|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,156.65 |
| Max. Negotiated Rate |
$4,413.73 |
| Rate for Payer: Aetna Commercial |
$1,485.00
|
| Rate for Payer: Aetna Medicare |
$3,530.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: ASR ASR |
$1,600.50
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.42
|
| Rate for Payer: BCN Commercial |
$1,360.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Cash Price |
$1,320.00
|
| 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: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Healthscope Commercial |
$1,600.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,530.98
|
| Rate for Payer: Mclaren Commercial |
$1,485.00
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$1,939.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| 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
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Commercial |
$3,884.08
|
| Rate for Payer: PHP Medicaid |
$1,892.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,445.73
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP DNSP |
$3,530.98
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Aetna Commercial |
$157.53
|
| Rate for Payer: Aetna Medicare |
$117.56
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$195.70
|
| Rate for Payer: BCN Medicare Advantage |
$117.56
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Cofinity Commercial |
$157.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.56
|
| Rate for Payer: Healthscope Commercial |
$141.07
|
| Rate for Payer: Healthscope Whirlpool |
$141.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.44
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.32
|
| Rate for Payer: Nomi Health Commercial |
$141.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.25
|
| Rate for Payer: PACE SWMI |
$117.56
|
| Rate for Payer: PHP Medicare Advantage |
$117.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.12
|
| Rate for Payer: Priority Health Medicare |
$117.56
|
| Rate for Payer: Priority Health Narrow Network |
$179.12
|
| Rate for Payer: Railroad Medicare Medicare |
$117.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.56
|
| Rate for Payer: UHC Exchange |
$236.81
|
| Rate for Payer: UHC Medicaid |
$76.04
|
| Rate for Payer: UHCCP DNSP |
$117.56
|
| Rate for Payer: UHCCP Medicaid |
$76.04
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,217.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$421.10 |
| Max. Negotiated Rate |
$1,662.75 |
| Rate for Payer: Aetna Commercial |
$863.91
|
| Rate for Payer: Aetna Medicare |
$644.71
|
| Rate for Payer: BCBS Complete |
$442.15
|
| Rate for Payer: BCBS MAPPO |
$644.71
|
| Rate for Payer: BCN Commercial |
$1,079.63
|
| Rate for Payer: BCN Medicare Advantage |
$644.71
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cofinity Commercial |
$928.38
|
| Rate for Payer: Cofinity Commercial |
$863.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.71
|
| Rate for Payer: Healthscope Commercial |
$773.65
|
| Rate for Payer: Healthscope Whirlpool |
$773.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.95
|
| Rate for Payer: Meridian Medicaid |
$442.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$709.18
|
| Rate for Payer: Nomi Health Commercial |
$773.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,662.75
|
| Rate for Payer: PACE SWMI |
$644.71
|
| Rate for Payer: PHP Medicare Advantage |
$644.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$988.13
|
| Rate for Payer: Priority Health Medicare |
$644.71
|
| Rate for Payer: Priority Health Narrow Network |
$988.13
|
| Rate for Payer: Railroad Medicare Medicare |
$644.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,245.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$644.71
|
| Rate for Payer: UHC Exchange |
$1,245.82
|
| Rate for Payer: UHC Medicaid |
$421.10
|
| Rate for Payer: UHCCP DNSP |
$644.71
|
| Rate for Payer: UHCCP Medicaid |
$421.10
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,217.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$421.10 |
| Max. Negotiated Rate |
$1,662.75 |
| Rate for Payer: Aetna Commercial |
$863.91
|
| Rate for Payer: Aetna Medicare |
$644.71
|
| Rate for Payer: BCBS Complete |
$442.15
|
| Rate for Payer: BCBS MAPPO |
$644.71
|
| Rate for Payer: BCN Commercial |
$1,079.63
|
| Rate for Payer: BCN Medicare Advantage |
$644.71
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cofinity Commercial |
$928.38
|
| Rate for Payer: Cofinity Commercial |
$863.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.71
|
| Rate for Payer: Healthscope Commercial |
$773.65
|
| Rate for Payer: Healthscope Whirlpool |
$773.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.95
|
| Rate for Payer: Meridian Medicaid |
$442.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$709.18
|
| Rate for Payer: Nomi Health Commercial |
$773.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,662.75
|
| Rate for Payer: PACE SWMI |
$644.71
|
| Rate for Payer: PHP Medicare Advantage |
$644.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$988.13
|
| Rate for Payer: Priority Health Medicare |
$644.71
|
| Rate for Payer: Priority Health Narrow Network |
$988.13
|
| Rate for Payer: Railroad Medicare Medicare |
$644.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,245.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$644.71
|
| Rate for Payer: UHC Exchange |
$1,245.82
|
| Rate for Payer: UHC Medicaid |
$421.10
|
| Rate for Payer: UHCCP DNSP |
$644.71
|
| Rate for Payer: UHCCP Medicaid |
$421.10
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,662.75 |
| Max. Negotiated Rate |
$2,217.00 |
| Rate for Payer: Aetna Commercial |
$1,995.30
|
| Rate for Payer: ASR ASR |
$2,150.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,820.60
|
| Rate for Payer: BCN Commercial |
$1,820.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cofinity Commercial |
$2,083.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.60
|
| Rate for Payer: Healthscope Commercial |
$2,150.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,217.00
|
| Rate for Payer: Mclaren Commercial |
$1,995.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.45
|
| Rate for Payer: Nomi Health Commercial |
$1,817.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,662.75
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$2,569.82 |
| Rate for Payer: Aetna Commercial |
$1,995.30
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$2,150.49
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.92
|
| Rate for Payer: BCN Commercial |
$1,827.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cofinity Commercial |
$2,083.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,773.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,150.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,217.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$1,995.30
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,884.45
|
| Rate for Payer: Nomi Health Commercial |
$1,817.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,662.75
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,942.54
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,554.12
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Aetna Medicare |
$99.41
|
| Rate for Payer: BCBS Complete |
$67.32
|
| Rate for Payer: BCBS MAPPO |
$99.41
|
| Rate for Payer: BCN Commercial |
$164.83
|
| Rate for Payer: BCN Medicare Advantage |
$99.41
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$133.21
|
| Rate for Payer: Cofinity Commercial |
$143.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.41
|
| Rate for Payer: Healthscope Commercial |
$119.29
|
| Rate for Payer: Healthscope Whirlpool |
$119.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.38
|
| Rate for Payer: Meridian Medicaid |
$67.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.35
|
| Rate for Payer: Nomi Health Commercial |
$119.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.00
|
| Rate for Payer: PACE SWMI |
$99.41
|
| Rate for Payer: PHP Medicare Advantage |
$99.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.87
|
| Rate for Payer: Priority Health Medicare |
$99.41
|
| Rate for Payer: Priority Health Narrow Network |
$150.87
|
| Rate for Payer: Railroad Medicare Medicare |
$99.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.41
|
| Rate for Payer: UHC Exchange |
$197.19
|
| Rate for Payer: UHC Medicaid |
$64.11
|
| Rate for Payer: UHCCP DNSP |
$99.41
|
| Rate for Payer: UHCCP Medicaid |
$64.11
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$27.78 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Aetna Commercial |
$37.23
|
| Rate for Payer: Aetna Commercial |
$37.23
|
| Rate for Payer: Aetna Medicare |
$27.78
|
| Rate for Payer: Aetna Medicare |
$27.78
|
| Rate for Payer: BCBS MAPPO |
$27.78
|
| Rate for Payer: BCBS MAPPO |
$27.78
|
| Rate for Payer: BCN Commercial |
$40.83
|
| Rate for Payer: BCN Commercial |
$40.83
|
| Rate for Payer: BCN Medicare Advantage |
$27.78
|
| Rate for Payer: BCN Medicare Advantage |
$27.78
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$37.23
|
| Rate for Payer: Cofinity Commercial |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$37.23
|
| Rate for Payer: Cofinity Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.78
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Healthscope Whirlpool |
$33.34
|
| Rate for Payer: Healthscope Whirlpool |
$33.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.56
|
| Rate for Payer: Nomi Health Commercial |
$33.34
|
| Rate for Payer: Nomi Health Commercial |
$33.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: PACE SWMI |
$27.78
|
| Rate for Payer: PACE SWMI |
$27.78
|
| Rate for Payer: PHP Medicare Advantage |
$27.78
|
| Rate for Payer: PHP Medicare Advantage |
$27.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.65
|
| Rate for Payer: Priority Health Medicare |
$27.78
|
| Rate for Payer: Priority Health Medicare |
$27.78
|
| Rate for Payer: Priority Health Narrow Network |
$37.65
|
| Rate for Payer: Priority Health Narrow Network |
$37.65
|
| Rate for Payer: Railroad Medicare Medicare |
$27.78
|
| Rate for Payer: Railroad Medicare Medicare |
$27.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.78
|
| Rate for Payer: UHC Exchange |
$54.10
|
| Rate for Payer: UHC Exchange |
$54.10
|
| Rate for Payer: UHCCP DNSP |
$27.78
|
| Rate for Payer: UHCCP DNSP |
$27.78
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$40.35 |
| Rate for Payer: Aetna Commercial |
$31.95
|
| Rate for Payer: Aetna Medicare |
$23.84
|
| Rate for Payer: BCBS MAPPO |
$23.84
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$23.84
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$31.95
|
| Rate for Payer: Cofinity Commercial |
$34.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.84
|
| Rate for Payer: Healthscope Commercial |
$28.61
|
| Rate for Payer: Healthscope Whirlpool |
$28.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: PACE SWMI |
$23.84
|
| Rate for Payer: PHP Medicare Advantage |
$23.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.44
|
| Rate for Payer: Priority Health Medicare |
$23.84
|
| Rate for Payer: Priority Health Narrow Network |
$34.44
|
| Rate for Payer: Railroad Medicare Medicare |
$23.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.84
|
| Rate for Payer: UHC Exchange |
$40.35
|
| Rate for Payer: UHCCP DNSP |
$23.84
|
|
|
PR SPORTS PHYSICAL
|
Professional
|
Both
|
$50.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Aetna Commercial |
$329.10
|
| Rate for Payer: Aetna Medicare |
$245.60
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$245.60
|
| Rate for Payer: BCN Commercial |
$396.39
|
| Rate for Payer: BCN Medicare Advantage |
$245.60
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$353.66
|
| Rate for Payer: Cofinity Commercial |
$329.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.60
|
| Rate for Payer: Healthscope Commercial |
$294.72
|
| Rate for Payer: Healthscope Whirlpool |
$294.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.88
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.16
|
| Rate for Payer: Nomi Health Commercial |
$294.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.50
|
| Rate for Payer: PACE SWMI |
$245.60
|
| Rate for Payer: PHP Medicare Advantage |
$245.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$426.27
|
| Rate for Payer: Priority Health Medicare |
$245.60
|
| Rate for Payer: Priority Health Narrow Network |
$426.27
|
| Rate for Payer: Railroad Medicare Medicare |
$245.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.60
|
| Rate for Payer: UHC Exchange |
$483.72
|
| Rate for Payer: UHC Medicaid |
$156.56
|
| Rate for Payer: UHCCP DNSP |
$245.60
|
| Rate for Payer: UHCCP Medicaid |
$156.56
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Aetna Commercial |
$405.01
|
| Rate for Payer: Aetna Medicare |
$302.25
|
| Rate for Payer: BCBS Complete |
$201.96
|
| Rate for Payer: BCBS MAPPO |
$302.25
|
| Rate for Payer: BCN Commercial |
$489.01
|
| Rate for Payer: BCN Medicare Advantage |
$302.25
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$405.01
|
| Rate for Payer: Cofinity Commercial |
$435.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.25
|
| Rate for Payer: Healthscope Commercial |
$362.70
|
| Rate for Payer: Healthscope Whirlpool |
$362.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.36
|
| Rate for Payer: Meridian Medicaid |
$201.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$332.48
|
| Rate for Payer: Nomi Health Commercial |
$362.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.00
|
| Rate for Payer: PACE SWMI |
$302.25
|
| Rate for Payer: PHP Medicare Advantage |
$302.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$525.87
|
| Rate for Payer: Priority Health Medicare |
$302.25
|
| Rate for Payer: Priority Health Narrow Network |
$525.87
|
| Rate for Payer: Railroad Medicare Medicare |
$302.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$302.25
|
| Rate for Payer: UHC Exchange |
$593.10
|
| Rate for Payer: UHC Medicaid |
$192.34
|
| Rate for Payer: UHCCP DNSP |
$302.25
|
| Rate for Payer: UHCCP Medicaid |
$192.34
|
|
|
PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA
|
Professional
|
Both
|
$1,795.00
|
|
|
Service Code
|
HCPCS 49220
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$1,346.25 |
| Rate for Payer: BCBS Complete |
$718.00
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,346.25
|
|
|
PR STANDARDIZED COGNITIVE PERFORMANCE TESTING
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 96125
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$173.61 |
| Rate for Payer: Aetna Commercial |
$132.86
|
| Rate for Payer: Aetna Medicare |
$99.15
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: BCBS MAPPO |
$99.15
|
| Rate for Payer: BCN Commercial |
$153.38
|
| Rate for Payer: BCN Medicare Advantage |
$99.15
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cofinity Commercial |
$142.78
|
| Rate for Payer: Cofinity Commercial |
$132.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.15
|
| Rate for Payer: Healthscope Commercial |
$118.98
|
| Rate for Payer: Healthscope Whirlpool |
$118.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.06
|
| Rate for Payer: Nomi Health Commercial |
$118.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.75
|
| Rate for Payer: PACE SWMI |
$99.15
|
| Rate for Payer: PHP Medicare Advantage |
$99.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$141.45
|
| Rate for Payer: Priority Health Medicare |
$99.15
|
| Rate for Payer: Priority Health Narrow Network |
$141.45
|
| Rate for Payer: Railroad Medicare Medicare |
$99.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.15
|
| Rate for Payer: UHC Exchange |
$173.61
|
| Rate for Payer: UHCCP DNSP |
$99.15
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$522.28 |
| Max. Negotiated Rate |
$1,582.34 |
| Rate for Payer: Aetna Commercial |
$1,064.27
|
| Rate for Payer: Aetna Medicare |
$794.23
|
| Rate for Payer: BCBS Complete |
$548.39
|
| Rate for Payer: BCBS MAPPO |
$794.23
|
| Rate for Payer: BCN Commercial |
$1,380.41
|
| Rate for Payer: BCN Medicare Advantage |
$794.23
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$1,143.69
|
| Rate for Payer: Cofinity Commercial |
$1,064.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$794.23
|
| Rate for Payer: Healthscope Commercial |
$953.08
|
| Rate for Payer: Healthscope Whirlpool |
$953.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$833.94
|
| Rate for Payer: Meridian Medicaid |
$548.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$873.65
|
| Rate for Payer: Nomi Health Commercial |
$953.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$794.23
|
| Rate for Payer: PHP Medicare Advantage |
$794.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,363.97
|
| Rate for Payer: Priority Health Medicare |
$794.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,363.97
|
| Rate for Payer: Railroad Medicare Medicare |
$794.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,582.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$794.23
|
| Rate for Payer: UHC Exchange |
$1,582.34
|
| Rate for Payer: UHC Medicaid |
$522.28
|
| Rate for Payer: UHCCP DNSP |
$794.23
|
| Rate for Payer: UHCCP Medicaid |
$522.28
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT
|
Professional
|
Both
|
$2,506.00
|
|
|
Service Code
|
HCPCS 69661
|
| Min. Negotiated Rate |
$678.83 |
| Max. Negotiated Rate |
$2,066.67 |
| Rate for Payer: Aetna Commercial |
$1,384.60
|
| Rate for Payer: Aetna Medicare |
$1,033.28
|
| Rate for Payer: BCBS Complete |
$712.77
|
| Rate for Payer: BCBS MAPPO |
$1,033.28
|
| Rate for Payer: BCN Commercial |
$1,797.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,033.28
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cash Price |
$2,004.80
|
| Rate for Payer: Cofinity Commercial |
$1,487.92
|
| Rate for Payer: Cofinity Commercial |
$1,384.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,033.28
|
| Rate for Payer: Healthscope Commercial |
$1,239.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,239.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,084.94
|
| Rate for Payer: Meridian Medicaid |
$712.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,136.61
|
| Rate for Payer: Nomi Health Commercial |
$1,239.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,879.50
|
| Rate for Payer: PACE SWMI |
$1,033.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,033.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$678.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,776.32
|
| Rate for Payer: Priority Health Medicare |
$1,033.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,033.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,066.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,033.28
|
| Rate for Payer: UHC Exchange |
$2,066.67
|
| Rate for Payer: UHC Medicaid |
$678.83
|
| Rate for Payer: UHCCP DNSP |
$1,033.28
|
| Rate for Payer: UHCCP Medicaid |
$678.83
|
|
|
PR STAPES MOBILIZATION
|
Professional
|
Both
|
$1,498.00
|
|
|
Service Code
|
HCPCS 69650
|
| Min. Negotiated Rate |
$457.52 |
| Max. Negotiated Rate |
$1,367.01 |
| Rate for Payer: Aetna Commercial |
$928.41
|
| Rate for Payer: Aetna Medicare |
$692.84
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS MAPPO |
$692.84
|
| Rate for Payer: BCN Commercial |
$1,199.14
|
| Rate for Payer: BCN Medicare Advantage |
$692.84
|
| Rate for Payer: Cash Price |
$1,198.40
|
| Rate for Payer: Cash Price |
$1,198.40
|
| Rate for Payer: Cofinity Commercial |
$997.69
|
| Rate for Payer: Cofinity Commercial |
$928.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.84
|
| Rate for Payer: Healthscope Commercial |
$831.41
|
| Rate for Payer: Healthscope Whirlpool |
$831.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$727.48
|
| Rate for Payer: Meridian Medicaid |
$480.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$762.12
|
| Rate for Payer: Nomi Health Commercial |
$831.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.50
|
| Rate for Payer: PACE SWMI |
$692.84
|
| Rate for Payer: PHP Medicare Advantage |
$692.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,184.86
|
| Rate for Payer: Priority Health Medicare |
$692.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.86
|
| Rate for Payer: Railroad Medicare Medicare |
$692.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,367.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$692.84
|
| Rate for Payer: UHC Exchange |
$1,367.01
|
| Rate for Payer: UHC Medicaid |
$457.52
|
| Rate for Payer: UHCCP DNSP |
$692.84
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
|
|
PR STENGER TEST PURE TONE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92565
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$32.87 |
| Rate for Payer: Aetna Commercial |
$27.47
|
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS MAPPO |
$20.50
|
| Rate for Payer: BCN Commercial |
$32.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.50
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.50
|
| Rate for Payer: Healthscope Commercial |
$24.60
|
| Rate for Payer: Healthscope Whirlpool |
$24.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$24.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: PACE SWMI |
$20.50
|
| Rate for Payer: PHP Medicare Advantage |
$20.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.31
|
| Rate for Payer: Priority Health Medicare |
$20.50
|
| Rate for Payer: Priority Health Narrow Network |
$30.31
|
| Rate for Payer: Railroad Medicare Medicare |
$20.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.50
|
| Rate for Payer: UHC Exchange |
$23.44
|
| Rate for Payer: UHCCP DNSP |
$20.50
|
|
|
PR STENGER TEST SPEECH
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 92577
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$27.89
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCN Commercial |
$34.36
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$29.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.89
|
| Rate for Payer: Nomi Health Commercial |
$24.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.69
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$31.69
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.81
|
| Rate for Payer: UHC Exchange |
$20.79
|
| Rate for Payer: UHCCP DNSP |
$20.81
|
|
|
PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 36908
|
| Min. Negotiated Rate |
$115.87 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Aetna Commercial |
$245.09
|
| Rate for Payer: Aetna Medicare |
$182.90
|
| Rate for Payer: BCBS Complete |
$121.66
|
| Rate for Payer: BCBS MAPPO |
$182.90
|
| Rate for Payer: BCN Commercial |
$302.28
|
| Rate for Payer: BCN Medicare Advantage |
$182.90
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Commercial |
$245.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.90
|
| Rate for Payer: Healthscope Commercial |
$219.48
|
| Rate for Payer: Healthscope Whirlpool |
$219.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.04
|
| Rate for Payer: Meridian Medicaid |
$121.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.19
|
| Rate for Payer: Nomi Health Commercial |
$219.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$444.75
|
| Rate for Payer: PACE SWMI |
$182.90
|
| Rate for Payer: PHP Medicare Advantage |
$182.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$325.05
|
| Rate for Payer: Priority Health Medicare |
$182.90
|
| Rate for Payer: Priority Health Narrow Network |
$325.05
|
| Rate for Payer: Railroad Medicare Medicare |
$182.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.90
|
| Rate for Payer: UHC Exchange |
$371.91
|
| Rate for Payer: UHC Medicaid |
$115.87
|
| Rate for Payer: UHCCP DNSP |
$182.90
|
| Rate for Payer: UHCCP Medicaid |
$115.87
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS G6002
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$113.04 |
| Rate for Payer: Aetna Commercial |
$85.81
|
| Rate for Payer: Aetna Commercial |
$85.81
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCN Commercial |
$113.04
|
| Rate for Payer: BCN Commercial |
$113.04
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
|
|
PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES
|
Professional
|
Both
|
$3,065.00
|
|
|
Service Code
|
HCPCS 61750
|
| Min. Negotiated Rate |
$883.52 |
| Max. Negotiated Rate |
$2,974.80 |
| Rate for Payer: Aetna Commercial |
$1,848.78
|
| Rate for Payer: Aetna Medicare |
$1,379.69
|
| Rate for Payer: BCBS Complete |
$927.70
|
| Rate for Payer: BCBS MAPPO |
$1,379.69
|
| Rate for Payer: BCN Commercial |
$2,974.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.69
|
| Rate for Payer: Cash Price |
$2,452.00
|
| Rate for Payer: Cash Price |
$2,452.00
|
| Rate for Payer: Cofinity Commercial |
$1,986.75
|
| Rate for Payer: Cofinity Commercial |
$1,848.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.69
|
| Rate for Payer: Healthscope Commercial |
$1,655.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,655.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.67
|
| Rate for Payer: Meridian Medicaid |
$927.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,517.66
|
| Rate for Payer: Nomi Health Commercial |
$1,655.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,298.75
|
| Rate for Payer: PACE SWMI |
$1,379.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$883.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,500.98
|
| Rate for Payer: Priority Health Medicare |
$1,379.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,500.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,479.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,379.69
|
| Rate for Payer: UHC Exchange |
$2,479.34
|
| Rate for Payer: UHC Medicaid |
$883.52
|
| Rate for Payer: UHCCP DNSP |
$1,379.69
|
| Rate for Payer: UHCCP Medicaid |
$883.52
|
|
|
PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 61783
|
| Min. Negotiated Rate |
$132.27 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Aetna Commercial |
$280.68
|
| Rate for Payer: Aetna Medicare |
$209.46
|
| Rate for Payer: BCBS Complete |
$138.88
|
| Rate for Payer: BCBS MAPPO |
$209.46
|
| Rate for Payer: BCN Commercial |
$347.09
|
| Rate for Payer: BCN Medicare Advantage |
$209.46
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$301.62
|
| Rate for Payer: Cofinity Commercial |
$280.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.46
|
| Rate for Payer: Healthscope Commercial |
$251.35
|
| Rate for Payer: Healthscope Whirlpool |
$251.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.93
|
| Rate for Payer: Meridian Medicaid |
$138.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.41
|
| Rate for Payer: Nomi Health Commercial |
$251.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$573.75
|
| Rate for Payer: PACE SWMI |
$209.46
|
| Rate for Payer: PHP Medicare Advantage |
$209.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$403.15
|
| Rate for Payer: Priority Health Medicare |
$209.46
|
| Rate for Payer: Priority Health Narrow Network |
$403.15
|
| Rate for Payer: Railroad Medicare Medicare |
$209.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.46
|
| Rate for Payer: UHC Exchange |
$415.02
|
| Rate for Payer: UHC Medicaid |
$132.27
|
| Rate for Payer: UHCCP DNSP |
$209.46
|
| Rate for Payer: UHCCP Medicaid |
$132.27
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES
|
Professional
|
Both
|
$8,565.00
|
|
|
Service Code
|
HCPCS 61798
|
| Min. Negotiated Rate |
$853.49 |
| Max. Negotiated Rate |
$6,423.75 |
| Rate for Payer: Aetna Commercial |
$1,789.69
|
| Rate for Payer: Aetna Medicare |
$1,335.59
|
| Rate for Payer: BCBS Complete |
$896.16
|
| Rate for Payer: BCBS MAPPO |
$1,335.59
|
| Rate for Payer: BCN Commercial |
$2,105.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,335.59
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cofinity Commercial |
$1,923.25
|
| Rate for Payer: Cofinity Commercial |
$1,789.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,335.59
|
| Rate for Payer: Healthscope Commercial |
$1,602.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,602.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,402.37
|
| Rate for Payer: Meridian Medicaid |
$896.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,469.15
|
| Rate for Payer: Nomi Health Commercial |
$1,602.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,423.75
|
| Rate for Payer: PACE SWMI |
$1,335.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,335.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$853.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,446.03
|
| Rate for Payer: Priority Health Medicare |
$1,335.59
|
| Rate for Payer: Priority Health Narrow Network |
$2,446.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,335.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,430.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,335.59
|
| Rate for Payer: UHC Exchange |
$2,430.29
|
| Rate for Payer: UHC Medicaid |
$853.49
|
| Rate for Payer: UHCCP DNSP |
$1,335.59
|
| Rate for Payer: UHCCP Medicaid |
$853.49
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES
|
Professional
|
Both
|
$8,565.00
|
|
|
Service Code
|
HCPCS 61796
|
| Min. Negotiated Rate |
$645.82 |
| Max. Negotiated Rate |
$6,423.75 |
| Rate for Payer: Aetna Commercial |
$1,346.77
|
| Rate for Payer: Aetna Medicare |
$1,005.05
|
| Rate for Payer: BCBS Complete |
$678.11
|
| Rate for Payer: BCBS MAPPO |
$1,005.05
|
| Rate for Payer: BCN Commercial |
$1,561.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.05
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cofinity Commercial |
$1,447.27
|
| Rate for Payer: Cofinity Commercial |
$1,346.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.05
|
| Rate for Payer: Healthscope Commercial |
$1,206.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,206.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.30
|
| Rate for Payer: Meridian Medicaid |
$678.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,105.56
|
| Rate for Payer: Nomi Health Commercial |
$1,206.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,423.75
|
| Rate for Payer: PACE SWMI |
$1,005.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,813.86
|
| Rate for Payer: Priority Health Medicare |
$1,005.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,813.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,005.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,781.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,005.05
|
| Rate for Payer: UHC Exchange |
$1,781.22
|
| Rate for Payer: UHC Medicaid |
$645.82
|
| Rate for Payer: UHCCP DNSP |
$1,005.05
|
| Rate for Payer: UHCCP Medicaid |
$645.82
|
|
