|
PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$4,049.00
|
|
|
Service Code
|
HCPCS 69641
|
| Min. Negotiated Rate |
$591.93 |
| Max. Negotiated Rate |
$3,036.75 |
| Rate for Payer: Aetna Commercial |
$1,202.42
|
| Rate for Payer: Aetna Medicare |
$897.33
|
| Rate for Payer: BCBS Complete |
$621.53
|
| Rate for Payer: BCBS MAPPO |
$897.33
|
| Rate for Payer: BCN Commercial |
$1,554.19
|
| Rate for Payer: BCN Medicare Advantage |
$897.33
|
| Rate for Payer: Cash Price |
$3,239.20
|
| Rate for Payer: Cash Price |
$3,239.20
|
| Rate for Payer: Cofinity Commercial |
$1,292.16
|
| Rate for Payer: Cofinity Commercial |
$1,202.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$897.33
|
| Rate for Payer: Healthscope Commercial |
$1,076.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,076.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$942.20
|
| Rate for Payer: Meridian Medicaid |
$621.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$987.06
|
| Rate for Payer: Nomi Health Commercial |
$1,076.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,036.75
|
| Rate for Payer: PACE SWMI |
$897.33
|
| Rate for Payer: PHP Medicare Advantage |
$897.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,535.70
|
| Rate for Payer: Priority Health Medicare |
$897.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,535.70
|
| Rate for Payer: Railroad Medicare Medicare |
$897.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,775.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$897.33
|
| Rate for Payer: UHC Exchange |
$1,775.98
|
| Rate for Payer: UHC Medicaid |
$591.93
|
| Rate for Payer: UHCCP DNSP |
$897.33
|
| Rate for Payer: UHCCP Medicaid |
$591.93
|
|
|
PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,765.00
|
|
|
Service Code
|
HCPCS 69642
|
| Min. Negotiated Rate |
$755.51 |
| Max. Negotiated Rate |
$2,285.14 |
| Rate for Payer: Aetna Commercial |
$1,537.66
|
| Rate for Payer: Aetna Medicare |
$1,147.51
|
| Rate for Payer: BCBS Complete |
$793.29
|
| Rate for Payer: BCBS MAPPO |
$1,147.51
|
| Rate for Payer: BCN Commercial |
$1,993.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,147.51
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cofinity Commercial |
$1,537.66
|
| Rate for Payer: Cofinity Commercial |
$1,652.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,147.51
|
| Rate for Payer: Healthscope Commercial |
$1,377.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,204.89
|
| Rate for Payer: Meridian Medicaid |
$793.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,262.26
|
| Rate for Payer: Nomi Health Commercial |
$1,377.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,073.75
|
| Rate for Payer: PACE SWMI |
$1,147.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,147.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,969.69
|
| Rate for Payer: Priority Health Medicare |
$1,147.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,969.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,147.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,285.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,147.51
|
| Rate for Payer: UHC Exchange |
$2,285.14
|
| Rate for Payer: UHC Medicaid |
$755.51
|
| Rate for Payer: UHCCP DNSP |
$1,147.51
|
| Rate for Payer: UHCCP Medicaid |
$755.51
|
|
|
PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH
|
Professional
|
Both
|
$3,872.00
|
|
|
Service Code
|
HCPCS 0483T
|
| Min. Negotiated Rate |
$1,415.73 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$1,415.73
|
| Rate for Payer: BCBS Complete |
$1,548.80
|
| Rate for Payer: BCN Commercial |
$2,635.81
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Cash Price |
$3,097.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,904.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,438.91
|
| Rate for Payer: UHC Exchange |
$2,438.91
|
|
|
PR TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 27681
|
| Min. Negotiated Rate |
$312.26 |
| Max. Negotiated Rate |
$1,340.25 |
| Rate for Payer: Aetna Commercial |
$637.80
|
| Rate for Payer: Aetna Medicare |
$475.97
|
| Rate for Payer: BCBS Complete |
$327.87
|
| Rate for Payer: BCBS MAPPO |
$475.97
|
| Rate for Payer: BCN Commercial |
$777.35
|
| Rate for Payer: BCN Medicare Advantage |
$475.97
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cofinity Commercial |
$685.40
|
| Rate for Payer: Cofinity Commercial |
$637.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.97
|
| Rate for Payer: Healthscope Commercial |
$571.16
|
| Rate for Payer: Healthscope Whirlpool |
$571.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$499.77
|
| Rate for Payer: Meridian Medicaid |
$327.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$523.57
|
| Rate for Payer: Nomi Health Commercial |
$571.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,340.25
|
| Rate for Payer: PACE SWMI |
$475.97
|
| Rate for Payer: PHP Medicare Advantage |
$475.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$830.97
|
| Rate for Payer: Priority Health Medicare |
$475.97
|
| Rate for Payer: Priority Health Narrow Network |
$830.97
|
| Rate for Payer: Railroad Medicare Medicare |
$475.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$900.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$475.97
|
| Rate for Payer: UHC Exchange |
$900.55
|
| Rate for Payer: UHC Medicaid |
$312.26
|
| Rate for Payer: UHCCP DNSP |
$475.97
|
| Rate for Payer: UHCCP Medicaid |
$312.26
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Aetna Commercial |
$645.73
|
| Rate for Payer: Aetna Medicare |
$481.89
|
| Rate for Payer: BCBS Complete |
$332.79
|
| Rate for Payer: BCBS MAPPO |
$481.89
|
| Rate for Payer: BCN Commercial |
$812.21
|
| Rate for Payer: BCN Medicare Advantage |
$481.89
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cofinity Commercial |
$693.92
|
| Rate for Payer: Cofinity Commercial |
$645.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.89
|
| Rate for Payer: Healthscope Commercial |
$578.27
|
| Rate for Payer: Healthscope Whirlpool |
$578.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.98
|
| Rate for Payer: Meridian Medicaid |
$332.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$530.08
|
| Rate for Payer: Nomi Health Commercial |
$578.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.50
|
| Rate for Payer: PACE SWMI |
$481.89
|
| Rate for Payer: PHP Medicare Advantage |
$481.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$868.22
|
| Rate for Payer: Priority Health Medicare |
$481.89
|
| Rate for Payer: Priority Health Narrow Network |
$868.22
|
| Rate for Payer: Railroad Medicare Medicare |
$481.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$481.89
|
| Rate for Payer: UHC Exchange |
$912.75
|
| Rate for Payer: UHC Medicaid |
$316.94
|
| Rate for Payer: UHCCP DNSP |
$481.89
|
| Rate for Payer: UHCCP Medicaid |
$316.94
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$318.86 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Aetna Commercial |
$649.36
|
| Rate for Payer: Aetna Medicare |
$484.60
|
| Rate for Payer: BCBS Complete |
$334.80
|
| Rate for Payer: BCBS MAPPO |
$484.60
|
| Rate for Payer: BCN Commercial |
$817.69
|
| Rate for Payer: BCN Medicare Advantage |
$484.60
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$697.82
|
| Rate for Payer: Cofinity Commercial |
$649.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.60
|
| Rate for Payer: Healthscope Commercial |
$581.52
|
| Rate for Payer: Healthscope Whirlpool |
$581.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.83
|
| Rate for Payer: Meridian Medicaid |
$334.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$533.06
|
| Rate for Payer: Nomi Health Commercial |
$581.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,203.00
|
| Rate for Payer: PACE SWMI |
$484.60
|
| Rate for Payer: PHP Medicare Advantage |
$484.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$318.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$874.08
|
| Rate for Payer: Priority Health Medicare |
$484.60
|
| Rate for Payer: Priority Health Narrow Network |
$874.08
|
| Rate for Payer: Railroad Medicare Medicare |
$484.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$913.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$484.60
|
| Rate for Payer: UHC Exchange |
$913.78
|
| Rate for Payer: UHC Medicaid |
$318.86
|
| Rate for Payer: UHCCP DNSP |
$484.60
|
| Rate for Payer: UHCCP Medicaid |
$318.86
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,909.00
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$393.41 |
| Max. Negotiated Rate |
$1,431.75 |
| Rate for Payer: Aetna Commercial |
$805.67
|
| Rate for Payer: Aetna Medicare |
$601.25
|
| Rate for Payer: BCBS Complete |
$413.08
|
| Rate for Payer: BCBS MAPPO |
$601.25
|
| Rate for Payer: BCN Commercial |
$1,016.38
|
| Rate for Payer: BCN Medicare Advantage |
$601.25
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cofinity Commercial |
$865.80
|
| Rate for Payer: Cofinity Commercial |
$805.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.25
|
| Rate for Payer: Healthscope Commercial |
$721.50
|
| Rate for Payer: Healthscope Whirlpool |
$721.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$631.31
|
| Rate for Payer: Meridian Medicaid |
$413.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$661.38
|
| Rate for Payer: Nomi Health Commercial |
$721.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,431.75
|
| Rate for Payer: PACE SWMI |
$601.25
|
| Rate for Payer: PHP Medicare Advantage |
$601.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$393.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,086.48
|
| Rate for Payer: Priority Health Medicare |
$601.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,086.48
|
| Rate for Payer: Railroad Medicare Medicare |
$601.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,153.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$601.25
|
| Rate for Payer: UHC Exchange |
$1,153.67
|
| Rate for Payer: UHC Medicaid |
$393.41
|
| Rate for Payer: UHCCP DNSP |
$601.25
|
| Rate for Payer: UHCCP Medicaid |
$393.41
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$264.33 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$537.47
|
| Rate for Payer: Aetna Medicare |
$401.10
|
| Rate for Payer: BCBS Complete |
$277.55
|
| Rate for Payer: BCBS MAPPO |
$401.10
|
| Rate for Payer: BCN Commercial |
$674.76
|
| Rate for Payer: BCN Medicare Advantage |
$401.10
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cofinity Commercial |
$577.58
|
| Rate for Payer: Cofinity Commercial |
$537.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.10
|
| Rate for Payer: Healthscope Commercial |
$481.32
|
| Rate for Payer: Healthscope Whirlpool |
$481.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.15
|
| Rate for Payer: Meridian Medicaid |
$277.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$441.21
|
| Rate for Payer: Nomi Health Commercial |
$481.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.50
|
| Rate for Payer: PACE SWMI |
$401.10
|
| Rate for Payer: PHP Medicare Advantage |
$401.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$721.31
|
| Rate for Payer: Priority Health Medicare |
$401.10
|
| Rate for Payer: Priority Health Narrow Network |
$721.31
|
| Rate for Payer: Railroad Medicare Medicare |
$401.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$401.10
|
| Rate for Payer: UHC Exchange |
$754.52
|
| Rate for Payer: UHC Medicaid |
$264.33
|
| Rate for Payer: UHCCP DNSP |
$401.10
|
| Rate for Payer: UHCCP Medicaid |
$264.33
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$37.09 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$21.87
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.87
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$31.49
|
| Rate for Payer: Cofinity Commercial |
$29.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.87
|
| Rate for Payer: Healthscope Commercial |
$24.06
|
| Rate for Payer: Healthscope Whirlpool |
$24.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.96
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.06
|
| Rate for Payer: Nomi Health Commercial |
$26.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.25
|
| Rate for Payer: PACE SWMI |
$21.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$21.87
|
| Rate for Payer: Priority Health Narrow Network |
$33.15
|
| Rate for Payer: Railroad Medicare Medicare |
$21.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.87
|
| Rate for Payer: UHC Exchange |
$37.09
|
| Rate for Payer: UHC Medicaid |
$14.06
|
| Rate for Payer: UHCCP DNSP |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$14.20
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS MAPPO |
$10.60
|
| Rate for Payer: BCN Commercial |
$12.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$15.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.60
|
| Rate for Payer: Healthscope Commercial |
$11.66
|
| Rate for Payer: Healthscope Whirlpool |
$11.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.13
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.66
|
| Rate for Payer: Nomi Health Commercial |
$12.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$10.60
|
| Rate for Payer: PHP Medicare Advantage |
$10.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.68
|
| Rate for Payer: Priority Health Medicare |
$10.60
|
| Rate for Payer: Priority Health Narrow Network |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$10.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.60
|
| Rate for Payer: UHC Exchange |
$17.54
|
| Rate for Payer: UHC Medicaid |
$6.82
|
| Rate for Payer: UHCCP DNSP |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
|
|
PR TOBACCO-USE COUNSEL>10MIN
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS G0437
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Narrow Network |
$32.16
|
|
|
PR TOBACCO-USE COUNSEL 3-10 MIN
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS G0436
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.42
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$53.29 |
| Rate for Payer: Aetna Commercial |
$43.82
|
| Rate for Payer: Aetna Medicare |
$32.70
|
| Rate for Payer: BCBS MAPPO |
$32.70
|
| Rate for Payer: BCN Commercial |
$53.29
|
| Rate for Payer: BCN Medicare Advantage |
$32.70
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$43.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.70
|
| Rate for Payer: Healthscope Commercial |
$39.24
|
| Rate for Payer: Healthscope Whirlpool |
$39.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.97
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PACE SWMI |
$32.70
|
| Rate for Payer: PHP Medicare Advantage |
$32.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.14
|
| Rate for Payer: Priority Health Medicare |
$32.70
|
| Rate for Payer: Priority Health Narrow Network |
$49.14
|
| Rate for Payer: Railroad Medicare Medicare |
$32.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.70
|
| Rate for Payer: UHC Exchange |
$45.77
|
| Rate for Payer: UHCCP DNSP |
$32.70
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Aetna Medicare |
$254.37
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$254.37
|
| Rate for Payer: BCN Commercial |
$442.70
|
| Rate for Payer: BCN Medicare Advantage |
$254.37
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cofinity Commercial |
$366.29
|
| Rate for Payer: Cofinity Commercial |
$340.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.37
|
| Rate for Payer: Healthscope Commercial |
$305.24
|
| Rate for Payer: Healthscope Whirlpool |
$305.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.09
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$279.81
|
| Rate for Payer: Nomi Health Commercial |
$305.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.00
|
| Rate for Payer: PACE SWMI |
$254.37
|
| Rate for Payer: PHP Medicare Advantage |
$254.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$539.41
|
| Rate for Payer: Priority Health Medicare |
$254.37
|
| Rate for Payer: Priority Health Narrow Network |
$539.41
|
| Rate for Payer: Railroad Medicare Medicare |
$254.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$254.37
|
| Rate for Payer: UHC Exchange |
$500.13
|
| Rate for Payer: UHC Medicaid |
$166.35
|
| Rate for Payer: UHCCP DNSP |
$254.37
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$562.46 |
| Rate for Payer: Aetna Commercial |
$355.49
|
| Rate for Payer: Aetna Medicare |
$265.29
|
| Rate for Payer: BCBS Complete |
$182.28
|
| Rate for Payer: BCBS MAPPO |
$265.29
|
| Rate for Payer: BCN Commercial |
$461.63
|
| Rate for Payer: BCN Medicare Advantage |
$265.29
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$382.02
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.29
|
| Rate for Payer: Healthscope Commercial |
$318.35
|
| Rate for Payer: Healthscope Whirlpool |
$318.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.55
|
| Rate for Payer: Meridian Medicaid |
$182.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$291.82
|
| Rate for Payer: Nomi Health Commercial |
$318.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.00
|
| Rate for Payer: PACE SWMI |
$265.29
|
| Rate for Payer: PHP Medicare Advantage |
$265.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$562.46
|
| Rate for Payer: Priority Health Medicare |
$265.29
|
| Rate for Payer: Priority Health Narrow Network |
$562.46
|
| Rate for Payer: Railroad Medicare Medicare |
$265.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$265.29
|
| Rate for Payer: UHC Exchange |
$521.72
|
| Rate for Payer: UHC Medicaid |
$173.60
|
| Rate for Payer: UHCCP DNSP |
$265.29
|
| Rate for Payer: UHCCP Medicaid |
$173.60
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$499.36 |
| Rate for Payer: Aetna Commercial |
$315.85
|
| Rate for Payer: Aetna Medicare |
$235.71
|
| Rate for Payer: BCBS Complete |
$163.04
|
| Rate for Payer: BCBS MAPPO |
$235.71
|
| Rate for Payer: BCN Commercial |
$409.84
|
| Rate for Payer: BCN Medicare Advantage |
$235.71
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$339.42
|
| Rate for Payer: Cofinity Commercial |
$315.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.71
|
| Rate for Payer: Healthscope Commercial |
$282.85
|
| Rate for Payer: Healthscope Whirlpool |
$282.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.50
|
| Rate for Payer: Meridian Medicaid |
$163.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.28
|
| Rate for Payer: Nomi Health Commercial |
$282.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: PACE SWMI |
$235.71
|
| Rate for Payer: PHP Medicare Advantage |
$235.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$499.36
|
| Rate for Payer: Priority Health Medicare |
$235.71
|
| Rate for Payer: Priority Health Narrow Network |
$499.36
|
| Rate for Payer: Railroad Medicare Medicare |
$235.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$453.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$235.71
|
| Rate for Payer: UHC Exchange |
$453.36
|
| Rate for Payer: UHC Medicaid |
$155.28
|
| Rate for Payer: UHCCP DNSP |
$235.71
|
| Rate for Payer: UHCCP Medicaid |
$155.28
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$147.61 |
| Max. Negotiated Rate |
$474.49 |
| Rate for Payer: Aetna Commercial |
$300.91
|
| Rate for Payer: Aetna Medicare |
$224.56
|
| Rate for Payer: BCBS Complete |
$154.99
|
| Rate for Payer: BCBS MAPPO |
$224.56
|
| Rate for Payer: BCN Commercial |
$389.42
|
| Rate for Payer: BCN Medicare Advantage |
$224.56
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$323.37
|
| Rate for Payer: Cofinity Commercial |
$300.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.56
|
| Rate for Payer: Healthscope Commercial |
$269.47
|
| Rate for Payer: Healthscope Whirlpool |
$269.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.79
|
| Rate for Payer: Meridian Medicaid |
$154.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$247.02
|
| Rate for Payer: Nomi Health Commercial |
$269.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.25
|
| Rate for Payer: PACE SWMI |
$224.56
|
| Rate for Payer: PHP Medicare Advantage |
$224.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$474.49
|
| Rate for Payer: Priority Health Medicare |
$224.56
|
| Rate for Payer: Priority Health Narrow Network |
$474.49
|
| Rate for Payer: Railroad Medicare Medicare |
$224.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$224.56
|
| Rate for Payer: UHC Exchange |
$434.65
|
| Rate for Payer: UHC Medicaid |
$147.61
|
| Rate for Payer: UHCCP DNSP |
$224.56
|
| Rate for Payer: UHCCP Medicaid |
$147.61
|
|
|
PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM
|
Professional
|
Both
|
$2,482.00
|
|
|
Service Code
|
HCPCS 58200
|
| Min. Negotiated Rate |
$801.31 |
| Max. Negotiated Rate |
$2,384.98 |
| Rate for Payer: Aetna Commercial |
$1,672.53
|
| Rate for Payer: Aetna Medicare |
$1,248.16
|
| Rate for Payer: BCBS Complete |
$841.38
|
| Rate for Payer: BCBS MAPPO |
$1,248.16
|
| Rate for Payer: BCN Commercial |
$2,028.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,248.16
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,797.35
|
| Rate for Payer: Cofinity Commercial |
$1,672.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,248.16
|
| Rate for Payer: Healthscope Commercial |
$1,497.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,497.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,310.57
|
| Rate for Payer: Meridian Medicaid |
$841.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,372.98
|
| Rate for Payer: Nomi Health Commercial |
$1,497.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,861.50
|
| Rate for Payer: PACE SWMI |
$1,248.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,248.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,054.20
|
| Rate for Payer: Priority Health Medicare |
$1,248.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,054.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,248.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,384.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,248.16
|
| Rate for Payer: UHC Exchange |
$2,384.98
|
| Rate for Payer: UHC Medicaid |
$801.31
|
| Rate for Payer: UHCCP DNSP |
$1,248.16
|
| Rate for Payer: UHCCP Medicaid |
$801.31
|
|
|
PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY
|
Professional
|
Both
|
$3,458.00
|
|
|
Service Code
|
HCPCS 58152
|
| Min. Negotiated Rate |
$695.23 |
| Max. Negotiated Rate |
$2,593.50 |
| Rate for Payer: Aetna Commercial |
$1,452.91
|
| Rate for Payer: Aetna Medicare |
$1,084.26
|
| Rate for Payer: BCBS Complete |
$729.99
|
| Rate for Payer: BCBS MAPPO |
$1,084.26
|
| Rate for Payer: BCN Commercial |
$1,851.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,084.26
|
| Rate for Payer: Cash Price |
$2,766.40
|
| Rate for Payer: Cash Price |
$2,766.40
|
| Rate for Payer: Cofinity Commercial |
$1,561.33
|
| Rate for Payer: Cofinity Commercial |
$1,452.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,084.26
|
| Rate for Payer: Healthscope Commercial |
$1,301.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,301.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,138.47
|
| Rate for Payer: Meridian Medicaid |
$729.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,192.69
|
| Rate for Payer: Nomi Health Commercial |
$1,301.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,593.50
|
| Rate for Payer: PACE SWMI |
$1,084.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,084.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$695.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,875.67
|
| Rate for Payer: Priority Health Medicare |
$1,084.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,875.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1,084.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,223.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,084.26
|
| Rate for Payer: UHC Exchange |
$2,223.23
|
| Rate for Payer: UHC Medicaid |
$695.23
|
| Rate for Payer: UHCCP DNSP |
$1,084.26
|
| Rate for Payer: UHCCP Medicaid |
$695.23
|
|
|
PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,312.00
|
|
|
Service Code
|
HCPCS 58150
|
| Min. Negotiated Rate |
$595.12 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Aetna Commercial |
$1,240.41
|
| Rate for Payer: Aetna Medicare |
$925.68
|
| Rate for Payer: BCBS Complete |
$624.88
|
| Rate for Payer: BCBS MAPPO |
$925.68
|
| Rate for Payer: BCN Commercial |
$1,528.80
|
| Rate for Payer: BCN Medicare Advantage |
$925.68
|
| Rate for Payer: Cash Price |
$2,649.60
|
| Rate for Payer: Cash Price |
$2,649.60
|
| Rate for Payer: Cofinity Commercial |
$1,332.98
|
| Rate for Payer: Cofinity Commercial |
$1,240.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.68
|
| Rate for Payer: Healthscope Commercial |
$1,110.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$971.96
|
| Rate for Payer: Meridian Medicaid |
$624.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,018.25
|
| Rate for Payer: Nomi Health Commercial |
$1,110.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,484.00
|
| Rate for Payer: PACE SWMI |
$925.68
|
| Rate for Payer: PHP Medicare Advantage |
$925.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,548.35
|
| Rate for Payer: Priority Health Medicare |
$925.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.35
|
| Rate for Payer: Railroad Medicare Medicare |
$925.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,787.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$925.68
|
| Rate for Payer: UHC Exchange |
$1,787.50
|
| Rate for Payer: UHC Medicaid |
$595.12
|
| Rate for Payer: UHCCP DNSP |
$925.68
|
| Rate for Payer: UHCCP Medicaid |
$595.12
|
|
|
PR TOTAL DISC ARTHRP ANT 2ND LEVEL CERVICAL
|
Professional
|
Both
|
$1,108.00
|
|
|
Service Code
|
HCPCS 22858
|
| Min. Negotiated Rate |
$286.49 |
| Max. Negotiated Rate |
$911.48 |
| Rate for Payer: Aetna Commercial |
$606.06
|
| Rate for Payer: Aetna Medicare |
$452.28
|
| Rate for Payer: BCBS Complete |
$300.81
|
| Rate for Payer: BCBS MAPPO |
$452.28
|
| Rate for Payer: BCN Commercial |
$758.43
|
| Rate for Payer: BCN Medicare Advantage |
$452.28
|
| Rate for Payer: Cash Price |
$886.40
|
| Rate for Payer: Cash Price |
$886.40
|
| Rate for Payer: Cofinity Commercial |
$651.28
|
| Rate for Payer: Cofinity Commercial |
$606.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.28
|
| Rate for Payer: Healthscope Commercial |
$542.74
|
| Rate for Payer: Healthscope Whirlpool |
$542.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.89
|
| Rate for Payer: Meridian Medicaid |
$300.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$497.51
|
| Rate for Payer: Nomi Health Commercial |
$542.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$831.00
|
| Rate for Payer: PACE SWMI |
$452.28
|
| Rate for Payer: PHP Medicare Advantage |
$452.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$810.74
|
| Rate for Payer: Priority Health Medicare |
$452.28
|
| Rate for Payer: Priority Health Narrow Network |
$810.74
|
| Rate for Payer: Railroad Medicare Medicare |
$452.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$911.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$452.28
|
| Rate for Payer: UHC Exchange |
$911.48
|
| Rate for Payer: UHC Medicaid |
$286.49
|
| Rate for Payer: UHCCP DNSP |
$452.28
|
| Rate for Payer: UHCCP Medicaid |
$286.49
|
|
|
PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE CERVICAL
|
Professional
|
Both
|
$3,521.00
|
|
|
Service Code
|
HCPCS 22856
|
| Min. Negotiated Rate |
$970.64 |
| Max. Negotiated Rate |
$2,888.40 |
| Rate for Payer: Aetna Commercial |
$2,024.99
|
| Rate for Payer: Aetna Medicare |
$1,511.19
|
| Rate for Payer: BCBS Complete |
$1,019.17
|
| Rate for Payer: BCBS MAPPO |
$1,511.19
|
| Rate for Payer: BCN Commercial |
$2,458.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,511.19
|
| Rate for Payer: Cash Price |
$2,816.80
|
| Rate for Payer: Cash Price |
$2,816.80
|
| Rate for Payer: Cofinity Commercial |
$2,176.11
|
| Rate for Payer: Cofinity Commercial |
$2,024.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,511.19
|
| Rate for Payer: Healthscope Commercial |
$1,813.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,813.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,586.75
|
| Rate for Payer: Meridian Medicaid |
$1,019.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,662.31
|
| Rate for Payer: Nomi Health Commercial |
$1,813.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,640.75
|
| Rate for Payer: PACE SWMI |
$1,511.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,511.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$970.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,628.11
|
| Rate for Payer: Priority Health Medicare |
$1,511.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,628.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1,511.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,888.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,511.19
|
| Rate for Payer: UHC Exchange |
$2,888.40
|
| Rate for Payer: UHC Medicaid |
$970.64
|
| Rate for Payer: UHCCP DNSP |
$1,511.19
|
| Rate for Payer: UHCCP Medicaid |
$970.64
|
|
|
PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE LUMBAR
|
Professional
|
Both
|
$7,256.00
|
|
|
Service Code
|
HCPCS 22857
|
| Min. Negotiated Rate |
$1,000.46 |
| Max. Negotiated Rate |
$5,442.00 |
| Rate for Payer: Aetna Commercial |
$2,076.77
|
| Rate for Payer: Aetna Medicare |
$1,549.83
|
| Rate for Payer: BCBS Complete |
$1,050.48
|
| Rate for Payer: BCBS MAPPO |
$1,549.83
|
| Rate for Payer: BCN Commercial |
$2,631.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,549.83
|
| Rate for Payer: Cash Price |
$5,804.80
|
| Rate for Payer: Cash Price |
$5,804.80
|
| Rate for Payer: Cofinity Commercial |
$2,231.76
|
| Rate for Payer: Cofinity Commercial |
$2,076.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,549.83
|
| Rate for Payer: Healthscope Commercial |
$1,859.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,859.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,627.32
|
| Rate for Payer: Meridian Medicaid |
$1,050.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,704.81
|
| Rate for Payer: Nomi Health Commercial |
$1,859.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,442.00
|
| Rate for Payer: PACE SWMI |
$1,549.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,549.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,812.82
|
| Rate for Payer: Priority Health Medicare |
$1,549.83
|
| Rate for Payer: Priority Health Narrow Network |
$2,812.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,549.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,120.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,549.83
|
| Rate for Payer: UHC Exchange |
$3,120.85
|
| Rate for Payer: UHC Medicaid |
$1,000.46
|
| Rate for Payer: UHCCP DNSP |
$1,549.83
|
| Rate for Payer: UHCCP Medicaid |
$1,000.46
|
|
|
PR TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY
|
Professional
|
Both
|
$6,062.00
|
|
|
Service Code
|
HCPCS 43112
|
| Min. Negotiated Rate |
$2,039.90 |
| Max. Negotiated Rate |
$6,226.12 |
| Rate for Payer: Aetna Commercial |
$4,296.20
|
| Rate for Payer: Aetna Medicare |
$3,206.12
|
| Rate for Payer: BCBS Complete |
$2,141.89
|
| Rate for Payer: BCBS MAPPO |
$3,206.12
|
| Rate for Payer: BCN Commercial |
$5,037.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,206.12
|
| Rate for Payer: Cash Price |
$4,849.60
|
| Rate for Payer: Cash Price |
$4,849.60
|
| Rate for Payer: Cofinity Commercial |
$4,616.81
|
| Rate for Payer: Cofinity Commercial |
$4,296.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,206.12
|
| Rate for Payer: Healthscope Commercial |
$3,847.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,847.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,366.43
|
| Rate for Payer: Meridian Medicaid |
$2,141.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,526.73
|
| Rate for Payer: Nomi Health Commercial |
$3,847.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,546.50
|
| Rate for Payer: PACE SWMI |
$3,206.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,206.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,039.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,137.95
|
| Rate for Payer: Priority Health Medicare |
$3,206.12
|
| Rate for Payer: Priority Health Narrow Network |
$6,137.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,206.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,226.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,206.12
|
| Rate for Payer: UHC Exchange |
$6,226.12
|
| Rate for Payer: UHC Medicaid |
$2,039.90
|
| Rate for Payer: UHCCP DNSP |
$3,206.12
|
| Rate for Payer: UHCCP Medicaid |
$2,039.90
|
|
|
PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Facility
|
OP
|
$2,621.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
60220
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,837.32 |
| Max. Negotiated Rate |
$7,529.74 |
| Rate for Payer: Aetna Commercial |
$2,358.90
|
| Rate for Payer: Aetna Medicare |
$6,023.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: ASR ASR |
$2,542.37
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,161.01
|
| Rate for Payer: BCN Commercial |
$2,161.01
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cofinity Commercial |
$2,463.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Healthscope Commercial |
$2,542.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,621.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,023.79
|
| Rate for Payer: Mclaren Commercial |
$2,358.90
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$3,308.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,227.85
|
| Rate for Payer: Nomi Health Commercial |
$2,149.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,965.75
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Commercial |
$6,626.17
|
| Rate for Payer: PHP Medicaid |
$3,228.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,296.52
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,837.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP DNSP |
$6,023.79
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
