|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$920.51 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$469.48
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$399.06
|
| Rate for Payer: BCN Commercial |
$399.06
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$454.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$469.48
|
| Rate for Payer: Healthscope Whirlpool |
$484.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$435.60
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.40
|
| Rate for Payer: Nomi Health Commercial |
$396.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$773.55
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$618.84
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$232.91
|
| Rate for Payer: Aetna Medicare |
$173.81
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$173.81
|
| Rate for Payer: BCN Commercial |
$284.85
|
| Rate for Payer: BCN Medicare Advantage |
$173.81
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$250.29
|
| Rate for Payer: Cofinity Commercial |
$232.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.81
|
| Rate for Payer: Healthscope Commercial |
$208.57
|
| Rate for Payer: Healthscope Whirlpool |
$208.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.50
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.19
|
| Rate for Payer: Nomi Health Commercial |
$208.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE SWMI |
$173.81
|
| Rate for Payer: PHP Medicare Advantage |
$173.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$260.70
|
| Rate for Payer: Priority Health Medicare |
$173.81
|
| Rate for Payer: Priority Health Narrow Network |
$260.70
|
| Rate for Payer: Railroad Medicare Medicare |
$173.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.81
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP DNSP |
$173.81
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: ASR ASR |
$469.48
|
| Rate for Payer: BCBS Trust/PPO |
$397.46
|
| Rate for Payer: BCN Commercial |
$397.46
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$454.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.20
|
| Rate for Payer: Healthscope Commercial |
$469.48
|
| Rate for Payer: Healthscope Whirlpool |
$484.00
|
| Rate for Payer: Mclaren Commercial |
$435.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.40
|
| Rate for Payer: Nomi Health Commercial |
$396.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$232.91
|
| Rate for Payer: Aetna Medicare |
$173.81
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$173.81
|
| Rate for Payer: BCN Commercial |
$284.85
|
| Rate for Payer: BCN Medicare Advantage |
$173.81
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$250.29
|
| Rate for Payer: Cofinity Commercial |
$232.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.81
|
| Rate for Payer: Healthscope Commercial |
$208.57
|
| Rate for Payer: Healthscope Whirlpool |
$208.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.50
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.19
|
| Rate for Payer: Nomi Health Commercial |
$208.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE SWMI |
$173.81
|
| Rate for Payer: PHP Medicare Advantage |
$173.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$260.70
|
| Rate for Payer: Priority Health Medicare |
$173.81
|
| Rate for Payer: Priority Health Narrow Network |
$260.70
|
| Rate for Payer: Railroad Medicare Medicare |
$173.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.81
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP DNSP |
$173.81
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Medicare |
$130.62
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$130.62
|
| Rate for Payer: BCN Commercial |
$211.65
|
| Rate for Payer: BCN Medicare Advantage |
$130.62
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$188.09
|
| Rate for Payer: Cofinity Commercial |
$175.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.62
|
| Rate for Payer: Healthscope Commercial |
$156.74
|
| Rate for Payer: Healthscope Whirlpool |
$156.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.15
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.68
|
| Rate for Payer: Nomi Health Commercial |
$156.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.25
|
| Rate for Payer: PACE SWMI |
$130.62
|
| Rate for Payer: PHP Medicare Advantage |
$130.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$193.70
|
| Rate for Payer: Priority Health Medicare |
$130.62
|
| Rate for Payer: Priority Health Narrow Network |
$193.70
|
| Rate for Payer: Railroad Medicare Medicare |
$130.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$130.62
|
| Rate for Payer: UHC Exchange |
$242.19
|
| Rate for Payer: UHC Medicaid |
$85.84
|
| Rate for Payer: UHCCP DNSP |
$130.62
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCNS W/O MNPJ EACH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$248.24
|
| Rate for Payer: Aetna Medicare |
$185.25
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS MAPPO |
$185.25
|
| Rate for Payer: BCN Commercial |
$298.79
|
| Rate for Payer: BCN Medicare Advantage |
$185.25
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$248.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.25
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Healthscope Whirlpool |
$222.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.51
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.78
|
| Rate for Payer: Nomi Health Commercial |
$222.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.00
|
| Rate for Payer: PACE SWMI |
$185.25
|
| Rate for Payer: PHP Medicare Advantage |
$185.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$319.40
|
| Rate for Payer: Priority Health Medicare |
$185.25
|
| Rate for Payer: Priority Health Narrow Network |
$319.40
|
| Rate for Payer: Railroad Medicare Medicare |
$185.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.25
|
| Rate for Payer: UHC Exchange |
$326.62
|
| Rate for Payer: UHC Medicaid |
$123.97
|
| Rate for Payer: UHCCP DNSP |
$185.25
|
| Rate for Payer: UHCCP Medicaid |
$123.97
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MNPJ EACH
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$141.01 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$285.34
|
| Rate for Payer: Aetna Medicare |
$212.94
|
| Rate for Payer: BCBS Complete |
$148.06
|
| Rate for Payer: BCBS MAPPO |
$212.94
|
| Rate for Payer: BCN Commercial |
$353.07
|
| Rate for Payer: BCN Medicare Advantage |
$212.94
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$306.63
|
| Rate for Payer: Cofinity Commercial |
$285.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.94
|
| Rate for Payer: Healthscope Commercial |
$255.53
|
| Rate for Payer: Healthscope Whirlpool |
$255.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.59
|
| Rate for Payer: Meridian Medicaid |
$148.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$234.23
|
| Rate for Payer: Nomi Health Commercial |
$255.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$212.94
|
| Rate for Payer: PHP Medicare Advantage |
$212.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$377.43
|
| Rate for Payer: Priority Health Medicare |
$212.94
|
| Rate for Payer: Priority Health Narrow Network |
$377.43
|
| Rate for Payer: Railroad Medicare Medicare |
$212.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.94
|
| Rate for Payer: UHC Exchange |
$444.48
|
| Rate for Payer: UHC Medicaid |
$141.01
|
| Rate for Payer: UHCCP DNSP |
$212.94
|
| Rate for Payer: UHCCP Medicaid |
$141.01
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,393.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$585.54 |
| Max. Negotiated Rate |
$3,294.75 |
| Rate for Payer: Aetna Commercial |
$1,206.91
|
| Rate for Payer: Aetna Medicare |
$900.68
|
| Rate for Payer: BCBS Complete |
$614.82
|
| Rate for Payer: BCBS MAPPO |
$900.68
|
| Rate for Payer: BCN Commercial |
$1,662.54
|
| Rate for Payer: BCN Medicare Advantage |
$900.68
|
| Rate for Payer: Cash Price |
$3,514.40
|
| Rate for Payer: Cash Price |
$3,514.40
|
| Rate for Payer: Cofinity Commercial |
$1,296.98
|
| Rate for Payer: Cofinity Commercial |
$1,206.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$900.68
|
| Rate for Payer: Healthscope Commercial |
$1,080.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,080.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$945.71
|
| Rate for Payer: Meridian Medicaid |
$614.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$990.75
|
| Rate for Payer: Nomi Health Commercial |
$1,080.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,294.75
|
| Rate for Payer: PACE SWMI |
$900.68
|
| Rate for Payer: PHP Medicare Advantage |
$900.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,617.74
|
| Rate for Payer: Priority Health Medicare |
$900.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,617.74
|
| Rate for Payer: Railroad Medicare Medicare |
$900.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,749.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$900.68
|
| Rate for Payer: UHC Exchange |
$1,749.78
|
| Rate for Payer: UHC Medicaid |
$585.54
|
| Rate for Payer: UHCCP DNSP |
$900.68
|
| Rate for Payer: UHCCP Medicaid |
$585.54
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$328.22
|
| Rate for Payer: Aetna Medicare |
$244.94
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$244.94
|
| Rate for Payer: BCN Commercial |
$431.75
|
| Rate for Payer: BCN Medicare Advantage |
$244.94
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cofinity Commercial |
$352.71
|
| Rate for Payer: Cofinity Commercial |
$328.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.94
|
| Rate for Payer: Healthscope Commercial |
$293.93
|
| Rate for Payer: Healthscope Whirlpool |
$293.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.19
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$269.43
|
| Rate for Payer: Nomi Health Commercial |
$293.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.00
|
| Rate for Payer: PACE SWMI |
$244.94
|
| Rate for Payer: PHP Medicare Advantage |
$244.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$426.60
|
| Rate for Payer: Priority Health Medicare |
$244.94
|
| Rate for Payer: Priority Health Narrow Network |
$426.60
|
| Rate for Payer: Railroad Medicare Medicare |
$244.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$244.94
|
| Rate for Payer: UHC Exchange |
$500.58
|
| Rate for Payer: UHC Medicaid |
$159.11
|
| Rate for Payer: UHCCP DNSP |
$244.94
|
| Rate for Payer: UHCCP Medicaid |
$159.11
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$11.50
|
| Rate for Payer: Aetna Medicare |
$8.58
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.58
|
| Rate for Payer: BCN Commercial |
$15.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.58
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Healthscope Whirlpool |
$10.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.01
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.44
|
| Rate for Payer: Nomi Health Commercial |
$10.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PACE SWMI |
$8.58
|
| Rate for Payer: PHP Medicare Advantage |
$8.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$8.58
|
| Rate for Payer: Priority Health Narrow Network |
$14.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.58
|
| Rate for Payer: UHC Exchange |
$17.52
|
| Rate for Payer: UHC Medicaid |
$5.54
|
| Rate for Payer: UHCCP DNSP |
$8.58
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$35.32 |
| Rate for Payer: Aetna Commercial |
$28.02
|
| Rate for Payer: Aetna Medicare |
$20.91
|
| Rate for Payer: BCBS MAPPO |
$20.91
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$20.91
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$28.02
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.91
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Whirlpool |
$25.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.00
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: PACE SWMI |
$20.91
|
| Rate for Payer: PHP Medicare Advantage |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.86
|
| Rate for Payer: Priority Health Medicare |
$20.91
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.91
|
| Rate for Payer: UHC Exchange |
$35.32
|
| Rate for Payer: UHCCP DNSP |
$20.91
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,877.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$912.71 |
| Max. Negotiated Rate |
$2,630.32 |
| Rate for Payer: Aetna Commercial |
$1,847.12
|
| Rate for Payer: Aetna Medicare |
$1,378.45
|
| Rate for Payer: BCBS Complete |
$958.35
|
| Rate for Payer: BCBS MAPPO |
$1,378.45
|
| Rate for Payer: BCN Commercial |
$2,342.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.45
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cofinity Commercial |
$1,984.97
|
| Rate for Payer: Cofinity Commercial |
$1,847.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.45
|
| Rate for Payer: Healthscope Commercial |
$1,654.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,654.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,447.37
|
| Rate for Payer: Meridian Medicaid |
$958.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,516.30
|
| Rate for Payer: Nomi Health Commercial |
$1,654.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,157.75
|
| Rate for Payer: PACE SWMI |
$1,378.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$912.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,314.14
|
| Rate for Payer: Priority Health Medicare |
$1,378.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,314.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,378.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,378.45
|
| Rate for Payer: UHC Exchange |
$2,630.32
|
| Rate for Payer: UHC Medicaid |
$912.71
|
| Rate for Payer: UHCCP DNSP |
$1,378.45
|
| Rate for Payer: UHCCP Medicaid |
$912.71
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,732.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$861.37 |
| Max. Negotiated Rate |
$2,477.95 |
| Rate for Payer: Aetna Commercial |
$1,739.33
|
| Rate for Payer: Aetna Medicare |
$1,298.01
|
| Rate for Payer: BCBS Complete |
$904.44
|
| Rate for Payer: BCBS MAPPO |
$1,298.01
|
| Rate for Payer: BCN Commercial |
$2,214.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,298.01
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,869.13
|
| Rate for Payer: Cofinity Commercial |
$1,739.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,298.01
|
| Rate for Payer: Healthscope Commercial |
$1,557.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,557.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,362.91
|
| Rate for Payer: Meridian Medicaid |
$904.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,427.81
|
| Rate for Payer: Nomi Health Commercial |
$1,557.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,049.00
|
| Rate for Payer: PACE SWMI |
$1,298.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,298.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$861.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,187.68
|
| Rate for Payer: Priority Health Medicare |
$1,298.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,187.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,298.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,477.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,298.01
|
| Rate for Payer: UHC Exchange |
$2,477.95
|
| Rate for Payer: UHC Medicaid |
$861.37
|
| Rate for Payer: UHCCP DNSP |
$1,298.01
|
| Rate for Payer: UHCCP Medicaid |
$861.37
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$601.51 |
| Max. Negotiated Rate |
$1,776.54 |
| Rate for Payer: Aetna Commercial |
$1,218.69
|
| Rate for Payer: Aetna Medicare |
$909.47
|
| Rate for Payer: BCBS Complete |
$631.59
|
| Rate for Payer: BCBS MAPPO |
$909.47
|
| Rate for Payer: BCN Commercial |
$1,571.13
|
| Rate for Payer: BCN Medicare Advantage |
$909.47
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$1,309.64
|
| Rate for Payer: Cofinity Commercial |
$1,218.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.47
|
| Rate for Payer: Healthscope Commercial |
$1,091.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$954.94
|
| Rate for Payer: Meridian Medicaid |
$631.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,000.42
|
| Rate for Payer: Nomi Health Commercial |
$1,091.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,458.75
|
| Rate for Payer: PACE SWMI |
$909.47
|
| Rate for Payer: PHP Medicare Advantage |
$909.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$601.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,552.43
|
| Rate for Payer: Priority Health Medicare |
$909.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,552.43
|
| Rate for Payer: Railroad Medicare Medicare |
$909.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,776.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$909.47
|
| Rate for Payer: UHC Exchange |
$1,776.54
|
| Rate for Payer: UHC Medicaid |
$601.51
|
| Rate for Payer: UHCCP DNSP |
$909.47
|
| Rate for Payer: UHCCP Medicaid |
$601.51
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$509.71 |
| Max. Negotiated Rate |
$2,429.25 |
| Rate for Payer: Aetna Commercial |
$1,029.94
|
| Rate for Payer: Aetna Medicare |
$768.61
|
| Rate for Payer: BCBS Complete |
$535.20
|
| Rate for Payer: BCBS MAPPO |
$768.61
|
| Rate for Payer: BCN Commercial |
$1,325.62
|
| Rate for Payer: BCN Medicare Advantage |
$768.61
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cofinity Commercial |
$1,106.80
|
| Rate for Payer: Cofinity Commercial |
$1,029.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.61
|
| Rate for Payer: Healthscope Commercial |
$922.33
|
| Rate for Payer: Healthscope Whirlpool |
$922.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$807.04
|
| Rate for Payer: Meridian Medicaid |
$535.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$845.47
|
| Rate for Payer: Nomi Health Commercial |
$922.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,429.25
|
| Rate for Payer: PACE SWMI |
$768.61
|
| Rate for Payer: PHP Medicare Advantage |
$768.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,309.84
|
| Rate for Payer: Priority Health Medicare |
$768.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.84
|
| Rate for Payer: Railroad Medicare Medicare |
$768.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,502.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$768.61
|
| Rate for Payer: UHC Exchange |
$1,502.49
|
| Rate for Payer: UHC Medicaid |
$509.71
|
| Rate for Payer: UHCCP DNSP |
$768.61
|
| Rate for Payer: UHCCP Medicaid |
$509.71
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna Commercial |
$187.28
|
| Rate for Payer: Aetna Medicare |
$139.76
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.76
|
| Rate for Payer: BCN Commercial |
$241.52
|
| Rate for Payer: BCN Medicare Advantage |
$139.76
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$201.25
|
| Rate for Payer: Cofinity Commercial |
$187.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.76
|
| Rate for Payer: Healthscope Commercial |
$167.71
|
| Rate for Payer: Healthscope Whirlpool |
$167.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.75
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$153.74
|
| Rate for Payer: Nomi Health Commercial |
$167.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$139.76
|
| Rate for Payer: PHP Medicare Advantage |
$139.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$238.65
|
| Rate for Payer: Priority Health Medicare |
$139.76
|
| Rate for Payer: Priority Health Narrow Network |
$238.65
|
| Rate for Payer: Railroad Medicare Medicare |
$139.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$139.76
|
| Rate for Payer: UHC Exchange |
$269.61
|
| Rate for Payer: UHC Medicaid |
$92.23
|
| Rate for Payer: UHCCP DNSP |
$139.76
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Aetna Commercial |
$154.27
|
| Rate for Payer: Aetna Medicare |
$115.13
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$115.13
|
| Rate for Payer: BCN Commercial |
$158.26
|
| Rate for Payer: BCN Medicare Advantage |
$115.13
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$165.79
|
| Rate for Payer: Cofinity Commercial |
$154.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.13
|
| Rate for Payer: Healthscope Commercial |
$138.16
|
| Rate for Payer: Healthscope Whirlpool |
$138.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.89
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.64
|
| Rate for Payer: Nomi Health Commercial |
$138.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.25
|
| Rate for Payer: PACE SWMI |
$115.13
|
| Rate for Payer: PHP Medicare Advantage |
$115.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$198.30
|
| Rate for Payer: Priority Health Medicare |
$115.13
|
| Rate for Payer: Priority Health Narrow Network |
$198.30
|
| Rate for Payer: Railroad Medicare Medicare |
$115.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.13
|
| Rate for Payer: UHC Exchange |
$223.28
|
| Rate for Payer: UHC Medicaid |
$76.25
|
| Rate for Payer: UHCCP DNSP |
$115.13
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$2,013.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$618.13 |
| Max. Negotiated Rate |
$1,835.00 |
| Rate for Payer: Aetna Commercial |
$1,253.54
|
| Rate for Payer: Aetna Medicare |
$935.48
|
| Rate for Payer: BCBS Complete |
$649.04
|
| Rate for Payer: BCBS MAPPO |
$935.48
|
| Rate for Payer: BCN Commercial |
$1,612.96
|
| Rate for Payer: BCN Medicare Advantage |
$935.48
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cofinity Commercial |
$1,347.09
|
| Rate for Payer: Cofinity Commercial |
$1,253.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$935.48
|
| Rate for Payer: Healthscope Commercial |
$1,122.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,122.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$982.25
|
| Rate for Payer: Meridian Medicaid |
$649.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,029.03
|
| Rate for Payer: Nomi Health Commercial |
$1,122.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,509.75
|
| Rate for Payer: PACE SWMI |
$935.48
|
| Rate for Payer: PHP Medicare Advantage |
$935.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,593.76
|
| Rate for Payer: Priority Health Medicare |
$935.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,593.76
|
| Rate for Payer: Railroad Medicare Medicare |
$935.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,835.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$935.48
|
| Rate for Payer: UHC Exchange |
$1,835.00
|
| Rate for Payer: UHC Medicaid |
$618.13
|
| Rate for Payer: UHCCP DNSP |
$935.48
|
| Rate for Payer: UHCCP Medicaid |
$618.13
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,745.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$749.97 |
| Max. Negotiated Rate |
$2,808.75 |
| Rate for Payer: Aetna Commercial |
$1,512.61
|
| Rate for Payer: Aetna Medicare |
$1,128.81
|
| Rate for Payer: BCBS Complete |
$787.47
|
| Rate for Payer: BCBS MAPPO |
$1,128.81
|
| Rate for Payer: BCN Commercial |
$1,915.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,128.81
|
| Rate for Payer: Cash Price |
$2,996.00
|
| Rate for Payer: Cash Price |
$2,996.00
|
| Rate for Payer: Cofinity Commercial |
$1,625.49
|
| Rate for Payer: Cofinity Commercial |
$1,512.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,354.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,354.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.25
|
| Rate for Payer: Meridian Medicaid |
$787.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,241.69
|
| Rate for Payer: Nomi Health Commercial |
$1,354.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,808.75
|
| Rate for Payer: PACE SWMI |
$1,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,892.45
|
| Rate for Payer: Priority Health Medicare |
$1,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,892.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,098.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,128.81
|
| Rate for Payer: UHC Exchange |
$2,098.61
|
| Rate for Payer: UHC Medicaid |
$749.97
|
| Rate for Payer: UHCCP DNSP |
$1,128.81
|
| Rate for Payer: UHCCP Medicaid |
$749.97
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$2,066.00
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$362.31 |
| Max. Negotiated Rate |
$1,549.50 |
| Rate for Payer: Aetna Commercial |
$749.57
|
| Rate for Payer: Aetna Medicare |
$559.38
|
| Rate for Payer: BCBS Complete |
$380.43
|
| Rate for Payer: BCBS MAPPO |
$559.38
|
| Rate for Payer: BCN Commercial |
$902.34
|
| Rate for Payer: BCN Medicare Advantage |
$559.38
|
| Rate for Payer: Cash Price |
$1,652.80
|
| Rate for Payer: Cash Price |
$1,652.80
|
| Rate for Payer: Cofinity Commercial |
$749.57
|
| Rate for Payer: Cofinity Commercial |
$805.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.38
|
| Rate for Payer: Healthscope Commercial |
$671.26
|
| Rate for Payer: Healthscope Whirlpool |
$671.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.35
|
| Rate for Payer: Meridian Medicaid |
$380.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$615.32
|
| Rate for Payer: Nomi Health Commercial |
$671.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,549.50
|
| Rate for Payer: PACE SWMI |
$559.38
|
| Rate for Payer: PHP Medicare Advantage |
$559.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,099.45
|
| Rate for Payer: Priority Health Medicare |
$559.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.45
|
| Rate for Payer: Railroad Medicare Medicare |
$559.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,040.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$559.38
|
| Rate for Payer: UHC Exchange |
$1,040.55
|
| Rate for Payer: UHC Medicaid |
$362.31
|
| Rate for Payer: UHCCP DNSP |
$559.38
|
| Rate for Payer: UHCCP Medicaid |
$362.31
|
|
|
PR UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 91299
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
|
|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$102.75 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.75
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$1,023.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$847.47 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Aetna Medicare |
$422.35
|
| Rate for Payer: BCBS Complete |
$284.93
|
| Rate for Payer: BCBS MAPPO |
$422.35
|
| Rate for Payer: BCN Commercial |
$706.64
|
| Rate for Payer: BCN Medicare Advantage |
$422.35
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cofinity Commercial |
$608.18
|
| Rate for Payer: Cofinity Commercial |
$565.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.35
|
| Rate for Payer: Healthscope Commercial |
$506.82
|
| Rate for Payer: Healthscope Whirlpool |
$506.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.47
|
| Rate for Payer: Meridian Medicaid |
$284.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$464.58
|
| Rate for Payer: Nomi Health Commercial |
$506.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$767.25
|
| Rate for Payer: PACE SWMI |
$422.35
|
| Rate for Payer: PHP Medicare Advantage |
$422.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$759.90
|
| Rate for Payer: Priority Health Medicare |
$422.35
|
| Rate for Payer: Priority Health Narrow Network |
$759.90
|
| Rate for Payer: Railroad Medicare Medicare |
$422.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$847.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$422.35
|
| Rate for Payer: UHC Exchange |
$847.47
|
| Rate for Payer: UHC Medicaid |
$271.36
|
| Rate for Payer: UHCCP DNSP |
$422.35
|
| Rate for Payer: UHCCP Medicaid |
$271.36
|
|
|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$632.66 |
| Rate for Payer: Aetna Commercial |
$588.73
|
| Rate for Payer: Aetna Medicare |
$439.35
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$439.35
|
| Rate for Payer: BCN Commercial |
$420.64
|
| Rate for Payer: BCN Medicare Advantage |
$439.35
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$632.66
|
| Rate for Payer: Cofinity Commercial |
$588.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.35
|
| Rate for Payer: Healthscope Commercial |
$527.22
|
| Rate for Payer: Healthscope Whirlpool |
$527.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.29
|
| Rate for Payer: Nomi Health Commercial |
$527.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.75
|
| Rate for Payer: PACE SWMI |
$439.35
|
| Rate for Payer: PHP Medicare Advantage |
$439.35
|
| Rate for Payer: Priority Health Medicare |
$439.35
|
| Rate for Payer: Railroad Medicare Medicare |
$439.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$439.35
|
| Rate for Payer: UHC Exchange |
$143.26
|
| Rate for Payer: UHCCP DNSP |
$439.35
|
|
