|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$535.75 |
| Rate for Payer: Aetna Commercial |
$498.55
|
| Rate for Payer: Aetna Medicare |
$372.05
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$372.05
|
| Rate for Payer: BCN Medicare Advantage |
$372.05
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$535.75
|
| Rate for Payer: Cofinity Commercial |
$498.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.05
|
| Rate for Payer: Healthscope Commercial |
$446.46
|
| Rate for Payer: Healthscope Whirlpool |
$446.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.65
|
| Rate for Payer: Nomi Health Commercial |
$446.46
|
| Rate for Payer: PACE SWMI |
$372.05
|
| Rate for Payer: PHP Medicare Advantage |
$372.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$372.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
| Rate for Payer: UHCCP DNSP |
$372.05
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$489.76
|
| Rate for Payer: Aetna Medicare |
$365.49
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$365.49
|
| Rate for Payer: BCN Medicare Advantage |
$365.49
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Cofinity Commercial |
$489.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.49
|
| Rate for Payer: Healthscope Commercial |
$438.59
|
| Rate for Payer: Healthscope Whirlpool |
$438.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$383.76
|
| Rate for Payer: Nomi Health Commercial |
$438.59
|
| Rate for Payer: PACE SWMI |
$365.49
|
| Rate for Payer: PHP Medicare Advantage |
$365.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$365.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$365.49
|
| Rate for Payer: UHC Medicare Advantage |
$365.49
|
| Rate for Payer: UHCCP DNSP |
$365.49
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$229.53 |
| Max. Negotiated Rate |
$412.75 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$229.53
|
| Rate for Payer: BCBS Complete |
$254.00
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Healthscope Commercial |
$275.44
|
| Rate for Payer: Healthscope Whirlpool |
$275.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health Medicare |
$229.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
| Rate for Payer: UHCCP DNSP |
$229.53
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$273.45
|
| Rate for Payer: BCBS Complete |
$248.40
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Healthscope Commercial |
$328.14
|
| Rate for Payer: Healthscope Whirlpool |
$328.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.65
|
| Rate for Payer: Priority Health Medicare |
$273.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.45
|
| Rate for Payer: UHC Medicare Advantage |
$273.45
|
| Rate for Payer: UHCCP DNSP |
$273.45
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$602.02
|
| Rate for Payer: Aetna Medicare |
$449.27
|
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: BCBS MAPPO |
$449.27
|
| Rate for Payer: BCN Medicare Advantage |
$449.27
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$646.95
|
| Rate for Payer: Cofinity Commercial |
$602.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$539.12
|
| Rate for Payer: Healthscope Whirlpool |
$539.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.73
|
| Rate for Payer: Nomi Health Commercial |
$539.12
|
| Rate for Payer: PACE SWMI |
$449.27
|
| Rate for Payer: PHP Medicare Advantage |
$449.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health Medicare |
$449.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.27
|
| Rate for Payer: UHC Medicare Advantage |
$449.27
|
| Rate for Payer: UHCCP DNSP |
$449.27
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,455.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$890.05 |
| Max. Negotiated Rate |
$4,195.75 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$890.05
|
| Rate for Payer: BCBS Complete |
$2,582.00
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Healthscope Commercial |
$1,068.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,195.75
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
| Rate for Payer: UHCCP DNSP |
$890.05
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$349.04 |
| Max. Negotiated Rate |
$567.45 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Aetna Medicare |
$349.04
|
| Rate for Payer: BCBS Complete |
$349.20
|
| Rate for Payer: BCBS MAPPO |
$349.04
|
| Rate for Payer: BCN Medicare Advantage |
$349.04
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$502.62
|
| Rate for Payer: Cofinity Commercial |
$467.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.04
|
| Rate for Payer: Healthscope Commercial |
$418.85
|
| Rate for Payer: Healthscope Whirlpool |
$418.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.49
|
| Rate for Payer: Nomi Health Commercial |
$418.85
|
| Rate for Payer: PACE SWMI |
$349.04
|
| Rate for Payer: PHP Medicare Advantage |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health Medicare |
$349.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.04
|
| Rate for Payer: UHC Medicare Advantage |
$349.04
|
| Rate for Payer: UHCCP DNSP |
$349.04
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Healthscope Commercial |
$215.87
|
| Rate for Payer: Healthscope Whirlpool |
$215.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$179.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
| Rate for Payer: UHCCP DNSP |
$179.89
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Healthscope Commercial |
$215.87
|
| Rate for Payer: Healthscope Whirlpool |
$215.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$179.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
| Rate for Payer: UHCCP DNSP |
$179.89
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Trust/PPO |
$383.00
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$384.88
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.81
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$329.47
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$226.85 |
| Rate for Payer: Aetna Commercial |
$178.51
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$133.22
|
| Rate for Payer: BCN Medicare Advantage |
$133.22
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$191.84
|
| Rate for Payer: Cofinity Commercial |
$178.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.22
|
| Rate for Payer: Healthscope Commercial |
$159.86
|
| Rate for Payer: Healthscope Whirlpool |
$159.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.88
|
| Rate for Payer: Nomi Health Commercial |
$159.86
|
| Rate for Payer: PACE SWMI |
$133.22
|
| Rate for Payer: PHP Medicare Advantage |
$133.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$133.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.22
|
| Rate for Payer: UHC Medicare Advantage |
$133.22
|
| Rate for Payer: UHCCP DNSP |
$133.22
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$220.37 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$295.30
|
| Rate for Payer: Aetna Medicare |
$220.37
|
| Rate for Payer: BCBS Complete |
$323.20
|
| Rate for Payer: BCBS MAPPO |
$220.37
|
| Rate for Payer: BCN Medicare Advantage |
$220.37
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$317.33
|
| Rate for Payer: Cofinity Commercial |
$295.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.37
|
| Rate for Payer: Healthscope Commercial |
$264.44
|
| Rate for Payer: Healthscope Whirlpool |
$264.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.39
|
| Rate for Payer: Nomi Health Commercial |
$264.44
|
| Rate for Payer: PACE SWMI |
$220.37
|
| Rate for Payer: PHP Medicare Advantage |
$220.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health Medicare |
$220.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.37
|
| Rate for Payer: UHC Medicare Advantage |
$220.37
|
| Rate for Payer: UHCCP DNSP |
$220.37
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$185.02 |
| Max. Negotiated Rate |
$378.95 |
| Rate for Payer: Aetna Commercial |
$247.93
|
| Rate for Payer: Aetna Medicare |
$185.02
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$185.02
|
| Rate for Payer: BCN Medicare Advantage |
$185.02
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$266.43
|
| Rate for Payer: Cofinity Commercial |
$247.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.02
|
| Rate for Payer: Healthscope Commercial |
$222.02
|
| Rate for Payer: Healthscope Whirlpool |
$222.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.27
|
| Rate for Payer: Nomi Health Commercial |
$222.02
|
| Rate for Payer: PACE SWMI |
$185.02
|
| Rate for Payer: PHP Medicare Advantage |
$185.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$185.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.02
|
| Rate for Payer: UHC Medicare Advantage |
$185.02
|
| Rate for Payer: UHCCP DNSP |
$185.02
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$2,772.25 |
| Rate for Payer: Aetna Commercial |
$1,288.91
|
| Rate for Payer: Aetna Medicare |
$961.87
|
| Rate for Payer: BCBS Complete |
$1,706.00
|
| Rate for Payer: BCBS MAPPO |
$961.87
|
| Rate for Payer: BCN Medicare Advantage |
$961.87
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cofinity Commercial |
$1,385.09
|
| Rate for Payer: Cofinity Commercial |
$1,288.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.87
|
| Rate for Payer: Healthscope Commercial |
$1,154.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,154.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,009.96
|
| Rate for Payer: Nomi Health Commercial |
$1,154.24
|
| Rate for Payer: PACE SWMI |
$961.87
|
| Rate for Payer: PHP Medicare Advantage |
$961.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,772.25
|
| Rate for Payer: Priority Health Medicare |
$961.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$961.87
|
| Rate for Payer: UHC Medicare Advantage |
$961.87
|
| Rate for Payer: UHCCP DNSP |
$961.87
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$267.20 |
| Max. Negotiated Rate |
$434.20 |
| Rate for Payer: Aetna Commercial |
$366.87
|
| Rate for Payer: Aetna Medicare |
$273.78
|
| Rate for Payer: BCBS Complete |
$267.20
|
| Rate for Payer: BCBS MAPPO |
$273.78
|
| Rate for Payer: BCN Medicare Advantage |
$273.78
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cofinity Commercial |
$394.24
|
| Rate for Payer: Cofinity Commercial |
$366.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.78
|
| Rate for Payer: Healthscope Commercial |
$328.54
|
| Rate for Payer: Healthscope Whirlpool |
$328.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.47
|
| Rate for Payer: Nomi Health Commercial |
$328.54
|
| Rate for Payer: PACE SWMI |
$273.78
|
| Rate for Payer: PHP Medicare Advantage |
$273.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.20
|
| Rate for Payer: Priority Health Medicare |
$273.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.78
|
| Rate for Payer: UHC Medicare Advantage |
$273.78
|
| Rate for Payer: UHCCP DNSP |
$273.78
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$10.09
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.09
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.09
|
| Rate for Payer: Healthscope Commercial |
$12.11
|
| Rate for Payer: Healthscope Whirlpool |
$12.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Nomi Health Commercial |
$12.11
|
| Rate for Payer: PACE SWMI |
$10.09
|
| Rate for Payer: PHP Medicare Advantage |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$10.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.09
|
| Rate for Payer: UHCCP DNSP |
$10.09
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$27.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$24.30
|
| Rate for Payer: Healthscope Whirlpool |
$24.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: Nomi Health Commercial |
$24.30
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$20.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.25
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
| Rate for Payer: UHCCP DNSP |
$20.25
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,117.20 |
| Max. Negotiated Rate |
$2,104.01 |
| Rate for Payer: Aetna Commercial |
$1,957.90
|
| Rate for Payer: Aetna Medicare |
$1,461.12
|
| Rate for Payer: BCBS Complete |
$1,117.20
|
| Rate for Payer: BCBS MAPPO |
$1,461.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,461.12
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,104.01
|
| Rate for Payer: Cofinity Commercial |
$1,957.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,461.12
|
| Rate for Payer: Healthscope Commercial |
$1,753.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,753.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,534.18
|
| Rate for Payer: Nomi Health Commercial |
$1,753.34
|
| Rate for Payer: PACE SWMI |
$1,461.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,461.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.45
|
| Rate for Payer: Priority Health Medicare |
$1,461.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,461.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,461.12
|
| Rate for Payer: UHCCP DNSP |
$1,461.12
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,985.89 |
| Rate for Payer: Aetna Commercial |
$1,847.98
|
| Rate for Payer: Aetna Medicare |
$1,379.09
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,379.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.09
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,985.89
|
| Rate for Payer: Cofinity Commercial |
$1,847.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.09
|
| Rate for Payer: Healthscope Commercial |
$1,654.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,654.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.04
|
| Rate for Payer: Nomi Health Commercial |
$1,654.91
|
| Rate for Payer: PACE SWMI |
$1,379.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,379.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,379.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,379.09
|
| Rate for Payer: UHCCP DNSP |
$1,379.09
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$1,413.00 |
| Rate for Payer: Aetna Commercial |
$1,314.88
|
| Rate for Payer: Aetna Medicare |
$981.25
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$981.25
|
| Rate for Payer: BCN Medicare Advantage |
$981.25
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,413.00
|
| Rate for Payer: Cofinity Commercial |
$1,314.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.31
|
| Rate for Payer: Nomi Health Commercial |
$1,177.50
|
| Rate for Payer: PACE SWMI |
$981.25
|
| Rate for Payer: PHP Medicare Advantage |
$981.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$981.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.25
|
| Rate for Payer: UHC Medicare Advantage |
$981.25
|
| Rate for Payer: UHCCP DNSP |
$981.25
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,145.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$825.82 |
| Max. Negotiated Rate |
$2,044.25 |
| Rate for Payer: Aetna Commercial |
$1,106.60
|
| Rate for Payer: Aetna Medicare |
$825.82
|
| Rate for Payer: BCBS Complete |
$1,258.00
|
| Rate for Payer: BCBS MAPPO |
$825.82
|
| Rate for Payer: BCN Medicare Advantage |
$825.82
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cofinity Commercial |
$1,189.18
|
| Rate for Payer: Cofinity Commercial |
$1,106.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$825.82
|
| Rate for Payer: Healthscope Commercial |
$990.98
|
| Rate for Payer: Healthscope Whirlpool |
$990.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.11
|
| Rate for Payer: Nomi Health Commercial |
$990.98
|
| Rate for Payer: PACE SWMI |
$825.82
|
| Rate for Payer: PHP Medicare Advantage |
$825.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.25
|
| Rate for Payer: Priority Health Medicare |
$825.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$825.82
|
| Rate for Payer: UHC Medicare Advantage |
$825.82
|
| Rate for Payer: UHCCP DNSP |
$825.82
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$245.05 |
| Rate for Payer: Aetna Commercial |
$202.55
|
| Rate for Payer: Aetna Medicare |
$151.16
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$151.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.16
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Cofinity Commercial |
$202.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.16
|
| Rate for Payer: Healthscope Commercial |
$181.39
|
| Rate for Payer: Healthscope Whirlpool |
$181.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.72
|
| Rate for Payer: Nomi Health Commercial |
$181.39
|
| Rate for Payer: PACE SWMI |
$151.16
|
| Rate for Payer: PHP Medicare Advantage |
$151.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$151.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.16
|
| Rate for Payer: UHC Medicare Advantage |
$151.16
|
| Rate for Payer: UHCCP DNSP |
$151.16
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna Commercial |
$167.69
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS MAPPO |
$125.14
|
| Rate for Payer: BCN Medicare Advantage |
$125.14
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$180.20
|
| Rate for Payer: Cofinity Commercial |
$167.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.14
|
| Rate for Payer: Healthscope Commercial |
$150.17
|
| Rate for Payer: Healthscope Whirlpool |
$150.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.40
|
| Rate for Payer: Nomi Health Commercial |
$150.17
|
| Rate for Payer: PACE SWMI |
$125.14
|
| Rate for Payer: PHP Medicare Advantage |
$125.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health Medicare |
$125.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.14
|
| Rate for Payer: UHC Medicare Advantage |
$125.14
|
| Rate for Payer: UHCCP DNSP |
$125.14
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$781.60 |
| Max. Negotiated Rate |
$1,451.20 |
| Rate for Payer: Aetna Commercial |
$1,350.43
|
| Rate for Payer: Aetna Medicare |
$1,007.78
|
| Rate for Payer: BCBS Complete |
$781.60
|
| Rate for Payer: BCBS MAPPO |
$1,007.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.78
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cofinity Commercial |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,350.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.78
|
| Rate for Payer: Healthscope Commercial |
$1,209.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,209.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.17
|
| Rate for Payer: Nomi Health Commercial |
$1,209.34
|
| Rate for Payer: PACE SWMI |
$1,007.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.10
|
| Rate for Payer: Priority Health Medicare |
$1,007.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.78
|
| Rate for Payer: UHCCP DNSP |
$1,007.78
|
|
