|
PR TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR
|
Professional
|
Both
|
$4,310.00
|
|
|
Service Code
|
HCPCS 69644
|
| Min. Negotiated Rate |
$1,406.10 |
| Max. Negotiated Rate |
$2,801.50 |
| Rate for Payer: Aetna Commercial |
$1,884.17
|
| Rate for Payer: Aetna Medicare |
$1,406.10
|
| Rate for Payer: BCBS Complete |
$1,724.00
|
| Rate for Payer: BCBS MAPPO |
$1,406.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,406.10
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,024.78
|
| Rate for Payer: Cofinity Commercial |
$1,884.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,406.10
|
| Rate for Payer: Healthscope Commercial |
$1,687.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,687.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,476.40
|
| Rate for Payer: Nomi Health Commercial |
$1,687.32
|
| Rate for Payer: PACE SWMI |
$1,406.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,406.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,801.50
|
| Rate for Payer: Priority Health Medicare |
$1,406.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,406.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,406.10
|
| Rate for Payer: UHCCP DNSP |
$1,406.10
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 69643
|
| Min. Negotiated Rate |
$1,143.06 |
| Max. Negotiated Rate |
$2,649.40 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$1,143.06
|
| Rate for Payer: BCBS Complete |
$1,630.40
|
| Rate for Payer: BCBS MAPPO |
$1,143.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,143.06
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cofinity Commercial |
$1,646.01
|
| Rate for Payer: Cofinity Commercial |
$1,531.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,143.06
|
| Rate for Payer: Healthscope Commercial |
$1,371.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,371.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,200.21
|
| Rate for Payer: Nomi Health Commercial |
$1,371.67
|
| Rate for Payer: PACE SWMI |
$1,143.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,143.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health Medicare |
$1,143.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,143.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,143.06
|
| Rate for Payer: UHCCP DNSP |
$1,143.06
|
|
|
PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,931.00
|
|
|
Service Code
|
HCPCS 69641
|
| Min. Negotiated Rate |
$972.81 |
| Max. Negotiated Rate |
$2,555.15 |
| Rate for Payer: Aetna Commercial |
$1,303.57
|
| Rate for Payer: Aetna Medicare |
$972.81
|
| Rate for Payer: BCBS Complete |
$1,572.40
|
| Rate for Payer: BCBS MAPPO |
$972.81
|
| Rate for Payer: BCN Medicare Advantage |
$972.81
|
| Rate for Payer: Cash Price |
$3,144.80
|
| Rate for Payer: Cash Price |
$3,144.80
|
| Rate for Payer: Cofinity Commercial |
$1,400.85
|
| Rate for Payer: Cofinity Commercial |
$1,303.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$972.81
|
| Rate for Payer: Healthscope Commercial |
$1,167.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,167.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.45
|
| Rate for Payer: Nomi Health Commercial |
$1,167.37
|
| Rate for Payer: PACE SWMI |
$972.81
|
| Rate for Payer: PHP Medicare Advantage |
$972.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,555.15
|
| Rate for Payer: Priority Health Medicare |
$972.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$972.81
|
| Rate for Payer: UHC Medicare Advantage |
$972.81
|
| Rate for Payer: UHCCP DNSP |
$972.81
|
|
|
PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,684.00
|
|
|
Service Code
|
HCPCS 69642
|
| Min. Negotiated Rate |
$1,073.60 |
| Max. Negotiated Rate |
$1,799.24 |
| Rate for Payer: Aetna Commercial |
$1,674.29
|
| Rate for Payer: Aetna Medicare |
$1,249.47
|
| Rate for Payer: BCBS Complete |
$1,073.60
|
| Rate for Payer: BCBS MAPPO |
$1,249.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,249.47
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cofinity Commercial |
$1,799.24
|
| Rate for Payer: Cofinity Commercial |
$1,674.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,249.47
|
| Rate for Payer: Healthscope Commercial |
$1,499.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,499.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,311.94
|
| Rate for Payer: Nomi Health Commercial |
$1,499.36
|
| Rate for Payer: PACE SWMI |
$1,249.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,249.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health Medicare |
$1,249.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,249.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,249.47
|
| Rate for Payer: UHCCP DNSP |
$1,249.47
|
|
|
PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH
|
Professional
|
Both
|
$3,759.00
|
|
|
Service Code
|
HCPCS 0483T
|
| Min. Negotiated Rate |
$1,503.60 |
| Max. Negotiated Rate |
$2,443.35 |
| Rate for Payer: Aetna Medicare |
$1,879.50
|
| Rate for Payer: BCBS Complete |
$1,503.60
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.35
|
|
|
PR TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27681
|
| Min. Negotiated Rate |
$490.12 |
| Max. Negotiated Rate |
$1,127.75 |
| Rate for Payer: Aetna Commercial |
$656.76
|
| Rate for Payer: Aetna Medicare |
$490.12
|
| Rate for Payer: BCBS Complete |
$694.00
|
| Rate for Payer: BCBS MAPPO |
$490.12
|
| Rate for Payer: BCN Medicare Advantage |
$490.12
|
| Rate for Payer: Cash Price |
$1,388.00
|
| Rate for Payer: Cash Price |
$1,388.00
|
| Rate for Payer: Cofinity Commercial |
$705.77
|
| Rate for Payer: Cofinity Commercial |
$656.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.12
|
| Rate for Payer: Healthscope Commercial |
$588.14
|
| Rate for Payer: Healthscope Whirlpool |
$588.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.63
|
| Rate for Payer: Nomi Health Commercial |
$588.14
|
| Rate for Payer: PACE SWMI |
$490.12
|
| Rate for Payer: PHP Medicare Advantage |
$490.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.75
|
| Rate for Payer: Priority Health Medicare |
$490.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.12
|
| Rate for Payer: UHC Medicare Advantage |
$490.12
|
| Rate for Payer: UHCCP DNSP |
$490.12
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$510.73
|
| Rate for Payer: BCBS Complete |
$589.60
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCN Medicare Advantage |
$510.73
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Cofinity Commercial |
$684.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.73
|
| Rate for Payer: Healthscope Commercial |
$612.88
|
| Rate for Payer: Healthscope Whirlpool |
$612.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.27
|
| Rate for Payer: Nomi Health Commercial |
$612.88
|
| Rate for Payer: PACE SWMI |
$510.73
|
| Rate for Payer: PHP Medicare Advantage |
$510.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$510.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
| Rate for Payer: UHCCP DNSP |
$510.73
|
|
|
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 |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,326.60
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$1,429.78
|
| Rate for Payer: ASR Commercial |
$1,429.78
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.06
|
| Rate for Payer: BCN Commercial |
$1,142.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| 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 |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,429.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,326.60
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| 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 |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| 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 |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,033.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,297.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$958.10 |
| Max. Negotiated Rate |
$1,474.00 |
| Rate for Payer: Aetna Commercial |
$1,326.60
|
| Rate for Payer: ASR ASR |
$1,429.78
|
| Rate for Payer: ASR Commercial |
$1,429.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.16
|
| Rate for Payer: BCN Commercial |
$1,142.79
|
| 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: Healthscope Commercial |
$1,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,429.78
|
| Rate for Payer: Mclaren Commercial |
$1,326.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: Nomi Health Commercial |
$1,208.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,297.12
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$510.73
|
| Rate for Payer: BCBS Complete |
$589.60
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCN Medicare Advantage |
$510.73
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Cofinity Commercial |
$684.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.73
|
| Rate for Payer: Healthscope Commercial |
$612.88
|
| Rate for Payer: Healthscope Whirlpool |
$612.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.27
|
| Rate for Payer: Nomi Health Commercial |
$612.88
|
| Rate for Payer: PACE SWMI |
$510.73
|
| Rate for Payer: PHP Medicare Advantage |
$510.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$510.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
| Rate for Payer: UHCCP DNSP |
$510.73
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$513.88 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$688.60
|
| Rate for Payer: Aetna Medicare |
$513.88
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$513.88
|
| Rate for Payer: BCN Medicare Advantage |
$513.88
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$739.99
|
| Rate for Payer: Cofinity Commercial |
$688.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$513.88
|
| Rate for Payer: Healthscope Commercial |
$616.66
|
| Rate for Payer: Healthscope Whirlpool |
$616.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$539.57
|
| Rate for Payer: Nomi Health Commercial |
$616.66
|
| Rate for Payer: PACE SWMI |
$513.88
|
| Rate for Payer: PHP Medicare Advantage |
$513.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$513.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$513.88
|
| Rate for Payer: UHC Medicare Advantage |
$513.88
|
| Rate for Payer: UHCCP DNSP |
$513.88
|
|
|
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 |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$1,797.41
|
| Rate for Payer: ASR Commercial |
$1,797.41
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.42
|
| Rate for Payer: BCN Commercial |
$1,436.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| 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 |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,853.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,797.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,667.70
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| 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 |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| 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 |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,298.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,630.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
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 |
$641.95 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$860.21
|
| Rate for Payer: Aetna Medicare |
$641.95
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCN Medicare Advantage |
$641.95
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| Rate for Payer: Cofinity Commercial |
$860.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.95
|
| Rate for Payer: Healthscope Commercial |
$770.34
|
| Rate for Payer: Healthscope Whirlpool |
$770.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.05
|
| Rate for Payer: Nomi Health Commercial |
$770.34
|
| Rate for Payer: PACE SWMI |
$641.95
|
| Rate for Payer: PHP Medicare Advantage |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$641.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
| Rate for Payer: UHCCP DNSP |
$641.95
|
|
|
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 |
$641.95 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$860.21
|
| Rate for Payer: Aetna Medicare |
$641.95
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCN Medicare Advantage |
$641.95
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| Rate for Payer: Cofinity Commercial |
$860.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.95
|
| Rate for Payer: Healthscope Commercial |
$770.34
|
| Rate for Payer: Healthscope Whirlpool |
$770.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.05
|
| Rate for Payer: Nomi Health Commercial |
$770.34
|
| Rate for Payer: PACE SWMI |
$641.95
|
| Rate for Payer: PHP Medicare Advantage |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$641.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
| Rate for Payer: UHCCP DNSP |
$641.95
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$423.48 |
| Max. Negotiated Rate |
$829.40 |
| Rate for Payer: Aetna Commercial |
$567.46
|
| Rate for Payer: Aetna Medicare |
$423.48
|
| Rate for Payer: BCBS Complete |
$510.40
|
| Rate for Payer: BCBS MAPPO |
$423.48
|
| Rate for Payer: BCN Medicare Advantage |
$423.48
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cofinity Commercial |
$609.81
|
| Rate for Payer: Cofinity Commercial |
$567.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.48
|
| Rate for Payer: Healthscope Commercial |
$508.18
|
| Rate for Payer: Healthscope Whirlpool |
$508.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.65
|
| Rate for Payer: Nomi Health Commercial |
$508.18
|
| Rate for Payer: PACE SWMI |
$423.48
|
| Rate for Payer: PHP Medicare Advantage |
$423.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health Medicare |
$423.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.48
|
| Rate for Payer: UHC Medicare Advantage |
$423.48
|
| Rate for Payer: UHCCP DNSP |
$423.48
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$33.96 |
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Medicare |
$23.58
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$23.58
|
| Rate for Payer: BCN Medicare Advantage |
$23.58
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$31.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.58
|
| Rate for Payer: Healthscope Commercial |
$25.94
|
| Rate for Payer: Healthscope Whirlpool |
$25.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$28.30
|
| Rate for Payer: PACE SWMI |
$23.58
|
| Rate for Payer: PHP Medicare Advantage |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.58
|
| Rate for Payer: UHCCP DNSP |
$23.58
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$11.17
|
| Rate for Payer: BCN Medicare Advantage |
$11.17
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$12.29
|
| Rate for Payer: Healthscope Whirlpool |
$12.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.73
|
| Rate for Payer: Nomi Health Commercial |
$13.40
|
| Rate for Payer: PACE SWMI |
$11.17
|
| Rate for Payer: PHP Medicare Advantage |
$11.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$11.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.17
|
| Rate for Payer: UHC Medicare Advantage |
$11.17
|
| Rate for Payer: UHCCP DNSP |
$11.17
|
|
|
PR TOBACCO-USE COUNSEL>10MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0437
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
|
|
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: Priority Health Cigna Priority Health |
$15.60
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Aetna Commercial |
$42.37
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$31.62
|
| Rate for Payer: BCN Medicare Advantage |
$31.62
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$37.94
|
| Rate for Payer: Healthscope Whirlpool |
$37.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$37.94
|
| Rate for Payer: PACE SWMI |
$31.62
|
| Rate for Payer: PHP Medicare Advantage |
$31.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.62
|
| Rate for Payer: UHC Medicare Advantage |
$31.62
|
| Rate for Payer: UHCCP DNSP |
$31.62
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$279.29 |
| Max. Negotiated Rate |
$590.85 |
| Rate for Payer: Aetna Commercial |
$374.25
|
| Rate for Payer: Aetna Medicare |
$279.29
|
| Rate for Payer: BCBS Complete |
$363.60
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Cofinity Commercial |
$374.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$335.15
|
| Rate for Payer: Healthscope Whirlpool |
$335.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: Nomi Health Commercial |
$335.15
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.85
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Medicare Advantage |
$279.29
|
| Rate for Payer: UHCCP DNSP |
$279.29
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$419.13 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna Medicare |
$291.06
|
| Rate for Payer: BCBS Complete |
$231.60
|
| Rate for Payer: BCBS MAPPO |
$291.06
|
| Rate for Payer: BCN Medicare Advantage |
$291.06
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cofinity Commercial |
$419.13
|
| Rate for Payer: Cofinity Commercial |
$390.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.06
|
| Rate for Payer: Healthscope Commercial |
$349.27
|
| Rate for Payer: Healthscope Whirlpool |
$349.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.61
|
| Rate for Payer: Nomi Health Commercial |
$349.27
|
| Rate for Payer: PACE SWMI |
$291.06
|
| Rate for Payer: PHP Medicare Advantage |
$291.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.35
|
| Rate for Payer: Priority Health Medicare |
$291.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.06
|
| Rate for Payer: UHC Medicare Advantage |
$291.06
|
| Rate for Payer: UHCCP DNSP |
$291.06
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$370.01 |
| Rate for Payer: Aetna Commercial |
$344.31
|
| Rate for Payer: Aetna Medicare |
$256.95
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$256.95
|
| Rate for Payer: BCN Medicare Advantage |
$256.95
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$370.01
|
| Rate for Payer: Cofinity Commercial |
$344.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.95
|
| Rate for Payer: Healthscope Commercial |
$308.34
|
| Rate for Payer: Healthscope Whirlpool |
$308.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.80
|
| Rate for Payer: Nomi Health Commercial |
$308.34
|
| Rate for Payer: PACE SWMI |
$256.95
|
| Rate for Payer: PHP Medicare Advantage |
$256.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$256.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.95
|
| Rate for Payer: UHC Medicare Advantage |
$256.95
|
| Rate for Payer: UHCCP DNSP |
$256.95
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$352.24 |
| Rate for Payer: Aetna Commercial |
$327.78
|
| Rate for Payer: Aetna Medicare |
$244.61
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$244.61
|
| Rate for Payer: BCN Medicare Advantage |
$244.61
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$352.24
|
| Rate for Payer: Cofinity Commercial |
$327.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.61
|
| Rate for Payer: Healthscope Commercial |
$293.53
|
| Rate for Payer: Healthscope Whirlpool |
$293.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.84
|
| Rate for Payer: Nomi Health Commercial |
$293.53
|
| Rate for Payer: PACE SWMI |
$244.61
|
| Rate for Payer: PHP Medicare Advantage |
$244.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$244.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.61
|
| Rate for Payer: UHC Medicare Advantage |
$244.61
|
| Rate for Payer: UHCCP DNSP |
$244.61
|
|
