|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$701.07
|
| Rate for Payer: Aetna Medicare |
$737.00
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$781.39
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Meridian Medicaid |
$364.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$821.30
|
| Rate for Payer: Priority Health Narrow Network |
$821.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.42
|
| Rate for Payer: UHC Exchange |
$637.42
|
| Rate for Payer: UHCCP Medicaid |
$347.40
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$958.10 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,326.60
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$1,429.78
|
| Rate for Payer: ASR Commercial |
$1,429.78
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.06
|
| Rate for Payer: BCN Commercial |
$1,142.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,385.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,429.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,326.60
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: Nomi Health Commercial |
$1,208.68
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.52
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,033.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,297.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$222.41 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$702.23
|
| Rate for Payer: Aetna Medicare |
$778.50
|
| Rate for Payer: BCBS Complete |
$367.24
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCN Commercial |
$783.35
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Meridian Medicaid |
$367.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.89
|
| Rate for Payer: Priority Health Narrow Network |
$825.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.22
|
| Rate for Payer: UHC Exchange |
$588.22
|
| Rate for Payer: UHCCP Medicaid |
$349.75
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$191.45 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$883.30
|
| Rate for Payer: Aetna Medicare |
$926.50
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS Trust/PPO |
$191.45
|
| Rate for Payer: BCN Commercial |
$978.82
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Meridian Medicaid |
$456.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$743.60
|
| Rate for Payer: UHC Exchange |
$743.60
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$1,204.45 |
| Max. Negotiated Rate |
$1,853.00 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: ASR ASR |
$1,797.41
|
| Rate for Payer: ASR Commercial |
$1,797.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,510.01
|
| Rate for Payer: BCN Commercial |
$1,436.63
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,741.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.40
|
| Rate for Payer: Healthscope Commercial |
$1,853.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,797.41
|
| Rate for Payer: Mclaren Commercial |
$1,667.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: Nomi Health Commercial |
$1,519.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,630.64
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$191.45 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$883.30
|
| Rate for Payer: Aetna Medicare |
$926.50
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS Trust/PPO |
$191.45
|
| Rate for Payer: BCN Commercial |
$978.82
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Meridian Medicaid |
$456.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$743.60
|
| Rate for Payer: UHC Exchange |
$743.60
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$1,204.45 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$1,797.41
|
| Rate for Payer: ASR Commercial |
$1,797.41
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.42
|
| Rate for Payer: BCN Commercial |
$1,436.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,741.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,853.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,797.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,667.70
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: Nomi Health Commercial |
$1,519.46
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,623.60
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,298.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,630.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$288.62 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$579.85
|
| Rate for Payer: Aetna Medicare |
$638.00
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$646.52
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Meridian Medicaid |
$303.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.87
|
| Rate for Payer: Priority Health Narrow Network |
$681.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.77
|
| Rate for Payer: UHC Exchange |
$566.77
|
| Rate for Payer: UHCCP Medicaid |
$288.62
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$1,526.79 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.79
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.20
|
| Rate for Payer: Priority Health Narrow Network |
$33.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.40
|
| Rate for Payer: UHC Exchange |
$27.40
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$1,290.64 |
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.64
|
| Rate for Payer: BCN Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.71
|
| Rate for Payer: Priority Health Narrow Network |
$15.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.30
|
| Rate for Payer: UHC Exchange |
$13.30
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
|
|
PR TOBACCO-USE COUNSEL>10MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0437
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$32.16 |
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: 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
|
$24.00
|
|
|
Service Code
|
HCPCS G0436
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.42
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$1,190.79 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.79
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.04
|
| Rate for Payer: Priority Health Narrow Network |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.65
|
| Rate for Payer: UHC Exchange |
$21.65
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$189.36 |
| Max. Negotiated Rate |
$652.98 |
| Rate for Payer: Aetna Commercial |
$381.77
|
| Rate for Payer: Aetna Medicare |
$454.50
|
| Rate for Payer: BCBS Complete |
$198.83
|
| Rate for Payer: BCBS Trust/PPO |
$652.98
|
| Rate for Payer: BCN Commercial |
$428.08
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Meridian Medicaid |
$198.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.98
|
| Rate for Payer: Priority Health Narrow Network |
$527.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.41
|
| Rate for Payer: UHC Exchange |
$355.41
|
| Rate for Payer: UHCCP Medicaid |
$189.36
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$197.45 |
| Max. Negotiated Rate |
$1,924.07 |
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: Aetna Medicare |
$289.50
|
| Rate for Payer: BCBS Complete |
$207.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.07
|
| Rate for Payer: BCN Commercial |
$448.61
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Meridian Medicaid |
$207.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$551.26
|
| Rate for Payer: Priority Health Narrow Network |
$551.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.51
|
| Rate for Payer: UHC Exchange |
$369.51
|
| Rate for Payer: UHCCP Medicaid |
$197.45
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$1,488.22 |
| Rate for Payer: Aetna Commercial |
$347.97
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.22
|
| Rate for Payer: BCN Commercial |
$395.83
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.42
|
| Rate for Payer: Priority Health Narrow Network |
$487.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.86
|
| Rate for Payer: UHC Exchange |
$317.86
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$166.57 |
| Max. Negotiated Rate |
$1,230.94 |
| Rate for Payer: Aetna Commercial |
$332.24
|
| Rate for Payer: Aetna Medicare |
$236.50
|
| Rate for Payer: BCBS Complete |
$174.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.94
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Meridian Medicaid |
$174.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$464.16
|
| Rate for Payer: Priority Health Narrow Network |
$464.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.24
|
| Rate for Payer: UHC Exchange |
$306.24
|
| Rate for Payer: UHCCP Medicaid |
$166.57
|
|
|
PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM
|
Professional
|
Both
|
$2,410.00
|
|
|
Service Code
|
HCPCS 58200
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$2,013.95 |
| Rate for Payer: Aetna Commercial |
$1,612.51
|
| Rate for Payer: Aetna Medicare |
$1,205.00
|
| Rate for Payer: BCBS Complete |
$910.93
|
| Rate for Payer: BCBS Trust/PPO |
$82.02
|
| Rate for Payer: BCN Commercial |
$1,964.97
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Meridian Medicaid |
$910.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$867.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,566.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,013.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,013.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,499.62
|
| Rate for Payer: UHC Exchange |
$1,499.62
|
| Rate for Payer: UHCCP Medicaid |
$867.55
|
|
|
PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY
|
Professional
|
Both
|
$3,357.00
|
|
|
Service Code
|
HCPCS 58152
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$2,182.05 |
| Rate for Payer: Aetna Commercial |
$1,487.05
|
| Rate for Payer: Aetna Medicare |
$1,678.50
|
| Rate for Payer: BCBS Complete |
$831.76
|
| Rate for Payer: BCBS Trust/PPO |
$11.46
|
| Rate for Payer: BCN Commercial |
$1,812.99
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Meridian Medicaid |
$831.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$792.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,182.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,847.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,847.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,430.57
|
| Rate for Payer: UHC Exchange |
$1,430.57
|
| Rate for Payer: UHCCP Medicaid |
$792.15
|
|
|
PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 58150
|
| Min. Negotiated Rate |
$653.91 |
| Max. Negotiated Rate |
$2,929.42 |
| Rate for Payer: Aetna Commercial |
$1,207.92
|
| Rate for Payer: Aetna Medicare |
$1,608.00
|
| Rate for Payer: BCBS Complete |
$686.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,929.42
|
| Rate for Payer: BCN Commercial |
$1,483.63
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Meridian Medicaid |
$686.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$653.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,090.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,518.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,136.71
|
| Rate for Payer: UHC Exchange |
$1,136.71
|
| Rate for Payer: UHCCP Medicaid |
$653.91
|
|
|
PR TOTAL DISC ARTHRP ANT 2ND LEVEL CERVICAL
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 22858
|
| Min. Negotiated Rate |
$65.37 |
| Max. Negotiated Rate |
$768.88 |
| Rate for Payer: Aetna Commercial |
$683.01
|
| Rate for Payer: Aetna Medicare |
$538.00
|
| Rate for Payer: BCBS Complete |
$340.62
|
| Rate for Payer: BCBS Trust/PPO |
$65.37
|
| Rate for Payer: BCN Commercial |
$735.95
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Meridian Medicaid |
$340.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$768.88
|
| Rate for Payer: Priority Health Narrow Network |
$768.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$645.56
|
| Rate for Payer: UHC Exchange |
$645.56
|
| Rate for Payer: UHCCP Medicaid |
$324.40
|
|
|
PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE CERVICAL
|
Professional
|
Both
|
$3,418.00
|
|
|
Service Code
|
HCPCS 22856
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$2,499.52 |
| Rate for Payer: Aetna Commercial |
$2,188.95
|
| Rate for Payer: Aetna Medicare |
$1,709.00
|
| Rate for Payer: BCBS Complete |
$1,104.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: BCN Commercial |
$2,383.28
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Meridian Medicaid |
$1,104.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,051.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,499.52
|
| Rate for Payer: Priority Health Narrow Network |
$2,499.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,927.94
|
| Rate for Payer: UHC Exchange |
$1,927.94
|
| Rate for Payer: UHCCP Medicaid |
$1,051.58
|
|
|
PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE LUMBAR
|
Professional
|
Both
|
$7,045.00
|
|
|
Service Code
|
HCPCS 22857
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$4,579.25 |
| Rate for Payer: Aetna Commercial |
$2,366.42
|
| Rate for Payer: Aetna Medicare |
$3,522.50
|
| Rate for Payer: BCBS Complete |
$1,181.76
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$2,576.80
|
| Rate for Payer: Cash Price |
$5,636.00
|
| Rate for Payer: Cash Price |
$5,636.00
|
| Rate for Payer: Meridian Medicaid |
$1,181.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,125.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,579.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,667.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,667.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,998.31
|
| Rate for Payer: UHC Exchange |
$1,998.31
|
| Rate for Payer: UHCCP Medicaid |
$1,125.49
|
|
|
PR TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY
|
Professional
|
Both
|
$5,885.00
|
|
|
Service Code
|
HCPCS 43112
|
| Min. Negotiated Rate |
$109.36 |
| Max. Negotiated Rate |
$6,094.80 |
| Rate for Payer: Aetna Commercial |
$4,681.60
|
| Rate for Payer: Aetna Medicare |
$2,942.50
|
| Rate for Payer: BCBS Complete |
$2,262.45
|
| Rate for Payer: BCBS Trust/PPO |
$109.36
|
| Rate for Payer: BCN Commercial |
$4,996.73
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Meridian Medicaid |
$2,262.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,154.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,825.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,094.80
|
| Rate for Payer: Priority Health Narrow Network |
$6,094.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,425.70
|
| Rate for Payer: UHC Exchange |
$3,425.70
|
| Rate for Payer: UHCCP Medicaid |
$2,154.71
|
|
|
PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
60220
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,654.25 |
| Max. Negotiated Rate |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$2,290.50
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$2,468.65
|
| Rate for Payer: ASR Commercial |
$2,468.65
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,084.10
|
| Rate for Payer: BCN Commercial |
$1,973.14
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$2,036.00
|
| Rate for Payer: Cash Price |
$2,036.00
|
| Rate for Payer: Cofinity Commercial |
$2,392.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,036.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$2,545.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,468.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$2,290.50
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,163.25
|
| Rate for Payer: Nomi Health Commercial |
$2,086.90
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,229.93
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,784.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,239.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
