|
PR QUAL NONMD EST PT 11-20M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2062
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR QUAL NONMD EST PT 21>MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2063
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR QUAL NONMD EST PT 5-10M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2061
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 90375
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$402.98 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare |
$279.85
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$402.98
|
| Rate for Payer: Cofinity Commercial |
$375.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Healthscope Commercial |
$335.82
|
| Rate for Payer: Healthscope Whirlpool |
$335.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Nomi Health Commercial |
$335.82
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHCCP DNSP |
$279.85
|
|
|
PR RABIES VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 90675
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$451.70 |
| Rate for Payer: Aetna Commercial |
$420.33
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$451.70
|
| Rate for Payer: Cofinity Commercial |
$420.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Healthscope Commercial |
$376.42
|
| Rate for Payer: Healthscope Whirlpool |
$376.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Nomi Health Commercial |
$376.42
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHCCP DNSP |
$313.68
|
|
|
PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY
|
Professional
|
Both
|
$6,028.00
|
|
|
Service Code
|
HCPCS 58210
|
| Min. Negotiated Rate |
$1,749.98 |
| Max. Negotiated Rate |
$3,918.20 |
| Rate for Payer: Aetna Commercial |
$2,344.97
|
| Rate for Payer: Aetna Medicare |
$1,749.98
|
| Rate for Payer: BCBS Complete |
$2,411.20
|
| Rate for Payer: BCBS MAPPO |
$1,749.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,749.98
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cofinity Commercial |
$2,519.97
|
| Rate for Payer: Cofinity Commercial |
$2,344.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,749.98
|
| Rate for Payer: Healthscope Commercial |
$2,099.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,099.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,837.48
|
| Rate for Payer: Nomi Health Commercial |
$2,099.98
|
| Rate for Payer: PACE SWMI |
$1,749.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,749.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.20
|
| Rate for Payer: Priority Health Medicare |
$1,749.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,749.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,749.98
|
| Rate for Payer: UHCCP DNSP |
$1,749.98
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$2,719.00
|
|
|
Service Code
|
HCPCS 25115
|
| Min. Negotiated Rate |
$732.84 |
| Max. Negotiated Rate |
$1,767.35 |
| Rate for Payer: Aetna Commercial |
$982.01
|
| Rate for Payer: Aetna Medicare |
$732.84
|
| Rate for Payer: BCBS Complete |
$1,087.60
|
| Rate for Payer: BCBS MAPPO |
$732.84
|
| Rate for Payer: BCN Medicare Advantage |
$732.84
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cofinity Commercial |
$982.01
|
| Rate for Payer: Cofinity Commercial |
$1,055.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$732.84
|
| Rate for Payer: Healthscope Commercial |
$879.41
|
| Rate for Payer: Healthscope Whirlpool |
$879.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.48
|
| Rate for Payer: Nomi Health Commercial |
$879.41
|
| Rate for Payer: PACE SWMI |
$732.84
|
| Rate for Payer: PHP Medicare Advantage |
$732.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.35
|
| Rate for Payer: Priority Health Medicare |
$732.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$732.84
|
| Rate for Payer: UHC Medicare Advantage |
$732.84
|
| Rate for Payer: UHCCP DNSP |
$732.84
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,330.00
|
|
|
Service Code
|
HCPCS 25116
|
| Min. Negotiated Rate |
$585.05 |
| Max. Negotiated Rate |
$1,514.50 |
| Rate for Payer: Aetna Commercial |
$783.97
|
| Rate for Payer: Aetna Medicare |
$585.05
|
| Rate for Payer: BCBS Complete |
$932.00
|
| Rate for Payer: BCBS MAPPO |
$585.05
|
| Rate for Payer: BCN Medicare Advantage |
$585.05
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cofinity Commercial |
$842.47
|
| Rate for Payer: Cofinity Commercial |
$783.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.05
|
| Rate for Payer: Healthscope Commercial |
$702.06
|
| Rate for Payer: Healthscope Whirlpool |
$702.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$614.30
|
| Rate for Payer: Nomi Health Commercial |
$702.06
|
| Rate for Payer: PACE SWMI |
$585.05
|
| Rate for Payer: PHP Medicare Advantage |
$585.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,514.50
|
| Rate for Payer: Priority Health Medicare |
$585.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$585.05
|
| Rate for Payer: UHC Medicare Advantage |
$585.05
|
| Rate for Payer: UHCCP DNSP |
$585.05
|
|
|
PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ
|
Professional
|
Both
|
$1,902.00
|
|
|
Service Code
|
HCPCS 69150
|
| Min. Negotiated Rate |
$760.80 |
| Max. Negotiated Rate |
$1,360.86 |
| Rate for Payer: Aetna Commercial |
$1,266.35
|
| Rate for Payer: Aetna Medicare |
$945.04
|
| Rate for Payer: BCBS Complete |
$760.80
|
| Rate for Payer: BCBS MAPPO |
$945.04
|
| Rate for Payer: BCN Medicare Advantage |
$945.04
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cofinity Commercial |
$1,360.86
|
| Rate for Payer: Cofinity Commercial |
$1,266.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.04
|
| Rate for Payer: Healthscope Commercial |
$1,134.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.29
|
| Rate for Payer: Nomi Health Commercial |
$1,134.05
|
| Rate for Payer: PACE SWMI |
$945.04
|
| Rate for Payer: PHP Medicare Advantage |
$945.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.30
|
| Rate for Payer: Priority Health Medicare |
$945.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.04
|
| Rate for Payer: UHC Medicare Advantage |
$945.04
|
| Rate for Payer: UHCCP DNSP |
$945.04
|
|
|
PR RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP
|
Professional
|
Both
|
$3,040.00
|
|
|
Service Code
|
HCPCS 42844
|
| Min. Negotiated Rate |
$1,216.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Aetna Commercial |
$1,725.81
|
| Rate for Payer: Aetna Medicare |
$1,287.92
|
| Rate for Payer: BCBS Complete |
$1,216.00
|
| Rate for Payer: BCBS MAPPO |
$1,287.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,287.92
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cofinity Commercial |
$1,854.60
|
| Rate for Payer: Cofinity Commercial |
$1,725.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,287.92
|
| Rate for Payer: Healthscope Commercial |
$1,545.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,545.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,352.32
|
| Rate for Payer: Nomi Health Commercial |
$1,545.50
|
| Rate for Payer: PACE SWMI |
$1,287.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,287.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.00
|
| Rate for Payer: Priority Health Medicare |
$1,287.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,287.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,287.92
|
| Rate for Payer: UHCCP DNSP |
$1,287.92
|
|
|
PR RADICAL RESECTION STERNUM
|
Professional
|
Both
|
$2,674.00
|
|
|
Service Code
|
HCPCS 21630
|
| Min. Negotiated Rate |
$1,069.60 |
| Max. Negotiated Rate |
$1,810.22 |
| Rate for Payer: Aetna Commercial |
$1,684.51
|
| Rate for Payer: Aetna Medicare |
$1,257.10
|
| Rate for Payer: BCBS Complete |
$1,069.60
|
| Rate for Payer: BCBS MAPPO |
$1,257.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.10
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cofinity Commercial |
$1,810.22
|
| Rate for Payer: Cofinity Commercial |
$1,684.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.10
|
| Rate for Payer: Healthscope Commercial |
$1,508.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,508.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.95
|
| Rate for Payer: Nomi Health Commercial |
$1,508.52
|
| Rate for Payer: PACE SWMI |
$1,257.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,738.10
|
| Rate for Payer: Priority Health Medicare |
$1,257.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,257.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,257.10
|
| Rate for Payer: UHCCP DNSP |
$1,257.10
|
|
|
PR RADICAL RESECTION TONSIL W/O CLOSURE
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 42842
|
| Min. Negotiated Rate |
$720.80 |
| Max. Negotiated Rate |
$1,358.40 |
| Rate for Payer: Aetna Commercial |
$1,264.06
|
| Rate for Payer: Aetna Medicare |
$943.33
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$943.33
|
| Rate for Payer: BCN Medicare Advantage |
$943.33
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$1,264.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.33
|
| Rate for Payer: Healthscope Commercial |
$1,132.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,132.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$990.50
|
| Rate for Payer: Nomi Health Commercial |
$1,132.00
|
| Rate for Payer: PACE SWMI |
$943.33
|
| Rate for Payer: PHP Medicare Advantage |
$943.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$943.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.33
|
| Rate for Payer: UHC Medicare Advantage |
$943.33
|
| Rate for Payer: UHCCP DNSP |
$943.33
|
|
|
PR RADICAL RESECTION TUMOR CLAVICLE
|
Professional
|
Both
|
$2,630.00
|
|
|
Service Code
|
HCPCS 23200
|
| Min. Negotiated Rate |
$1,052.00 |
| Max. Negotiated Rate |
$2,086.89 |
| Rate for Payer: Aetna Commercial |
$1,941.97
|
| Rate for Payer: Aetna Medicare |
$1,449.23
|
| Rate for Payer: BCBS Complete |
$1,052.00
|
| Rate for Payer: BCBS MAPPO |
$1,449.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,449.23
|
| Rate for Payer: Cash Price |
$2,104.00
|
| Rate for Payer: Cash Price |
$2,104.00
|
| Rate for Payer: Cofinity Commercial |
$2,086.89
|
| Rate for Payer: Cofinity Commercial |
$1,941.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,449.23
|
| Rate for Payer: Healthscope Commercial |
$1,739.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,739.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,521.69
|
| Rate for Payer: Nomi Health Commercial |
$1,739.08
|
| Rate for Payer: PACE SWMI |
$1,449.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,449.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,709.50
|
| Rate for Payer: Priority Health Medicare |
$1,449.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,449.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,449.23
|
| Rate for Payer: UHCCP DNSP |
$1,449.23
|
|
|
PR RADICAL RESECTION TUMOR FEMOR OR KNEE
|
Professional
|
Both
|
$5,511.00
|
|
|
Service Code
|
HCPCS 27365
|
| Min. Negotiated Rate |
$1,976.41 |
| Max. Negotiated Rate |
$3,582.15 |
| Rate for Payer: Aetna Commercial |
$2,648.39
|
| Rate for Payer: Aetna Medicare |
$1,976.41
|
| Rate for Payer: BCBS Complete |
$2,204.40
|
| Rate for Payer: BCBS MAPPO |
$1,976.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,976.41
|
| Rate for Payer: Cash Price |
$4,408.80
|
| Rate for Payer: Cash Price |
$4,408.80
|
| Rate for Payer: Cofinity Commercial |
$2,846.03
|
| Rate for Payer: Cofinity Commercial |
$2,648.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,976.41
|
| Rate for Payer: Healthscope Commercial |
$2,371.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,371.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,075.23
|
| Rate for Payer: Nomi Health Commercial |
$2,371.69
|
| Rate for Payer: PACE SWMI |
$1,976.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,976.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,582.15
|
| Rate for Payer: Priority Health Medicare |
$1,976.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,976.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,976.41
|
| Rate for Payer: UHCCP DNSP |
$1,976.41
|
|
|
PR RADICAL RESECTION TUMOR METACARPAL
|
Professional
|
Both
|
$3,029.00
|
|
|
Service Code
|
HCPCS 26250
|
| Min. Negotiated Rate |
$1,027.84 |
| Max. Negotiated Rate |
$1,968.85 |
| Rate for Payer: Aetna Commercial |
$1,377.31
|
| Rate for Payer: Aetna Medicare |
$1,027.84
|
| Rate for Payer: BCBS Complete |
$1,211.60
|
| Rate for Payer: BCBS MAPPO |
$1,027.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,027.84
|
| Rate for Payer: Cash Price |
$2,423.20
|
| Rate for Payer: Cash Price |
$2,423.20
|
| Rate for Payer: Cofinity Commercial |
$1,480.09
|
| Rate for Payer: Cofinity Commercial |
$1,377.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,027.84
|
| Rate for Payer: Healthscope Commercial |
$1,233.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,233.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,079.23
|
| Rate for Payer: Nomi Health Commercial |
$1,233.41
|
| Rate for Payer: PACE SWMI |
$1,027.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,027.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,968.85
|
| Rate for Payer: Priority Health Medicare |
$1,027.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,027.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,027.84
|
| Rate for Payer: UHCCP DNSP |
$1,027.84
|
|
|
PR RADICAL RESECTION TUMOR METATARSAL
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 28173
|
| Min. Negotiated Rate |
$551.60 |
| Max. Negotiated Rate |
$1,000.81 |
| Rate for Payer: Aetna Commercial |
$931.31
|
| Rate for Payer: Aetna Medicare |
$695.01
|
| Rate for Payer: BCBS Complete |
$551.60
|
| Rate for Payer: BCBS MAPPO |
$695.01
|
| Rate for Payer: BCN Medicare Advantage |
$695.01
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$931.31
|
| Rate for Payer: Cofinity Commercial |
$1,000.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.01
|
| Rate for Payer: Healthscope Commercial |
$834.01
|
| Rate for Payer: Healthscope Whirlpool |
$834.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.76
|
| Rate for Payer: Nomi Health Commercial |
$834.01
|
| Rate for Payer: PACE SWMI |
$695.01
|
| Rate for Payer: PHP Medicare Advantage |
$695.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.35
|
| Rate for Payer: Priority Health Medicare |
$695.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.01
|
| Rate for Payer: UHC Medicare Advantage |
$695.01
|
| Rate for Payer: UHCCP DNSP |
$695.01
|
|
|
PR RADICAL RESECTION TUMOR RADIUS OR ULNA
|
Professional
|
Both
|
$2,595.00
|
|
|
Service Code
|
HCPCS 25170
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$2,035.22 |
| Rate for Payer: Aetna Commercial |
$1,893.89
|
| Rate for Payer: Aetna Medicare |
$1,413.35
|
| Rate for Payer: BCBS Complete |
$1,038.00
|
| Rate for Payer: BCBS MAPPO |
$1,413.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,413.35
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cash Price |
$2,076.00
|
| Rate for Payer: Cofinity Commercial |
$2,035.22
|
| Rate for Payer: Cofinity Commercial |
$1,893.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,413.35
|
| Rate for Payer: Healthscope Commercial |
$1,696.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,696.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,484.02
|
| Rate for Payer: Nomi Health Commercial |
$1,696.02
|
| Rate for Payer: PACE SWMI |
$1,413.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,413.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,686.75
|
| Rate for Payer: Priority Health Medicare |
$1,413.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,413.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,413.35
|
| Rate for Payer: UHCCP DNSP |
$1,413.35
|
|
|
PR RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$2,314.00
|
|
|
Service Code
|
HCPCS 24150
|
| Min. Negotiated Rate |
$925.60 |
| Max. Negotiated Rate |
$2,141.16 |
| Rate for Payer: Aetna Commercial |
$1,992.47
|
| Rate for Payer: Aetna Medicare |
$1,486.92
|
| Rate for Payer: BCBS Complete |
$925.60
|
| Rate for Payer: BCBS MAPPO |
$1,486.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,486.92
|
| Rate for Payer: Cash Price |
$1,851.20
|
| Rate for Payer: Cash Price |
$1,851.20
|
| Rate for Payer: Cofinity Commercial |
$2,141.16
|
| Rate for Payer: Cofinity Commercial |
$1,992.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,486.92
|
| Rate for Payer: Healthscope Commercial |
$1,784.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,784.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,561.27
|
| Rate for Payer: Nomi Health Commercial |
$1,784.30
|
| Rate for Payer: PACE SWMI |
$1,486.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,486.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.10
|
| Rate for Payer: Priority Health Medicare |
$1,486.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,486.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,486.92
|
| Rate for Payer: UHCCP DNSP |
$1,486.92
|
|
|
PR RADICAL STYLOIDECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
HCPCS 25230
|
| Min. Negotiated Rate |
$421.03 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Aetna Commercial |
$564.18
|
| Rate for Payer: Aetna Medicare |
$421.03
|
| Rate for Payer: BCBS Complete |
$615.60
|
| Rate for Payer: BCBS MAPPO |
$421.03
|
| Rate for Payer: BCN Medicare Advantage |
$421.03
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cofinity Commercial |
$606.28
|
| Rate for Payer: Cofinity Commercial |
$564.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.03
|
| Rate for Payer: Healthscope Commercial |
$505.24
|
| Rate for Payer: Healthscope Whirlpool |
$505.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.08
|
| Rate for Payer: Nomi Health Commercial |
$505.24
|
| Rate for Payer: PACE SWMI |
$421.03
|
| Rate for Payer: PHP Medicare Advantage |
$421.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.35
|
| Rate for Payer: Priority Health Medicare |
$421.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.03
|
| Rate for Payer: UHC Medicare Advantage |
$421.03
|
| Rate for Payer: UHCCP DNSP |
$421.03
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
HCPCS 64625
|
| Min. Negotiated Rate |
$186.42 |
| Max. Negotiated Rate |
$607.10 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: Aetna Medicare |
$186.42
|
| Rate for Payer: BCBS Complete |
$373.60
|
| Rate for Payer: BCBS MAPPO |
$186.42
|
| Rate for Payer: BCN Medicare Advantage |
$186.42
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$249.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.42
|
| Rate for Payer: Healthscope Commercial |
$223.70
|
| Rate for Payer: Healthscope Whirlpool |
$223.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.74
|
| Rate for Payer: Nomi Health Commercial |
$223.70
|
| Rate for Payer: PACE SWMI |
$186.42
|
| Rate for Payer: PHP Medicare Advantage |
$186.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.10
|
| Rate for Payer: Priority Health Medicare |
$186.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.42
|
| Rate for Payer: UHC Medicare Advantage |
$186.42
|
| Rate for Payer: UHCCP DNSP |
$186.42
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$186.42 |
| Max. Negotiated Rate |
$607.10 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: Aetna Medicare |
$186.42
|
| Rate for Payer: BCBS Complete |
$373.60
|
| Rate for Payer: BCBS MAPPO |
$186.42
|
| Rate for Payer: BCN Medicare Advantage |
$186.42
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$268.44
|
| Rate for Payer: Cofinity Commercial |
$249.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.42
|
| Rate for Payer: Healthscope Commercial |
$223.70
|
| Rate for Payer: Healthscope Whirlpool |
$223.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.74
|
| Rate for Payer: Nomi Health Commercial |
$223.70
|
| Rate for Payer: PACE SWMI |
$186.42
|
| Rate for Payer: PHP Medicare Advantage |
$186.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.10
|
| Rate for Payer: Priority Health Medicare |
$186.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.42
|
| Rate for Payer: UHC Medicare Advantage |
$186.42
|
| Rate for Payer: UHCCP DNSP |
$186.42
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$607.10 |
| Max. Negotiated Rate |
$934.00 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: ASR ASR |
$905.98
|
| Rate for Payer: ASR Commercial |
$905.98
|
| Rate for Payer: BCBS Trust/PPO |
$761.12
|
| Rate for Payer: BCN Commercial |
$724.13
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$877.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.20
|
| Rate for Payer: Healthscope Commercial |
$934.00
|
| Rate for Payer: Healthscope Whirlpool |
$905.98
|
| Rate for Payer: Mclaren Commercial |
$840.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.90
|
| Rate for Payer: Nomi Health Commercial |
$765.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$821.92
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$607.10 |
| Max. Negotiated Rate |
$2,951.97 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Medicare |
$1,904.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: ASR ASR |
$905.98
|
| Rate for Payer: ASR Commercial |
$905.98
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCBS Trust/PPO |
$764.85
|
| Rate for Payer: BCN Commercial |
$724.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$877.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$934.00
|
| Rate for Payer: Healthscope Whirlpool |
$905.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,904.50
|
| Rate for Payer: Mclaren Commercial |
$840.60
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.90
|
| Rate for Payer: Nomi Health Commercial |
$765.88
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,094.95
|
| Rate for Payer: PHP Medicaid |
$1,020.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$818.37
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health Narrow Network |
$654.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$821.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$2,951.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP DNSP |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
PR RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 24149
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$1,734.20 |
| Rate for Payer: Aetna Commercial |
$1,522.51
|
| Rate for Payer: Aetna Medicare |
$1,136.20
|
| Rate for Payer: BCBS Complete |
$1,067.20
|
| Rate for Payer: BCBS MAPPO |
$1,136.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.20
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cofinity Commercial |
$1,636.13
|
| Rate for Payer: Cofinity Commercial |
$1,522.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.20
|
| Rate for Payer: Healthscope Commercial |
$1,363.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,363.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,193.01
|
| Rate for Payer: Nomi Health Commercial |
$1,363.44
|
| Rate for Payer: PACE SWMI |
$1,136.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.20
|
| Rate for Payer: Priority Health Medicare |
$1,136.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,136.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,136.20
|
| Rate for Payer: UHCCP DNSP |
$1,136.20
|
|
|
PR RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW <5CM
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 24077
|
| Min. Negotiated Rate |
$738.80 |
| Max. Negotiated Rate |
$1,428.90 |
| Rate for Payer: Aetna Commercial |
$1,329.67
|
| Rate for Payer: Aetna Medicare |
$992.29
|
| Rate for Payer: BCBS Complete |
$738.80
|
| Rate for Payer: BCBS MAPPO |
$992.29
|
| Rate for Payer: BCN Medicare Advantage |
$992.29
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,428.90
|
| Rate for Payer: Cofinity Commercial |
$1,329.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.29
|
| Rate for Payer: Healthscope Commercial |
$1,190.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,190.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.90
|
| Rate for Payer: Nomi Health Commercial |
$1,190.75
|
| Rate for Payer: PACE SWMI |
$992.29
|
| Rate for Payer: PHP Medicare Advantage |
$992.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health Medicare |
$992.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.29
|
| Rate for Payer: UHC Medicare Advantage |
$992.29
|
| Rate for Payer: UHCCP DNSP |
$992.29
|
|
