|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$468.00
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$504.40
|
| Rate for Payer: ASR Commercial |
$504.40
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$425.83
|
| Rate for Payer: BCN Commercial |
$403.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$488.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$520.00
|
| Rate for Payer: Healthscope Whirlpool |
$504.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$468.00
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.00
|
| Rate for Payer: Nomi Health Commercial |
$426.40
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.62
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$364.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna Commercial |
$468.00
|
| Rate for Payer: ASR ASR |
$504.40
|
| Rate for Payer: ASR Commercial |
$504.40
|
| Rate for Payer: BCBS Trust/PPO |
$423.75
|
| Rate for Payer: BCN Commercial |
$403.16
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$488.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.00
|
| Rate for Payer: Healthscope Commercial |
$520.00
|
| Rate for Payer: Healthscope Whirlpool |
$504.40
|
| Rate for Payer: Mclaren Commercial |
$468.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.00
|
| Rate for Payer: Nomi Health Commercial |
$426.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.60
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 45332
|
| Hospital Charge Code |
45332
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Medicare |
$99.25
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$99.25
|
| Rate for Payer: BCN Medicare Advantage |
$99.25
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$142.92
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$119.10
|
| Rate for Payer: Healthscope Whirlpool |
$119.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.21
|
| Rate for Payer: Nomi Health Commercial |
$119.10
|
| Rate for Payer: PACE SWMI |
$99.25
|
| Rate for Payer: PHP Medicare Advantage |
$99.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$99.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.25
|
| Rate for Payer: UHC Medicare Advantage |
$99.25
|
| Rate for Payer: UHCCP DNSP |
$99.25
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 45332
|
| Min. Negotiated Rate |
$99.25 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Medicare |
$99.25
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$99.25
|
| Rate for Payer: BCN Medicare Advantage |
$99.25
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$142.92
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$119.10
|
| Rate for Payer: Healthscope Whirlpool |
$119.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.21
|
| Rate for Payer: Nomi Health Commercial |
$119.10
|
| Rate for Payer: PACE SWMI |
$99.25
|
| Rate for Payer: PHP Medicare Advantage |
$99.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$99.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.25
|
| Rate for Payer: UHC Medicare Advantage |
$99.25
|
| Rate for Payer: UHCCP DNSP |
$99.25
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 45333
|
| Min. Negotiated Rate |
$89.22 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Medicare |
$89.22
|
| Rate for Payer: BCBS Complete |
$300.40
|
| Rate for Payer: BCBS MAPPO |
$89.22
|
| Rate for Payer: BCN Medicare Advantage |
$89.22
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$128.48
|
| Rate for Payer: Cofinity Commercial |
$119.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.22
|
| Rate for Payer: Healthscope Commercial |
$107.06
|
| Rate for Payer: Healthscope Whirlpool |
$107.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.68
|
| Rate for Payer: Nomi Health Commercial |
$107.06
|
| Rate for Payer: PACE SWMI |
$89.22
|
| Rate for Payer: PHP Medicare Advantage |
$89.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health Medicare |
$89.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.22
|
| Rate for Payer: UHC Medicare Advantage |
$89.22
|
| Rate for Payer: UHCCP DNSP |
$89.22
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$488.15 |
| Max. Negotiated Rate |
$751.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: ASR ASR |
$728.47
|
| Rate for Payer: ASR Commercial |
$728.47
|
| Rate for Payer: BCBS Trust/PPO |
$611.99
|
| Rate for Payer: BCN Commercial |
$582.25
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$705.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.80
|
| Rate for Payer: Healthscope Commercial |
$751.00
|
| Rate for Payer: Healthscope Whirlpool |
$728.47
|
| Rate for Payer: Mclaren Commercial |
$675.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.35
|
| Rate for Payer: Nomi Health Commercial |
$615.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.88
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$89.22 |
| Max. Negotiated Rate |
$488.15 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Medicare |
$89.22
|
| Rate for Payer: BCBS Complete |
$300.40
|
| Rate for Payer: BCBS MAPPO |
$89.22
|
| Rate for Payer: BCN Medicare Advantage |
$89.22
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$128.48
|
| Rate for Payer: Cofinity Commercial |
$119.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.22
|
| Rate for Payer: Healthscope Commercial |
$107.06
|
| Rate for Payer: Healthscope Whirlpool |
$107.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.68
|
| Rate for Payer: Nomi Health Commercial |
$107.06
|
| Rate for Payer: PACE SWMI |
$89.22
|
| Rate for Payer: PHP Medicare Advantage |
$89.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health Medicare |
$89.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.22
|
| Rate for Payer: UHC Medicare Advantage |
$89.22
|
| Rate for Payer: UHCCP DNSP |
$89.22
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$1,378.21 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Medicare |
$889.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: ASR ASR |
$728.47
|
| Rate for Payer: ASR Commercial |
$728.47
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCBS Trust/PPO |
$614.99
|
| Rate for Payer: BCN Commercial |
$582.25
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$705.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$751.00
|
| Rate for Payer: Healthscope Whirlpool |
$728.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$889.17
|
| Rate for Payer: Mclaren Commercial |
$675.90
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.35
|
| Rate for Payer: Nomi Health Commercial |
$615.82
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$978.09
|
| Rate for Payer: PHP Medicaid |
$476.60
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$658.03
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health Narrow Network |
$526.45
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$660.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,378.21
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP DNSP |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
PR SIGMOIDOSCOPY,TRANSENDOSCOPIC STENT
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 45345
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
|
|
PR SIGMOIDOSCOPY W/STENT
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS G6023
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
|
|
PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93278
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$41.59 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$28.88
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$28.88
|
| Rate for Payer: BCN Medicare Advantage |
$28.88
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$41.59
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$34.66
|
| Rate for Payer: Healthscope Whirlpool |
$34.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.32
|
| Rate for Payer: Nomi Health Commercial |
$34.66
|
| Rate for Payer: PACE SWMI |
$28.88
|
| Rate for Payer: PHP Medicare Advantage |
$28.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Medicare |
$28.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.88
|
| Rate for Payer: UHC Medicare Advantage |
$28.88
|
| Rate for Payer: UHCCP DNSP |
$28.88
|
|
|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 51725
|
| Min. Negotiated Rate |
$188.87 |
| Max. Negotiated Rate |
$349.05 |
| Rate for Payer: Aetna Commercial |
$253.09
|
| Rate for Payer: Aetna Medicare |
$188.87
|
| Rate for Payer: BCBS Complete |
$214.80
|
| Rate for Payer: BCBS MAPPO |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$188.87
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cofinity Commercial |
$271.97
|
| Rate for Payer: Cofinity Commercial |
$253.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.87
|
| Rate for Payer: Healthscope Commercial |
$226.64
|
| Rate for Payer: Healthscope Whirlpool |
$226.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.31
|
| Rate for Payer: Nomi Health Commercial |
$226.64
|
| Rate for Payer: PACE SWMI |
$188.87
|
| Rate for Payer: PHP Medicare Advantage |
$188.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.05
|
| Rate for Payer: Priority Health Medicare |
$188.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.87
|
| Rate for Payer: UHC Medicare Advantage |
$188.87
|
| Rate for Payer: UHCCP DNSP |
$188.87
|
|
|
PR SIMPLE IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 00522
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$9,729.00
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$3,376.65 |
| Max. Negotiated Rate |
$6,323.85 |
| Rate for Payer: Aetna Commercial |
$4,524.71
|
| Rate for Payer: Aetna Medicare |
$3,376.65
|
| Rate for Payer: BCBS Complete |
$3,891.60
|
| Rate for Payer: BCBS MAPPO |
$3,376.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,376.65
|
| Rate for Payer: Cash Price |
$7,783.20
|
| Rate for Payer: Cash Price |
$7,783.20
|
| Rate for Payer: Cofinity Commercial |
$4,862.38
|
| Rate for Payer: Cofinity Commercial |
$4,524.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,376.65
|
| Rate for Payer: Healthscope Commercial |
$4,051.98
|
| Rate for Payer: Healthscope Whirlpool |
$4,051.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,545.48
|
| Rate for Payer: Nomi Health Commercial |
$4,051.98
|
| Rate for Payer: PACE SWMI |
$3,376.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,376.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,323.85
|
| Rate for Payer: Priority Health Medicare |
$3,376.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,376.65
|
| Rate for Payer: UHC Medicare Advantage |
$3,376.65
|
| Rate for Payer: UHCCP DNSP |
$3,376.65
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$8,669.00
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$3,467.60 |
| Max. Negotiated Rate |
$5,735.58 |
| Rate for Payer: Aetna Commercial |
$5,337.27
|
| Rate for Payer: Aetna Medicare |
$3,983.04
|
| Rate for Payer: BCBS Complete |
$3,467.60
|
| Rate for Payer: BCBS MAPPO |
$3,983.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,983.04
|
| Rate for Payer: Cash Price |
$6,935.20
|
| Rate for Payer: Cash Price |
$6,935.20
|
| Rate for Payer: Cofinity Commercial |
$5,735.58
|
| Rate for Payer: Cofinity Commercial |
$5,337.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,983.04
|
| Rate for Payer: Healthscope Commercial |
$4,779.65
|
| Rate for Payer: Healthscope Whirlpool |
$4,779.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,182.19
|
| Rate for Payer: Nomi Health Commercial |
$4,779.65
|
| Rate for Payer: PACE SWMI |
$3,983.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,983.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,634.85
|
| Rate for Payer: Priority Health Medicare |
$3,983.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,983.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,983.04
|
| Rate for Payer: UHCCP DNSP |
$3,983.04
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$124.65 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Aetna Commercial |
$167.03
|
| Rate for Payer: Aetna Medicare |
$124.65
|
| Rate for Payer: BCBS Complete |
$265.60
|
| Rate for Payer: BCBS MAPPO |
$124.65
|
| Rate for Payer: BCN Medicare Advantage |
$124.65
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$179.50
|
| Rate for Payer: Cofinity Commercial |
$167.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.65
|
| Rate for Payer: Healthscope Commercial |
$149.58
|
| Rate for Payer: Healthscope Whirlpool |
$149.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.88
|
| Rate for Payer: Nomi Health Commercial |
$149.58
|
| Rate for Payer: PACE SWMI |
$124.65
|
| Rate for Payer: PHP Medicare Advantage |
$124.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.60
|
| Rate for Payer: Priority Health Medicare |
$124.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.65
|
| Rate for Payer: UHC Medicare Advantage |
$124.65
|
| Rate for Payer: UHCCP DNSP |
$124.65
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$216.55 |
| Rate for Payer: Aetna Commercial |
$201.51
|
| Rate for Payer: Aetna Medicare |
$150.38
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$150.38
|
| Rate for Payer: BCN Medicare Advantage |
$150.38
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$216.55
|
| Rate for Payer: Cofinity Commercial |
$201.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.38
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Healthscope Whirlpool |
$180.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.90
|
| Rate for Payer: Nomi Health Commercial |
$180.46
|
| Rate for Payer: PACE SWMI |
$150.38
|
| Rate for Payer: PHP Medicare Advantage |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$150.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.38
|
| Rate for Payer: UHC Medicare Advantage |
$150.38
|
| Rate for Payer: UHCCP DNSP |
$150.38
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$54.07 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$72.45
|
| Rate for Payer: Aetna Medicare |
$54.07
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$54.07
|
| Rate for Payer: BCN Medicare Advantage |
$54.07
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$77.86
|
| Rate for Payer: Cofinity Commercial |
$72.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.07
|
| Rate for Payer: Healthscope Commercial |
$64.88
|
| Rate for Payer: Healthscope Whirlpool |
$64.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.77
|
| Rate for Payer: Nomi Health Commercial |
$64.88
|
| Rate for Payer: PACE SWMI |
$54.07
|
| Rate for Payer: PHP Medicare Advantage |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$54.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.07
|
| Rate for Payer: UHC Medicare Advantage |
$54.07
|
| Rate for Payer: UHCCP DNSP |
$54.07
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$232.70 |
| Rate for Payer: Aetna Commercial |
$75.75
|
| Rate for Payer: Aetna Medicare |
$56.53
|
| Rate for Payer: BCBS Complete |
$143.20
|
| Rate for Payer: BCBS MAPPO |
$56.53
|
| Rate for Payer: BCN Medicare Advantage |
$56.53
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.53
|
| Rate for Payer: Healthscope Commercial |
$67.84
|
| Rate for Payer: Healthscope Whirlpool |
$67.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.36
|
| Rate for Payer: Nomi Health Commercial |
$67.84
|
| Rate for Payer: PACE SWMI |
$56.53
|
| Rate for Payer: PHP Medicare Advantage |
$56.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health Medicare |
$56.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.53
|
| Rate for Payer: UHC Medicare Advantage |
$56.53
|
| Rate for Payer: UHCCP DNSP |
$56.53
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Aetna Commercial |
$228.39
|
| Rate for Payer: Aetna Medicare |
$170.44
|
| Rate for Payer: BCBS Complete |
$544.00
|
| Rate for Payer: BCBS MAPPO |
$170.44
|
| Rate for Payer: BCN Medicare Advantage |
$170.44
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cofinity Commercial |
$245.43
|
| Rate for Payer: Cofinity Commercial |
$228.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.44
|
| Rate for Payer: Healthscope Commercial |
$204.53
|
| Rate for Payer: Healthscope Whirlpool |
$204.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.96
|
| Rate for Payer: Nomi Health Commercial |
$204.53
|
| Rate for Payer: PACE SWMI |
$170.44
|
| Rate for Payer: PHP Medicare Advantage |
$170.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.00
|
| Rate for Payer: Priority Health Medicare |
$170.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.44
|
| Rate for Payer: UHC Medicare Advantage |
$170.44
|
| Rate for Payer: UHCCP DNSP |
$170.44
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$319.15 |
| Rate for Payer: Aetna Commercial |
$97.12
|
| Rate for Payer: Aetna Medicare |
$72.48
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS MAPPO |
$72.48
|
| Rate for Payer: BCN Medicare Advantage |
$72.48
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.48
|
| Rate for Payer: Healthscope Commercial |
$86.98
|
| Rate for Payer: Healthscope Whirlpool |
$86.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Nomi Health Commercial |
$86.98
|
| Rate for Payer: PACE SWMI |
$72.48
|
| Rate for Payer: PHP Medicare Advantage |
$72.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health Medicare |
$72.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.48
|
| Rate for Payer: UHC Medicare Advantage |
$72.48
|
| Rate for Payer: UHCCP DNSP |
$72.48
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$91.89 |
| Max. Negotiated Rate |
$412.10 |
| Rate for Payer: Aetna Commercial |
$123.13
|
| Rate for Payer: Aetna Medicare |
$91.89
|
| Rate for Payer: BCBS Complete |
$253.60
|
| Rate for Payer: BCBS MAPPO |
$91.89
|
| Rate for Payer: BCN Medicare Advantage |
$91.89
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cash Price |
$507.20
|
| Rate for Payer: Cofinity Commercial |
$132.32
|
| Rate for Payer: Cofinity Commercial |
$123.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.89
|
| Rate for Payer: Healthscope Commercial |
$110.27
|
| Rate for Payer: Healthscope Whirlpool |
$110.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.48
|
| Rate for Payer: Nomi Health Commercial |
$110.27
|
| Rate for Payer: PACE SWMI |
$91.89
|
| Rate for Payer: PHP Medicare Advantage |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.10
|
| Rate for Payer: Priority Health Medicare |
$91.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.89
|
| Rate for Payer: UHC Medicare Advantage |
$91.89
|
| Rate for Payer: UHCCP DNSP |
$91.89
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$165.10 |
| Rate for Payer: Aetna Commercial |
$57.97
|
| Rate for Payer: Aetna Medicare |
$43.26
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$43.26
|
| Rate for Payer: BCN Medicare Advantage |
$43.26
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$62.29
|
| Rate for Payer: Cofinity Commercial |
$57.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$51.91
|
| Rate for Payer: Healthscope Whirlpool |
$51.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.42
|
| Rate for Payer: Nomi Health Commercial |
$51.91
|
| Rate for Payer: PACE SWMI |
$43.26
|
| Rate for Payer: PHP Medicare Advantage |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.10
|
| Rate for Payer: Priority Health Medicare |
$43.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.26
|
| Rate for Payer: UHC Medicare Advantage |
$43.26
|
| Rate for Payer: UHCCP DNSP |
$43.26
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$140.94
|
| Rate for Payer: BCBS Complete |
$220.40
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cash Price |
$440.80
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Healthscope Whirlpool |
$169.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.15
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
| Rate for Payer: UHCCP DNSP |
$140.94
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna Commercial |
$95.21
|
| Rate for Payer: Aetna Medicare |
$71.05
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS MAPPO |
$71.05
|
| Rate for Payer: BCN Medicare Advantage |
$71.05
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$95.21
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.05
|
| Rate for Payer: Healthscope Commercial |
$85.26
|
| Rate for Payer: Healthscope Whirlpool |
$85.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.60
|
| Rate for Payer: Nomi Health Commercial |
$85.26
|
| Rate for Payer: PACE SWMI |
$71.05
|
| Rate for Payer: PHP Medicare Advantage |
$71.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$71.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.05
|
| Rate for Payer: UHC Medicare Advantage |
$71.05
|
| Rate for Payer: UHCCP DNSP |
$71.05
|
|
