$474.18
|
| Rate for Payer: Priority Health Narrow Network |
$676.01
|
| Rate for Payer: Priority Health Narrow Network |
$676.01
|
| Rate for Payer: Railroad Medicare Medicare |
$474.18
|
| Rate for Payer: Railroad Medicare Medicare |
$474.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$474.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$474.18
|
| Rate for Payer: UHC Exchange |
$988.64
|
| Rate for Payer: UHC Exchange |
$988.64
|
| Rate for Payer: UHCCP DNSP |
$474.18
|
| Rate for Payer: UHCCP DNSP |
$474.18
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,959.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$1,033.26 |
| Max. Negotiated Rate |
$3,719.25 |
| Rate for Payer: Aetna Commercial |
$2,163.66
|
| Rate for Payer: Aetna Medicare |
$1,614.67
|
| Rate for Payer: BCBS Complete |
$1,084.92
|
| Rate for Payer: BCBS MAPPO |
$1,614.67
|
| Rate for Payer: BCN Commercial |
$2,600.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,614.67
|
| Rate for Payer: Cash Price |
$3,967.20
|
| Rate for Payer: Cash Price |
$3,967.20
|
| Rate for Payer: Cofinity Commercial |
$2,325.12
|
| Rate for Payer: Cofinity Commercial |
$2,163.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,614.67
|
| Rate for Payer: Healthscope Commercial |
$1,937.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,937.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,695.40
|
| Rate for Payer: Meridian Medicaid |
$1,084.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,776.14
|
| Rate for Payer: Nomi Health Commercial |
$1,937.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,719.25
|
| Rate for Payer: PACE SWMI |
$1,614.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,614.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,168.48
|
| Rate for Payer: Priority Health Medicare |
$1,614.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,168.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,614.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,104.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,614.67
|
| Rate for Payer: UHC Exchange |
$3,104.40
|
| Rate for Payer: UHC Medicaid |
$1,033.26
|
| Rate for Payer: UHCCP DNSP |
$1,614.67
|
| Rate for Payer: UHCCP Medicaid |
$1,033.26
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$47.12 |
| Rate for Payer: Aetna Commercial |
$36.76
|
| Rate for Payer: Aetna Medicare |
$27.43
|
| Rate for Payer: BCBS MAPPO |
$27.43
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: BCN Medicare Advantage |
$27.43
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.76
|
| Rate for Payer: Cofinity Commercial |
$39.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.43
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Whirlpool |
$32.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.17
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.25
|
| Rate for Payer: PACE SWMI |
$27.43
|
| Rate for Payer: PHP Medicare Advantage |
$27.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.50
|
| Rate for Payer: Priority Health Medicare |
$27.43
|
| Rate for Payer: Priority Health Narrow Network |
$39.50
|
| Rate for Payer: Railroad Medicare Medicare |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.43
|
| Rate for Payer: UHC Exchange |
$47.12
|
| Rate for Payer: UHCCP DNSP |
$27.43
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$538.97 |
| Rate for Payer: Aetna Commercial |
$352.10
|
| Rate for Payer: Aetna Medicare |
$262.76
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCBS MAPPO |
$262.76
|
| Rate for Payer: BCN Commercial |
$460.13
|
| Rate for Payer: BCN Medicare Advantage |
$262.76
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cofinity Commercial |
$378.37
|
| Rate for Payer: Cofinity Commercial |
$352.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.76
|
| Rate for Payer: Healthscope Commercial |
$315.31
|
| Rate for Payer: Healthscope Whirlpool |
$315.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.90
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$289.04
|
| Rate for Payer: Nomi Health Commercial |
$315.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.25
|
| Rate for Payer: PACE SWMI |
$262.76
|
| Rate for Payer: PHP Medicare Advantage |
$262.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$538.97
|
| Rate for Payer: Priority Health Medicare |
$262.76
|
| Rate for Payer: Priority Health Narrow Network |
$538.97
|
| Rate for Payer: Railroad Medicare Medicare |
$262.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$525.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.76
|
| Rate for Payer: UHC Exchange |
$525.83
|
| Rate for Payer: UHC Medicaid |
$175.51
|
| Rate for Payer: UHCCP DNSP |
$262.76
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
57250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: ASR ASR |
$1,364.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.43
|
| Rate for Payer: BCN Commercial |
$1,155.43
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Healthscope Commercial |
$1,364.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,407.00
|
| Rate for Payer: Mclaren Commercial |
$1,266.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,055.25
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$721.52
|
| Rate for Payer: Aetna Medicare |
$538.45
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS MAPPO |
$538.45
|
| Rate for Payer: BCN Commercial |
$924.26
|
| Rate for Payer: BCN Medicare Advantage |
$538.45
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$775.37
|
| Rate for Payer: Cofinity Commercial |
$721.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.45
|
| Rate for Payer: Healthscope Commercial |
$646.14
|
| Rate for Payer: Healthscope Whirlpool |
$646.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.37
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$592.29
|
| Rate for Payer: Nomi Health Commercial |
$646.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PACE SWMI |
$538.45
|
| Rate for Payer: PHP Medicare Advantage |
$538.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$936.07
|
| Rate for Payer: Priority Health Medicare |
$538.45
|
| Rate for Payer: Priority Health Narrow Network |
$936.07
|
| Rate for Payer: Railroad Medicare Medicare |
$538.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,073.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$538.45
|
| Rate for Payer: UHC Exchange |
$1,073.09
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP DNSP |
$538.45
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
57250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$986.31 |
| Max. Negotiated Rate |
$6,230.57 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: Aetna Medicare |
$4,984.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: ASR ASR |
$1,364.79
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.07
|
| Rate for Payer: BCN Commercial |
$1,160.07
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$1,364.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,407.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,984.46
|
| Rate for Payer: Mclaren Commercial |
$1,266.30
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$2,737.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,055.25
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$5,482.91
|
| Rate for Payer: PHP Medicaid |
$2,671.67
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,232.81
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Narrow Network |
$986.31
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP DNSP |
$4,984.46
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 57250
|
| Hospital Charge Code |
57250
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$721.52
|
| Rate for Payer: Aetna Medicare |
$538.45
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS MAPPO |
$538.45
|
| Rate for Payer: BCN Commercial |
$924.26
|
| Rate for Payer: BCN Medicare Advantage |
$538.45
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$775.37
|
| Rate for Payer: Cofinity Commercial |
$721.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.45
|
| Rate for Payer: Healthscope Commercial |
$646.14
|
| Rate for Payer: Healthscope Whirlpool |
$646.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.37
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$592.29
|
| Rate for Payer: Nomi Health Commercial |
$646.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PACE SWMI |
$538.45
|
| Rate for Payer: PHP Medicare Advantage |
$538.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$936.07
|
| Rate for Payer: Priority Health Medicare |
$538.45
|
| Rate for Payer: Priority Health Narrow Network |
$936.07
|
| Rate for Payer: Railroad Medicare Medicare |
$538.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,073.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$538.45
|
| Rate for Payer: UHC Exchange |
$1,073.09
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP DNSP |
$538.45
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,433.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$2,574.75 |
| Rate for Payer: Aetna Commercial |
$901.57
|
| Rate for Payer: Aetna Medicare |
$672.81
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$672.81
|
| Rate for Payer: BCN Commercial |
$1,238.57
|
| Rate for Payer: BCN Medicare Advantage |
$672.81
|
| Rate for Payer: Cash Price |
$2,746.40
|
| Rate for Payer: Cash Price |
$2,746.40
|
| Rate for Payer: Cofinity Commercial |
$968.85
|
| Rate for Payer: Cofinity Commercial |
$901.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.81
|
| Rate for Payer: Healthscope Commercial |
$807.37
|
| Rate for Payer: Healthscope Whirlpool |
$807.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.45
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$740.09
|
| Rate for Payer: Nomi Health Commercial |
$807.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,574.75
|
| Rate for Payer: PACE SWMI |
$672.81
|
| Rate for Payer: PHP Medicare Advantage |
$672.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,205.18
|
| Rate for Payer: Priority Health Medicare |
$672.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,205.18
|
| Rate for Payer: Railroad Medicare Medicare |
$672.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,354.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$672.81
|
| Rate for Payer: UHC Exchange |
$1,354.22
|
| Rate for Payer: UHC Medicaid |
$426.21
|
| Rate for Payer: UHCCP DNSP |
$672.81
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$4,047.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$558.06 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Aetna Commercial |
$1,180.04
|
| Rate for Payer: Aetna Medicare |
$880.63
|
| Rate for Payer: BCBS Complete |
$585.96
|
| Rate for Payer: BCBS MAPPO |
$880.63
|
| Rate for Payer: BCN Commercial |
$1,619.33
|
| Rate for Payer: BCN Medicare Advantage |
$880.63
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cofinity Commercial |
$1,268.11
|
| Rate for Payer: Cofinity Commercial |
$1,180.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.63
|
| Rate for Payer: Healthscope Commercial |
$1,056.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.66
|
| Rate for Payer: Meridian Medicaid |
$585.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$968.69
|
| Rate for Payer: Nomi Health Commercial |
$1,056.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,035.25
|
| Rate for Payer: PACE SWMI |
$880.63
|
| Rate for Payer: PHP Medicare Advantage |
$880.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,575.70
|
| Rate for Payer: Priority Health Medicare |
$880.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.70
|
| Rate for Payer: Railroad Medicare Medicare |
$880.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,755.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$880.63
|
| Rate for Payer: UHC Exchange |
$1,755.56
|
| Rate for Payer: UHC Medicaid |
$558.06
|
| Rate for Payer: UHCCP DNSP |
$880.63
|
| Rate for Payer: UHCCP Medicaid |
$558.06
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,832.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$918.45
|
| Rate for Payer: Aetna Medicare |
$685.41
|
| Rate for Payer: BCBS Complete |
$455.35
|
| Rate for Payer: BCBS MAPPO |
$685.41
|
| Rate for Payer: BCN Commercial |
$1,253.88
|
| Rate for Payer: BCN Medicare Advantage |
$685.41
|
| Rate for Payer: Cash Price |
$3,065.60
|
| Rate for Payer: Cash Price |
$3,065.60
|
| Rate for Payer: Cofinity Commercial |
$986.99
|
| Rate for Payer: Cofinity Commercial |
$918.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.41
|
| Rate for Payer: Healthscope Commercial |
$822.49
|
| Rate for Payer: Healthscope Whirlpool |
$822.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.68
|
| Rate for Payer: Meridian Medicaid |
$455.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$753.95
|
| Rate for Payer: Nomi Health Commercial |
$822.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,874.00
|
| Rate for Payer: PACE SWMI |
$685.41
|
| Rate for Payer: PHP Medicare Advantage |
$685.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,220.09
|
| Rate for Payer: Priority Health Medicare |
$685.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,220.09
|
| Rate for Payer: Railroad Medicare Medicare |
$685.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,360.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$685.41
|
| Rate for Payer: UHC Exchange |
$1,360.45
|
| Rate for Payer: UHC Medicaid |
$433.67
|
| Rate for Payer: UHCCP DNSP |
$685.41
|
| Rate for Payer: UHCCP Medicaid |
$433.67
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,214.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$464.55 |
| Max. Negotiated Rate |
$3,160.50 |
| Rate for Payer: Aetna Commercial |
$983.91
|
| Rate for Payer: Aetna Medicare |
$734.26
|
| Rate for Payer: BCBS Complete |
$487.78
|
| Rate for Payer: BCBS MAPPO |
$734.26
|
| Rate for Payer: BCN Commercial |
$1,343.60
|
| Rate for Payer: BCN Medicare Advantage |
$734.26
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Cofinity Commercial |
$983.91
|
| Rate for Payer: Cofinity Commercial |
$1,057.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$734.26
|
| Rate for Payer: Healthscope Commercial |
$881.11
|
| Rate for Payer: Healthscope Whirlpool |
$881.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.97
|
| Rate for Payer: Meridian Medicaid |
$487.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$807.69
|
| Rate for Payer: Nomi Health Commercial |
$881.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,160.50
|
| Rate for Payer: PACE SWMI |
$734.26
|
| Rate for Payer: PHP Medicare Advantage |
$734.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,307.40
|
| Rate for Payer: Priority Health Medicare |
$734.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.40
|
| Rate for Payer: Railroad Medicare Medicare |
$734.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,453.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$734.26
|
| Rate for Payer: UHC Exchange |
$1,453.54
|
| Rate for Payer: UHC Medicaid |
$464.55
|
| Rate for Payer: UHCCP DNSP |
$734.26
|
| Rate for Payer: UHCCP Medicaid |
$464.55
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$155.05 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$219.21
|
| Rate for Payer: Aetna Medicare |
$163.59
|
| Rate for Payer: BCBS Complete |
$162.80
|
| Rate for Payer: BCBS MAPPO |
$163.59
|
| Rate for Payer: BCN Commercial |
$253.10
|
| Rate for Payer: BCN Medicare Advantage |
$163.59
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.59
|
| Rate for Payer: Healthscope Commercial |
$196.31
|
| Rate for Payer: Healthscope Whirlpool |
$196.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.77
|
| Rate for Payer: Meridian Medicaid |
$162.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$196.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE SWMI |
$163.59
|
| Rate for Payer: PHP Medicare Advantage |
$163.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.98
|
| Rate for Payer: Priority Health Medicare |
$163.59
|
| Rate for Payer: Priority Health Narrow Network |
$251.98
|
| Rate for Payer: Railroad Medicare Medicare |
$163.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.59
|
| Rate for Payer: UHC Exchange |
$249.17
|
| Rate for Payer: UHC Medicaid |
$155.05
|
| Rate for Payer: UHCCP DNSP |
$163.59
|
| Rate for Payer: UHCCP Medicaid |
$155.05
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$34.85
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCN Commercial |
$44.32
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$37.45
|
| Rate for Payer: Cofinity Commercial |
$34.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$31.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$31.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.50
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.48
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health Narrow Network |
$51.48
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.01
|
| Rate for Payer: UHC Exchange |
$55.38
|
| Rate for Payer: UHC Medicaid |
$16.61
|
| Rate for Payer: UHCCP DNSP |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$16.61
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$7.81
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: BCBS MAPPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$5.83
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.83
|
| Rate for Payer: Healthscope Commercial |
$7.00
|
| Rate for Payer: Healthscope Whirlpool |
$7.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$7.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PACE SWMI |
$5.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.83
|
| Rate for Payer: Priority Health Medicare |
$5.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.83
|
| Rate for Payer: UHC Exchange |
$3.50
|
| Rate for Payer: UHCCP DNSP |
$5.83
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$225.08
|
| Rate for Payer: Aetna Medicare |
$167.97
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS MAPPO |
$167.97
|
| Rate for Payer: BCN Commercial |
$247.00
|
| Rate for Payer: BCN Medicare Advantage |
$167.97
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$225.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.97
|
| Rate for Payer: Healthscope Commercial |
$201.56
|
| Rate for Payer: Healthscope Whirlpool |
$201.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.77
|
| Rate for Payer: Nomi Health Commercial |
$201.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.25
|
| Rate for Payer: PACE SWMI |
$167.97
|
| Rate for Payer: PHP Medicare Advantage |
$167.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$216.03
|
| Rate for Payer: Priority Health Medicare |
$167.97
|
| Rate for Payer: Priority Health Narrow Network |
$216.03
|
| Rate for Payer: Railroad Medicare Medicare |
$167.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$167.97
|
| Rate for Payer: UHC Exchange |
$235.75
|
| Rate for Payer: UHCCP DNSP |
$167.97
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Aetna Commercial |
$177.09
|
| Rate for Payer: Aetna Medicare |
$132.16
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$132.16
|
| Rate for Payer: BCN Commercial |
$194.71
|
| Rate for Payer: BCN Medicare Advantage |
$132.16
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Cofinity Commercial |
$177.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.16
|
| Rate for Payer: Healthscope Commercial |
$158.59
|
| Rate for Payer: Healthscope Whirlpool |
$158.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.38
|
| Rate for Payer: Nomi Health Commercial |
$158.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE SWMI |
$132.16
|
| Rate for Payer: PHP Medicare Advantage |
$132.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.29
|
| Rate for Payer: Priority Health Medicare |
$132.16
|
| Rate for Payer: Priority Health Narrow Network |
$170.29
|
| Rate for Payer: Railroad Medicare Medicare |
$132.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.16
|
| Rate for Payer: UHC Exchange |
$159.32
|
| Rate for Payer: UHCCP DNSP |
$132.16
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$230.41 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$133.47
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$117.08
|
| Rate for Payer: BCN Commercial |
$230.41
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Healthscope Commercial |
$160.16
|
| Rate for Payer: Healthscope Whirlpool |
$160.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$146.82
|
| Rate for Payer: Nomi Health Commercial |
$160.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Medicare |
$133.47
|
| Rate for Payer: Railroad Medicare Medicare |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.47
|
| Rate for Payer: UHC Exchange |
$117.08
|
| Rate for Payer: UHCCP DNSP |
$133.47
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,792.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$1,046.26 |
| Max. Negotiated Rate |
$3,594.00 |
| Rate for Payer: Aetna Commercial |
$2,178.22
|
| Rate for Payer: Aetna Medicare |
$1,625.54
|
| Rate for Payer: BCBS Complete |
$1,098.57
|
| Rate for Payer: BCBS MAPPO |
$1,625.54
|
| Rate for Payer: BCN Commercial |
$2,691.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,625.54
|
| Rate for Payer: Cash Price |
$3,833.60
|
| Rate for Payer: Cash Price |
$3,833.60
|
| Rate for Payer: Cofinity Commercial |
$2,340.78
|
| Rate for Payer: Cofinity Commercial |
$2,178.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,625.54
|
| Rate for Payer: Healthscope Commercial |
$1,950.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,950.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,706.82
|
| Rate for Payer: Meridian Medicaid |
$1,098.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,788.09
|
| Rate for Payer: Nomi Health Commercial |
$1,950.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,594.00
|
| Rate for Payer: PACE SWMI |
$1,625.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,625.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,279.53
|
| Rate for Payer: Priority Health Medicare |
$1,625.54
|
| Rate for Payer: Priority Health Narrow Network |
$3,279.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,625.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,306.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,625.54
|
| Rate for Payer: UHC Exchange |
$3,306.30
|
| Rate for Payer: UHC Medicaid |
$1,046.26
|
| Rate for Payer: UHCCP DNSP |
$1,625.54
|
| Rate for Payer: UHCCP Medicaid |
$1,046.26
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,867.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$1,066.49 |
| Max. Negotiated Rate |
$3,650.25 |
| Rate for Payer: Aetna Commercial |
$2,216.27
|
| Rate for Payer: Aetna Medicare |
$1,653.93
|
| Rate for Payer: BCBS Complete |
$1,119.81
|
| Rate for Payer: BCBS MAPPO |
$1,653.93
|
| Rate for Payer: BCN Commercial |
$2,698.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,653.93
|
| Rate for Payer: Cash Price |
$3,893.60
|
| Rate for Payer: Cash Price |
$3,893.60
|
| Rate for Payer: Cofinity Commercial |
$2,381.66
|
| Rate for Payer: Cofinity Commercial |
$2,216.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,653.93
|
| Rate for Payer: Healthscope Commercial |
$1,984.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,984.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,736.63
|
| Rate for Payer: Meridian Medicaid |
$1,119.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,819.32
|
| Rate for Payer: Nomi Health Commercial |
$1,984.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,650.25
|
| Rate for Payer: PACE SWMI |
$1,653.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,653.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,066.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,288.02
|
| Rate for Payer: Priority Health Medicare |
$1,653.93
|
| Rate for Payer: Priority Health Narrow Network |
$3,288.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,653.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,246.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,653.93
|
| Rate for Payer: UHC Exchange |
$3,246.37
|
| Rate for Payer: UHC Medicaid |
$1,066.49
|
| Rate for Payer: UHCCP DNSP |
$1,653.93
|
| Rate for Payer: UHCCP Medicaid |
$1,066.49
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$5,143.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$955.31 |
| Max. Negotiated Rate |
$3,857.25 |
| Rate for Payer: Aetna Commercial |
$1,999.36
|
| Rate for Payer: Aetna Medicare |
$1,492.06
|
| Rate for Payer: BCBS Complete |
$1,003.08
|
| Rate for Payer: BCBS MAPPO |
$1,492.06
|
| Rate for Payer: BCN Commercial |
$2,403.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,492.06
|
| Rate for Payer: Cash Price |
$4,114.40
|
| Rate for Payer: Cash Price |
$4,114.40
|
| Rate for Payer: Cofinity Commercial |
$2,148.57
|
| Rate for Payer: Cofinity Commercial |
$1,999.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,492.06
|
| Rate for Payer: Healthscope Commercial |
$1,790.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,790.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,566.66
|
| Rate for Payer: Meridian Medicaid |
$1,003.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,641.27
|
| Rate for Payer: Nomi Health Commercial |
$1,790.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,857.25
|
| Rate for Payer: PACE SWMI |
$1,492.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,492.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$955.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,928.83
|
| Rate for Payer: Priority Health Medicare |
$1,492.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,928.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,492.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,849.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,492.06
|
| Rate for Payer: UHC Exchange |
$2,849.41
|
| Rate for Payer: UHC Medicaid |
$955.31
|
| Rate for Payer: UHCCP DNSP |
$1,492.06
|
| Rate for Payer: UHCCP Medicaid |
$955.31
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$5,047.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$1,039.65 |
| Max. Negotiated Rate |
$3,785.25 |
| Rate for Payer: Aetna Commercial |
$2,178.30
|
| Rate for Payer: Aetna Medicare |
$1,625.60
|
| Rate for Payer: BCBS Complete |
$1,091.63
|
| Rate for Payer: BCBS MAPPO |
$1,625.60
|
| Rate for Payer: BCN Commercial |
$2,620.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,625.60
|
| Rate for Payer: Cash Price |
$4,037.60
|
| Rate for Payer: Cash Price |
$4,037.60
|
| Rate for Payer: Cofinity Commercial |
$2,340.86
|
| Rate for Payer: Cofinity Commercial |
$2,178.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,625.60
|
| Rate for Payer: Healthscope Commercial |
$1,950.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,950.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,706.88
|
| Rate for Payer: Meridian Medicaid |
$1,091.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,788.16
|
| Rate for Payer: Nomi Health Commercial |
$1,950.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,785.25
|
| Rate for Payer: PACE SWMI |
$1,625.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,625.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,039.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,192.75
|
| Rate for Payer: Priority Health Medicare |
$1,625.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,192.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,625.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,114.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,625.60
|
| Rate for Payer: UHC Exchange |
$3,114.90
|
| Rate for Payer: UHC Medicaid |
$1,039.65
|
| Rate for Payer: UHCCP DNSP |
$1,625.60
|
| Rate for Payer: UHCCP Medicaid |
$1,039.65
|
|
