|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,348.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$423.23 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna Commercial |
$876.48
|
| Rate for Payer: Aetna Medicare |
$654.09
|
| Rate for Payer: BCBS Complete |
$444.39
|
| Rate for Payer: BCBS MAPPO |
$654.09
|
| Rate for Payer: BCN Commercial |
$1,543.82
|
| Rate for Payer: BCN Medicare Advantage |
$654.09
|
| Rate for Payer: Cash Price |
$1,878.40
|
| Rate for Payer: Cash Price |
$1,878.40
|
| Rate for Payer: Cofinity Commercial |
$941.89
|
| Rate for Payer: Cofinity Commercial |
$876.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.09
|
| Rate for Payer: Healthscope Commercial |
$784.91
|
| Rate for Payer: Healthscope Whirlpool |
$784.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.79
|
| Rate for Payer: Meridian Medicaid |
$444.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$719.50
|
| Rate for Payer: Nomi Health Commercial |
$784.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,761.00
|
| Rate for Payer: PACE SWMI |
$654.09
|
| Rate for Payer: PHP Medicare Advantage |
$654.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,131.76
|
| Rate for Payer: Priority Health Medicare |
$654.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,131.76
|
| Rate for Payer: Railroad Medicare Medicare |
$654.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,291.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$654.09
|
| Rate for Payer: UHC Exchange |
$1,291.20
|
| Rate for Payer: UHC Medicaid |
$423.23
|
| Rate for Payer: UHCCP DNSP |
$654.09
|
| Rate for Payer: UHCCP Medicaid |
$423.23
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$434.52 |
| Max. Negotiated Rate |
$1,328.52 |
| Rate for Payer: Aetna Commercial |
$900.49
|
| Rate for Payer: Aetna Medicare |
$672.01
|
| Rate for Payer: BCBS Complete |
$456.25
|
| Rate for Payer: BCBS MAPPO |
$672.01
|
| Rate for Payer: BCN Commercial |
$1,127.43
|
| Rate for Payer: BCN Medicare Advantage |
$672.01
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cofinity Commercial |
$967.69
|
| Rate for Payer: Cofinity Commercial |
$900.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.01
|
| Rate for Payer: Healthscope Commercial |
$806.41
|
| Rate for Payer: Healthscope Whirlpool |
$806.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.61
|
| Rate for Payer: Meridian Medicaid |
$456.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$739.21
|
| Rate for Payer: Nomi Health Commercial |
$806.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,295.25
|
| Rate for Payer: PACE SWMI |
$672.01
|
| Rate for Payer: PHP Medicare Advantage |
$672.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,228.13
|
| Rate for Payer: Priority Health Medicare |
$672.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,228.13
|
| Rate for Payer: Railroad Medicare Medicare |
$672.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,328.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$672.01
|
| Rate for Payer: UHC Exchange |
$1,328.52
|
| Rate for Payer: UHC Medicaid |
$434.52
|
| Rate for Payer: UHCCP DNSP |
$672.01
|
| Rate for Payer: UHCCP Medicaid |
$434.52
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$15.81 |
| Rate for Payer: Aetna Commercial |
$14.71
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$10.98
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: BCN Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$13.18
|
| Rate for Payer: Healthscope Whirlpool |
$13.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.08
|
| Rate for Payer: Nomi Health Commercial |
$13.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PACE SWMI |
$10.98
|
| Rate for Payer: PHP Medicare Advantage |
$10.98
|
| Rate for Payer: Priority Health Medicare |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.98
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHCCP DNSP |
$10.98
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Aetna Commercial |
$169.64
|
| Rate for Payer: Aetna Medicare |
$126.60
|
| Rate for Payer: BCBS Complete |
$86.77
|
| Rate for Payer: BCBS MAPPO |
$126.60
|
| Rate for Payer: BCN Commercial |
$212.64
|
| Rate for Payer: BCN Medicare Advantage |
$126.60
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cofinity Commercial |
$182.30
|
| Rate for Payer: Cofinity Commercial |
$169.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.60
|
| Rate for Payer: Healthscope Commercial |
$151.92
|
| Rate for Payer: Healthscope Whirlpool |
$151.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.93
|
| Rate for Payer: Meridian Medicaid |
$86.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.26
|
| Rate for Payer: Nomi Health Commercial |
$151.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.75
|
| Rate for Payer: PACE SWMI |
$126.60
|
| Rate for Payer: PHP Medicare Advantage |
$126.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.63
|
| Rate for Payer: Priority Health Medicare |
$126.60
|
| Rate for Payer: Priority Health Narrow Network |
$231.63
|
| Rate for Payer: Railroad Medicare Medicare |
$126.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$126.60
|
| Rate for Payer: UHC Exchange |
$244.37
|
| Rate for Payer: UHC Medicaid |
$82.64
|
| Rate for Payer: UHCCP DNSP |
$126.60
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$253.20 |
| Rate for Payer: Aetna Commercial |
$176.67
|
| Rate for Payer: Aetna Commercial |
$176.67
|
| Rate for Payer: Aetna Medicare |
$131.84
|
| Rate for Payer: Aetna Medicare |
$131.84
|
| Rate for Payer: BCBS MAPPO |
$131.84
|
| Rate for Payer: BCBS MAPPO |
$131.84
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Medicare Advantage |
$131.84
|
| Rate for Payer: BCN Medicare Advantage |
$131.84
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$176.67
|
| Rate for Payer: Cofinity Commercial |
$189.85
|
| Rate for Payer: Cofinity Commercial |
$176.67
|
| Rate for Payer: Cofinity Commercial |
$189.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.84
|
| Rate for Payer: Healthscope Commercial |
$158.21
|
| Rate for Payer: Healthscope Commercial |
$158.21
|
| Rate for Payer: Healthscope Whirlpool |
$158.21
|
| Rate for Payer: Healthscope Whirlpool |
$158.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.02
|
| Rate for Payer: Nomi Health Commercial |
$158.21
|
| Rate for Payer: Nomi Health Commercial |
$158.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PACE SWMI |
$131.84
|
| Rate for Payer: PACE SWMI |
$131.84
|
| Rate for Payer: PHP Medicare Advantage |
$131.84
|
| Rate for Payer: PHP Medicare Advantage |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$131.84
|
| Rate for Payer: Priority Health Medicare |
$131.84
|
| Rate for Payer: Priority Health Narrow Network |
$176.80
|
| Rate for Payer: Priority Health Narrow Network |
$176.80
|
| Rate for Payer: Railroad Medicare Medicare |
$131.84
|
| Rate for Payer: Railroad Medicare Medicare |
$131.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$131.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$131.84
|
| Rate for Payer: UHC Exchange |
$253.20
|
| Rate for Payer: UHC Exchange |
$253.20
|
| Rate for Payer: UHCCP DNSP |
$131.84
|
| Rate for Payer: UHCCP DNSP |
$131.84
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna Medicare |
$57.41
|
| Rate for Payer: BCBS Complete |
$38.47
|
| Rate for Payer: BCBS MAPPO |
$57.41
|
| Rate for Payer: BCN Commercial |
$87.65
|
| Rate for Payer: BCN Medicare Advantage |
$57.41
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$76.93
|
| Rate for Payer: Cofinity Commercial |
$82.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.41
|
| Rate for Payer: Healthscope Commercial |
$68.89
|
| Rate for Payer: Healthscope Whirlpool |
$68.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.28
|
| Rate for Payer: Meridian Medicaid |
$38.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$68.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PACE SWMI |
$57.41
|
| Rate for Payer: PHP Medicare Advantage |
$57.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Medicare |
$57.41
|
| Rate for Payer: Priority Health Narrow Network |
$80.22
|
| Rate for Payer: Railroad Medicare Medicare |
$57.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.41
|
| Rate for Payer: UHC Exchange |
$106.64
|
| Rate for Payer: UHC Medicaid |
$36.64
|
| Rate for Payer: UHCCP DNSP |
$57.41
|
| Rate for Payer: UHCCP Medicaid |
$36.64
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Aetna Commercial |
$121.55
|
| Rate for Payer: Aetna Medicare |
$90.71
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS MAPPO |
$90.71
|
| Rate for Payer: BCN Commercial |
$140.43
|
| Rate for Payer: BCN Medicare Advantage |
$90.71
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$130.62
|
| Rate for Payer: Cofinity Commercial |
$121.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.71
|
| Rate for Payer: Healthscope Commercial |
$108.85
|
| Rate for Payer: Healthscope Whirlpool |
$108.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.25
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.78
|
| Rate for Payer: Nomi Health Commercial |
$108.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.50
|
| Rate for Payer: PACE SWMI |
$90.71
|
| Rate for Payer: PHP Medicare Advantage |
$90.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$128.53
|
| Rate for Payer: Priority Health Medicare |
$90.71
|
| Rate for Payer: Priority Health Narrow Network |
$128.53
|
| Rate for Payer: Railroad Medicare Medicare |
$90.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$90.71
|
| Rate for Payer: UHC Exchange |
$173.41
|
| Rate for Payer: UHC Medicaid |
$57.30
|
| Rate for Payer: UHCCP DNSP |
$90.71
|
| Rate for Payer: UHCCP Medicaid |
$57.30
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Aetna Commercial |
$147.63
|
| Rate for Payer: Aetna Medicare |
$110.17
|
| Rate for Payer: BCBS Complete |
$73.13
|
| Rate for Payer: BCBS MAPPO |
$110.17
|
| Rate for Payer: BCN Commercial |
$173.80
|
| Rate for Payer: BCN Medicare Advantage |
$110.17
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$158.64
|
| Rate for Payer: Cofinity Commercial |
$147.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.17
|
| Rate for Payer: Healthscope Commercial |
$132.20
|
| Rate for Payer: Healthscope Whirlpool |
$132.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.68
|
| Rate for Payer: Meridian Medicaid |
$73.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.19
|
| Rate for Payer: Nomi Health Commercial |
$132.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.75
|
| Rate for Payer: PACE SWMI |
$110.17
|
| Rate for Payer: PHP Medicare Advantage |
$110.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.07
|
| Rate for Payer: Priority Health Medicare |
$110.17
|
| Rate for Payer: Priority Health Narrow Network |
$159.07
|
| Rate for Payer: Railroad Medicare Medicare |
$110.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.17
|
| Rate for Payer: UHC Exchange |
$212.26
|
| Rate for Payer: UHC Medicaid |
$69.65
|
| Rate for Payer: UHCCP DNSP |
$110.17
|
| Rate for Payer: UHCCP Medicaid |
$69.65
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$116.06 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Medicare |
$80.60
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS MAPPO |
$80.60
|
| Rate for Payer: BCN Commercial |
$77.17
|
| Rate for Payer: BCN Medicare Advantage |
$80.60
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$108.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.60
|
| Rate for Payer: Healthscope Commercial |
$96.72
|
| Rate for Payer: Healthscope Whirlpool |
$96.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.66
|
| Rate for Payer: Nomi Health Commercial |
$96.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PACE SWMI |
$80.60
|
| Rate for Payer: PHP Medicare Advantage |
$80.60
|
| Rate for Payer: Priority Health Medicare |
$80.60
|
| Rate for Payer: Railroad Medicare Medicare |
$80.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.60
|
| Rate for Payer: UHC Exchange |
$26.28
|
| Rate for Payer: UHCCP DNSP |
$80.60
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.30
|
| Rate for Payer: UHC Exchange |
$10.30
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$27.21 |
| Max. Negotiated Rate |
$45.32 |
| Rate for Payer: Aetna Commercial |
$36.46
|
| Rate for Payer: Aetna Medicare |
$27.21
|
| Rate for Payer: BCBS MAPPO |
$27.21
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.21
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$39.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.21
|
| Rate for Payer: Healthscope Commercial |
$32.65
|
| Rate for Payer: Healthscope Whirlpool |
$32.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.93
|
| Rate for Payer: Nomi Health Commercial |
$32.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PACE SWMI |
$27.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.80
|
| Rate for Payer: Priority Health Medicare |
$27.21
|
| Rate for Payer: Priority Health Narrow Network |
$41.80
|
| Rate for Payer: Railroad Medicare Medicare |
$27.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.21
|
| Rate for Payer: UHC Exchange |
$35.68
|
| Rate for Payer: UHCCP DNSP |
$27.21
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$70.22 |
| Rate for Payer: Aetna Commercial |
$56.90
|
| Rate for Payer: Aetna Medicare |
$42.46
|
| Rate for Payer: BCBS MAPPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$70.22
|
| Rate for Payer: BCN Medicare Advantage |
$42.46
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$56.90
|
| Rate for Payer: Cofinity Commercial |
$61.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.46
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: Healthscope Whirlpool |
$50.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.71
|
| Rate for Payer: Nomi Health Commercial |
$50.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: PACE SWMI |
$42.46
|
| Rate for Payer: PHP Medicare Advantage |
$42.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$64.76
|
| Rate for Payer: Priority Health Medicare |
$42.46
|
| Rate for Payer: Priority Health Narrow Network |
$64.76
|
| Rate for Payer: Railroad Medicare Medicare |
$42.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.46
|
| Rate for Payer: UHC Exchange |
$56.93
|
| Rate for Payer: UHCCP DNSP |
$42.46
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$197.80
|
| Rate for Payer: Aetna Medicare |
$147.61
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$147.61
|
| Rate for Payer: BCN Commercial |
$239.03
|
| Rate for Payer: BCN Medicare Advantage |
$147.61
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cofinity Commercial |
$212.56
|
| Rate for Payer: Cofinity Commercial |
$197.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.61
|
| Rate for Payer: Healthscope Commercial |
$177.13
|
| Rate for Payer: Healthscope Whirlpool |
$177.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.99
|
| Rate for Payer: Meridian Medicaid |
$100.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.37
|
| Rate for Payer: Nomi Health Commercial |
$177.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
| Rate for Payer: PACE SWMI |
$147.61
|
| Rate for Payer: PHP Medicare Advantage |
$147.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$291.24
|
| Rate for Payer: Priority Health Medicare |
$147.61
|
| Rate for Payer: Priority Health Narrow Network |
$291.24
|
| Rate for Payer: Railroad Medicare Medicare |
$147.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.61
|
| Rate for Payer: UHC Exchange |
$280.45
|
| Rate for Payer: UHC Medicaid |
$95.64
|
| Rate for Payer: UHCCP DNSP |
$147.61
|
| Rate for Payer: UHCCP Medicaid |
$95.64
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,555.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,368.23 |
| Rate for Payer: Aetna Commercial |
$906.62
|
| Rate for Payer: Aetna Medicare |
$676.58
|
| Rate for Payer: BCBS Complete |
$460.05
|
| Rate for Payer: BCBS MAPPO |
$676.58
|
| Rate for Payer: BCN Commercial |
$1,122.94
|
| Rate for Payer: BCN Medicare Advantage |
$676.58
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cofinity Commercial |
$974.28
|
| Rate for Payer: Cofinity Commercial |
$906.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.58
|
| Rate for Payer: Healthscope Commercial |
$811.90
|
| Rate for Payer: Healthscope Whirlpool |
$811.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.41
|
| Rate for Payer: Meridian Medicaid |
$460.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$744.24
|
| Rate for Payer: Nomi Health Commercial |
$811.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,166.25
|
| Rate for Payer: PACE SWMI |
$676.58
|
| Rate for Payer: PHP Medicare Advantage |
$676.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,368.23
|
| Rate for Payer: Priority Health Medicare |
$676.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,368.23
|
| Rate for Payer: Railroad Medicare Medicare |
$676.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,324.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$676.58
|
| Rate for Payer: UHC Exchange |
$1,324.33
|
| Rate for Payer: UHC Medicaid |
$438.14
|
| Rate for Payer: UHCCP DNSP |
$676.58
|
| Rate for Payer: UHCCP Medicaid |
$438.14
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$423.44 |
| Max. Negotiated Rate |
$1,238.39 |
| Rate for Payer: Aetna Commercial |
$871.08
|
| Rate for Payer: Aetna Medicare |
$650.06
|
| Rate for Payer: BCBS Complete |
$444.61
|
| Rate for Payer: BCBS MAPPO |
$650.06
|
| Rate for Payer: BCN Commercial |
$1,016.38
|
| Rate for Payer: BCN Medicare Advantage |
$650.06
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$936.09
|
| Rate for Payer: Cofinity Commercial |
$871.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.06
|
| Rate for Payer: Healthscope Commercial |
$780.07
|
| Rate for Payer: Healthscope Whirlpool |
$780.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$682.56
|
| Rate for Payer: Meridian Medicaid |
$444.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$715.07
|
| Rate for Payer: Nomi Health Commercial |
$780.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,005.00
|
| Rate for Payer: PACE SWMI |
$650.06
|
| Rate for Payer: PHP Medicare Advantage |
$650.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,238.39
|
| Rate for Payer: Priority Health Medicare |
$650.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,238.39
|
| Rate for Payer: Railroad Medicare Medicare |
$650.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,166.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$650.06
|
| Rate for Payer: UHC Exchange |
$1,166.43
|
| Rate for Payer: UHC Medicaid |
$423.44
|
| Rate for Payer: UHCCP DNSP |
$650.06
|
| Rate for Payer: UHCCP Medicaid |
$423.44
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$529.31 |
| Max. Negotiated Rate |
$1,664.95 |
| Rate for Payer: Aetna Commercial |
$1,098.45
|
| Rate for Payer: Aetna Medicare |
$819.74
|
| Rate for Payer: BCBS Complete |
$555.78
|
| Rate for Payer: BCBS MAPPO |
$819.74
|
| Rate for Payer: BCN Commercial |
$1,366.46
|
| Rate for Payer: BCN Medicare Advantage |
$819.74
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$1,180.43
|
| Rate for Payer: Cofinity Commercial |
$1,098.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.74
|
| Rate for Payer: Healthscope Commercial |
$983.69
|
| Rate for Payer: Healthscope Whirlpool |
$983.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$860.73
|
| Rate for Payer: Meridian Medicaid |
$555.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$901.71
|
| Rate for Payer: Nomi Health Commercial |
$983.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,458.75
|
| Rate for Payer: PACE SWMI |
$819.74
|
| Rate for Payer: PHP Medicare Advantage |
$819.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,664.95
|
| Rate for Payer: Priority Health Medicare |
$819.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,664.95
|
| Rate for Payer: Railroad Medicare Medicare |
$819.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,626.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$819.74
|
| Rate for Payer: UHC Exchange |
$1,626.00
|
| Rate for Payer: UHC Medicaid |
$529.31
|
| Rate for Payer: UHCCP DNSP |
$819.74
|
| Rate for Payer: UHCCP Medicaid |
$529.31
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,778.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$150.59 |
| Max. Negotiated Rate |
$2,083.50 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Aetna Medicare |
$237.32
|
| Rate for Payer: BCBS Complete |
$158.12
|
| Rate for Payer: BCBS MAPPO |
$237.32
|
| Rate for Payer: BCN Commercial |
$389.42
|
| Rate for Payer: BCN Medicare Advantage |
$237.32
|
| Rate for Payer: Cash Price |
$2,222.40
|
| Rate for Payer: Cash Price |
$2,222.40
|
| Rate for Payer: Cofinity Commercial |
$341.74
|
| Rate for Payer: Cofinity Commercial |
$318.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.32
|
| Rate for Payer: Healthscope Commercial |
$284.78
|
| Rate for Payer: Healthscope Whirlpool |
$284.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.19
|
| Rate for Payer: Meridian Medicaid |
$158.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.05
|
| Rate for Payer: Nomi Health Commercial |
$284.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,083.50
|
| Rate for Payer: PACE SWMI |
$237.32
|
| Rate for Payer: PHP Medicare Advantage |
$237.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$518.16
|
| Rate for Payer: Priority Health Medicare |
$237.32
|
| Rate for Payer: Priority Health Narrow Network |
$518.16
|
| Rate for Payer: Railroad Medicare Medicare |
$237.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.32
|
| Rate for Payer: UHC Exchange |
$469.45
|
| Rate for Payer: UHC Medicaid |
$150.59
|
| Rate for Payer: UHCCP DNSP |
$237.32
|
| Rate for Payer: UHCCP Medicaid |
$150.59
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,087.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$692.89 |
| Max. Negotiated Rate |
$2,326.41 |
| Rate for Payer: Aetna Commercial |
$1,452.61
|
| Rate for Payer: Aetna Medicare |
$1,084.04
|
| Rate for Payer: BCBS Complete |
$727.53
|
| Rate for Payer: BCBS MAPPO |
$1,084.04
|
| Rate for Payer: BCN Commercial |
$1,748.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,084.04
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cofinity Commercial |
$1,561.02
|
| Rate for Payer: Cofinity Commercial |
$1,452.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,084.04
|
| Rate for Payer: Healthscope Commercial |
$1,300.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,300.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,138.24
|
| Rate for Payer: Meridian Medicaid |
$727.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,192.44
|
| Rate for Payer: Nomi Health Commercial |
$1,300.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,315.25
|
| Rate for Payer: PACE SWMI |
$1,084.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,084.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,326.41
|
| Rate for Payer: Priority Health Medicare |
$1,084.04
|
| Rate for Payer: Priority Health Narrow Network |
$2,326.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,084.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,080.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,084.04
|
| Rate for Payer: UHC Exchange |
$2,080.64
|
| Rate for Payer: UHC Medicaid |
$692.89
|
| Rate for Payer: UHCCP DNSP |
$1,084.04
|
| Rate for Payer: UHCCP Medicaid |
$692.89
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,874.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$684.80 |
| Max. Negotiated Rate |
$3,655.50 |
| Rate for Payer: Aetna Commercial |
$1,434.38
|
| Rate for Payer: Aetna Medicare |
$1,070.43
|
| Rate for Payer: BCBS Complete |
$719.04
|
| Rate for Payer: BCBS MAPPO |
$1,070.43
|
| Rate for Payer: BCN Commercial |
$1,725.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,070.43
|
| Rate for Payer: Cash Price |
$3,899.20
|
| Rate for Payer: Cash Price |
$3,899.20
|
| Rate for Payer: Cofinity Commercial |
$1,434.38
|
| Rate for Payer: Cofinity Commercial |
$1,541.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,070.43
|
| Rate for Payer: Healthscope Commercial |
$1,284.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,284.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,123.95
|
| Rate for Payer: Meridian Medicaid |
$719.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,177.47
|
| Rate for Payer: Nomi Health Commercial |
$1,284.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,655.50
|
| Rate for Payer: PACE SWMI |
$1,070.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,070.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$684.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,295.25
|
| Rate for Payer: Priority Health Medicare |
$1,070.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,295.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,070.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,058.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,070.43
|
| Rate for Payer: UHC Exchange |
$2,058.32
|
| Rate for Payer: UHC Medicaid |
$684.80
|
| Rate for Payer: UHCCP DNSP |
$1,070.43
|
| Rate for Payer: UHCCP Medicaid |
$684.80
|
|
|
PR SPLINT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
| Rate for Payer: UHC Exchange |
$4.62
|
|
|
PR SPLINT SUPPLIES MISC
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS Q4051
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.75
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$392.13 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$806.60
|
| Rate for Payer: Aetna Medicare |
$601.94
|
| Rate for Payer: BCBS Complete |
$411.74
|
| Rate for Payer: BCBS MAPPO |
$601.94
|
| Rate for Payer: BCN Commercial |
$1,039.79
|
| Rate for Payer: BCN Medicare Advantage |
$601.94
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$866.79
|
| Rate for Payer: Cofinity Commercial |
$806.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.94
|
| Rate for Payer: Healthscope Commercial |
$722.33
|
| Rate for Payer: Healthscope Whirlpool |
$722.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.04
|
| Rate for Payer: Meridian Medicaid |
$411.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$662.13
|
| Rate for Payer: Nomi Health Commercial |
$722.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.50
|
| Rate for Payer: PACE SWMI |
$601.94
|
| Rate for Payer: PHP Medicare Advantage |
$601.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$951.66
|
| Rate for Payer: Priority Health Medicare |
$601.94
|
| Rate for Payer: Priority Health Narrow Network |
$951.66
|
| Rate for Payer: Railroad Medicare Medicare |
$601.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,208.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$601.94
|
| Rate for Payer: UHC Exchange |
$1,208.97
|
| Rate for Payer: UHC Medicaid |
$392.13
|
| Rate for Payer: UHCCP DNSP |
$601.94
|
| Rate for Payer: UHCCP Medicaid |
$392.13
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,485.00
|
| Rate for Payer: ASR ASR |
$1,600.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,354.98
|
| Rate for Payer: BCN Commercial |
$1,354.98
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$1,551.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.00
|
| Rate for Payer: Healthscope Commercial |
$1,600.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.00
|
| Rate for Payer: Mclaren Commercial |
$1,485.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.50
|
| Rate for Payer: Nomi Health Commercial |
$1,353.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$392.13 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$806.60
|
| Rate for Payer: Aetna Medicare |
$601.94
|
| Rate for Payer: BCBS Complete |
$411.74
|
| Rate for Payer: BCBS MAPPO |
$601.94
|
| Rate for Payer: BCN Commercial |
$1,039.79
|
| Rate for Payer: BCN Medicare Advantage |
$601.94
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$866.79
|
| Rate for Payer: Cofinity Commercial |
$806.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.94
|
| Rate for Payer: Healthscope Commercial |
$722.33
|
| Rate for Payer: Healthscope Whirlpool |
$722.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.04
|
| Rate for Payer: Meridian Medicaid |
$411.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$662.13
|
| Rate for Payer: Nomi Health Commercial |
$722.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.50
|
| Rate for Payer: PACE SWMI |
$601.94
|
| Rate for Payer: PHP Medicare Advantage |
$601.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$951.66
|
| Rate for Payer: Priority Health Medicare |
$601.94
|
| Rate for Payer: Priority Health Narrow Network |
$951.66
|
| Rate for Payer: Railroad Medicare Medicare |
$601.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,208.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$601.94
|
| Rate for Payer: UHC Exchange |
$1,208.97
|
| Rate for Payer: UHC Medicaid |
$392.13
|
| Rate for Payer: UHCCP DNSP |
$601.94
|
| Rate for Payer: UHCCP Medicaid |
$392.13
|
|
