|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Aetna Commercial |
$696.15
|
| Rate for Payer: Aetna Medicare |
$212.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.94
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS MAPPO |
$204.75
|
| Rate for Payer: BCBS Trust/PPO |
$636.77
|
| Rate for Payer: BCN Commercial |
$636.77
|
| Rate for Payer: BCN Medicare Advantage |
$204.75
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$704.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$737.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: PACE Senior Care Partners |
$194.51
|
| Rate for Payer: PACE SWMI |
$204.75
|
| Rate for Payer: PHP Commercial |
$696.15
|
| Rate for Payer: PHP Medicare Advantage |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$712.53
|
| Rate for Payer: Priority Health Medicare |
$204.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$499.51
|
| Rate for Payer: Railroad Medicare Medicare |
$204.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.72
|
| Rate for Payer: UHC Core |
$683.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.75
|
| Rate for Payer: UHC Medicare Advantage |
$210.89
|
| Rate for Payer: VA VA |
$204.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.25
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$36.22
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$128.52
|
| Rate for Payer: BCN Medicare Advantage |
$36.22
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$52.16
|
| Rate for Payer: Cofinity Commercial |
$48.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.22
|
| Rate for Payer: Mclaren Medicaid |
$24.07
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.03
|
| Rate for Payer: PACE SWMI |
$36.22
|
| Rate for Payer: PHP Medicare Advantage |
$36.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.62
|
| Rate for Payer: Priority Health Medicare |
$36.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.22
|
| Rate for Payer: UHC Medicare Advantage |
$37.31
|
|
|
PR CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
HCPCS 15788
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$276.31
|
| Rate for Payer: Aetna Medicare |
$214.45
|
| Rate for Payer: BCBS Complete |
$146.26
|
| Rate for Payer: BCBS MAPPO |
$206.20
|
| Rate for Payer: BCBS Trust/PPO |
$25.00
|
| Rate for Payer: BCN Commercial |
$459.42
|
| Rate for Payer: BCN Medicare Advantage |
$206.20
|
| Rate for Payer: Cash Price |
$699.20
|
| Rate for Payer: Cash Price |
$699.20
|
| Rate for Payer: Cofinity Commercial |
$296.93
|
| Rate for Payer: Cofinity Commercial |
$276.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.20
|
| Rate for Payer: Mclaren Medicaid |
$139.30
|
| Rate for Payer: Meridian Medicaid |
$146.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.51
|
| Rate for Payer: PACE SWMI |
$206.20
|
| Rate for Payer: PHP Medicare Advantage |
$206.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.29
|
| Rate for Payer: Priority Health Medicare |
$206.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.20
|
| Rate for Payer: UHC Medicare Advantage |
$212.39
|
|
|
PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 64644
|
| Min. Negotiated Rate |
$74.12 |
| Max. Negotiated Rate |
$896.53 |
| Rate for Payer: Aetna Commercial |
$153.15
|
| Rate for Payer: Aetna Medicare |
$118.86
|
| Rate for Payer: BCBS Complete |
$77.83
|
| Rate for Payer: BCBS MAPPO |
$114.29
|
| Rate for Payer: BCBS Trust/PPO |
$896.53
|
| Rate for Payer: BCN Commercial |
$258.02
|
| Rate for Payer: BCN Medicare Advantage |
$114.29
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$164.58
|
| Rate for Payer: Cofinity Commercial |
$153.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.29
|
| Rate for Payer: Mclaren Medicaid |
$74.12
|
| Rate for Payer: Meridian Medicaid |
$77.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.00
|
| Rate for Payer: PACE SWMI |
$114.29
|
| Rate for Payer: PHP Medicare Advantage |
$114.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.35
|
| Rate for Payer: Priority Health Medicare |
$114.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.29
|
| Rate for Payer: UHC Medicare Advantage |
$117.72
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 64643
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$151.09 |
| Rate for Payer: Aetna Commercial |
$93.26
|
| Rate for Payer: Aetna Medicare |
$72.38
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$69.60
|
| Rate for Payer: BCBS Trust/PPO |
$151.09
|
| Rate for Payer: BCN Commercial |
$135.36
|
| Rate for Payer: BCN Medicare Advantage |
$69.60
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$93.26
|
| Rate for Payer: Cofinity Commercial |
$100.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.60
|
| Rate for Payer: Mclaren Medicaid |
$44.52
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.08
|
| Rate for Payer: PACE SWMI |
$69.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.33
|
| Rate for Payer: Priority Health Medicare |
$69.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.60
|
| Rate for Payer: UHC Medicare Advantage |
$71.69
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 64645
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$831.02 |
| Rate for Payer: Aetna Commercial |
$108.69
|
| Rate for Payer: Aetna Medicare |
$84.35
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS MAPPO |
$81.11
|
| Rate for Payer: BCBS Trust/PPO |
$831.02
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$81.11
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$108.69
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.11
|
| Rate for Payer: Mclaren Medicaid |
$51.76
|
| Rate for Payer: Meridian Medicaid |
$54.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.17
|
| Rate for Payer: PACE SWMI |
$81.11
|
| Rate for Payer: PHP Medicare Advantage |
$81.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.60
|
| Rate for Payer: Priority Health Medicare |
$81.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.11
|
| Rate for Payer: UHC Medicare Advantage |
$83.54
|
|
|
PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 64614
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: BCBS Complete |
$184.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.00
|
|
|
PR CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 46505
|
| Min. Negotiated Rate |
$160.82 |
| Max. Negotiated Rate |
$3,709.19 |
| Rate for Payer: Aetna Commercial |
$328.47
|
| Rate for Payer: Aetna Medicare |
$254.94
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS MAPPO |
$245.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.19
|
| Rate for Payer: BCN Commercial |
$463.76
|
| Rate for Payer: BCN Medicare Advantage |
$245.13
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cofinity Commercial |
$352.99
|
| Rate for Payer: Cofinity Commercial |
$328.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.13
|
| Rate for Payer: Mclaren Medicaid |
$160.82
|
| Rate for Payer: Meridian Medicaid |
$168.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$257.39
|
| Rate for Payer: PACE SWMI |
$245.13
|
| Rate for Payer: PHP Medicare Advantage |
$245.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.74
|
| Rate for Payer: Priority Health Medicare |
$245.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.13
|
| Rate for Payer: UHC Medicare Advantage |
$252.48
|
|
|
PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 64617
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$525.13 |
| Rate for Payer: Aetna Commercial |
$143.31
|
| Rate for Payer: Aetna Medicare |
$111.23
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$106.95
|
| Rate for Payer: BCBS Trust/PPO |
$525.13
|
| Rate for Payer: BCN Commercial |
$238.96
|
| Rate for Payer: BCN Medicare Advantage |
$106.95
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$143.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.95
|
| Rate for Payer: Mclaren Medicaid |
$69.01
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.30
|
| Rate for Payer: PACE SWMI |
$106.95
|
| Rate for Payer: PHP Medicare Advantage |
$106.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$106.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.95
|
| Rate for Payer: UHC Medicare Advantage |
$110.16
|
|
|
PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$3,744.06 |
| Rate for Payer: Aetna Commercial |
$144.45
|
| Rate for Payer: Aetna Medicare |
$112.11
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS MAPPO |
$107.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,744.06
|
| Rate for Payer: BCN Commercial |
$200.85
|
| Rate for Payer: BCN Medicare Advantage |
$107.80
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cofinity Commercial |
$155.23
|
| Rate for Payer: Cofinity Commercial |
$144.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.80
|
| Rate for Payer: Mclaren Medicaid |
$70.50
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.19
|
| Rate for Payer: PACE SWMI |
$107.80
|
| Rate for Payer: PHP Medicare Advantage |
$107.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.02
|
| Rate for Payer: Priority Health Medicare |
$107.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.80
|
| Rate for Payer: UHC Medicare Advantage |
$111.03
|
|
|
PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 64646
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$2,036.60 |
| Rate for Payer: Aetna Commercial |
$153.66
|
| Rate for Payer: Aetna Medicare |
$119.26
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$114.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,036.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: BCN Medicare Advantage |
$114.67
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$153.66
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.67
|
| Rate for Payer: Mclaren Medicaid |
$74.34
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.40
|
| Rate for Payer: PACE SWMI |
$114.67
|
| Rate for Payer: PHP Medicare Advantage |
$114.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.35
|
| Rate for Payer: Priority Health Medicare |
$114.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.67
|
| Rate for Payer: UHC Medicare Advantage |
$118.11
|
|
|
PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 64642
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$805.66 |
| Rate for Payer: Aetna Commercial |
$140.23
|
| Rate for Payer: Aetna Medicare |
$108.84
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS MAPPO |
$104.65
|
| Rate for Payer: BCBS Trust/PPO |
$805.66
|
| Rate for Payer: BCN Commercial |
$220.39
|
| Rate for Payer: BCN Medicare Advantage |
$104.65
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$140.23
|
| Rate for Payer: Cofinity Commercial |
$150.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.65
|
| Rate for Payer: Mclaren Medicaid |
$68.59
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.88
|
| Rate for Payer: PACE SWMI |
$104.65
|
| Rate for Payer: PHP Medicare Advantage |
$104.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.92
|
| Rate for Payer: Priority Health Medicare |
$104.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.65
|
| Rate for Payer: UHC Medicare Advantage |
$107.79
|
|
|
PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 64611
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$939.85 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Aetna Medicare |
$112.35
|
| Rate for Payer: BCBS Complete |
$76.71
|
| Rate for Payer: BCBS MAPPO |
$108.03
|
| Rate for Payer: BCBS Trust/PPO |
$939.85
|
| Rate for Payer: BCN Commercial |
$190.10
|
| Rate for Payer: BCN Medicare Advantage |
$108.03
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$155.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.03
|
| Rate for Payer: Mclaren Medicaid |
$73.06
|
| Rate for Payer: Meridian Medicaid |
$76.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.43
|
| Rate for Payer: PACE SWMI |
$108.03
|
| Rate for Payer: PHP Medicare Advantage |
$108.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.55
|
| Rate for Payer: Priority Health Medicare |
$108.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.03
|
| Rate for Payer: UHC Medicare Advantage |
$111.27
|
|
|
PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$2,950.03 |
| Rate for Payer: Aetna Commercial |
$164.58
|
| Rate for Payer: Aetna Medicare |
$127.73
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$122.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,950.03
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$122.82
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$176.86
|
| Rate for Payer: Cofinity Commercial |
$164.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.82
|
| Rate for Payer: Mclaren Medicaid |
$78.81
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.96
|
| Rate for Payer: PACE SWMI |
$122.82
|
| Rate for Payer: PHP Medicare Advantage |
$122.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.36
|
| Rate for Payer: Priority Health Medicare |
$122.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.82
|
| Rate for Payer: UHC Medicare Advantage |
$126.50
|
|
|
PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$2,247.92 |
| Rate for Payer: Aetna Commercial |
$154.31
|
| Rate for Payer: Aetna Medicare |
$119.77
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS MAPPO |
$115.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,247.92
|
| Rate for Payer: BCN Commercial |
$160.60
|
| Rate for Payer: BCN Medicare Advantage |
$115.16
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$165.83
|
| Rate for Payer: Cofinity Commercial |
$154.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.16
|
| Rate for Payer: Mclaren Medicaid |
$76.68
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.92
|
| Rate for Payer: PACE SWMI |
$115.16
|
| Rate for Payer: PHP Medicare Advantage |
$115.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.44
|
| Rate for Payer: Priority Health Medicare |
$115.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.16
|
| Rate for Payer: UHC Medicare Advantage |
$118.61
|
|
|
PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 96415
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$1,570.64 |
| Rate for Payer: Aetna Commercial |
$35.67
|
| Rate for Payer: Aetna Medicare |
$27.68
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$26.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,570.64
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: BCN Medicare Advantage |
$26.62
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$38.33
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.95
|
| Rate for Payer: PACE SWMI |
$26.62
|
| Rate for Payer: PHP Medicare Advantage |
$26.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.73
|
| Rate for Payer: Priority Health Medicare |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.62
|
| Rate for Payer: UHC Medicare Advantage |
$27.42
|
|
|
PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 96450
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$889.66 |
| Rate for Payer: Aetna Commercial |
$101.13
|
| Rate for Payer: Aetna Medicare |
$78.49
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS MAPPO |
$75.47
|
| Rate for Payer: BCBS Trust/PPO |
$889.66
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: BCN Medicare Advantage |
$75.47
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$101.13
|
| Rate for Payer: Cofinity Commercial |
$108.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.47
|
| Rate for Payer: Mclaren Medicaid |
$48.14
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.24
|
| Rate for Payer: PACE SWMI |
$75.47
|
| Rate for Payer: PHP Medicare Advantage |
$75.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.95
|
| Rate for Payer: Priority Health Medicare |
$75.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.47
|
| Rate for Payer: UHC Medicare Advantage |
$77.73
|
|
|
PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 96417
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna Commercial |
$80.57
|
| Rate for Payer: Aetna Medicare |
$62.54
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$60.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.41
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: BCN Medicare Advantage |
$60.13
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$80.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.14
|
| Rate for Payer: PACE SWMI |
$60.13
|
| Rate for Payer: PHP Medicare Advantage |
$60.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.23
|
| Rate for Payer: Priority Health Medicare |
$60.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.13
|
| Rate for Payer: UHC Medicare Advantage |
$61.93
|
|
|
PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 96413
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$1,457.05 |
| Rate for Payer: Aetna Commercial |
$162.98
|
| Rate for Payer: Aetna Medicare |
$126.50
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$121.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.05
|
| Rate for Payer: BCN Commercial |
$190.59
|
| Rate for Payer: BCN Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$175.15
|
| Rate for Payer: Cofinity Commercial |
$162.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.71
|
| Rate for Payer: PACE SWMI |
$121.63
|
| Rate for Payer: PHP Medicare Advantage |
$121.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.17
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.63
|
| Rate for Payer: UHC Medicare Advantage |
$125.28
|
|
|
PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96409
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$1,506.18 |
| Rate for Payer: Aetna Commercial |
$125.93
|
| Rate for Payer: Aetna Medicare |
$97.74
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$93.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,506.18
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: BCN Medicare Advantage |
$93.98
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$135.33
|
| Rate for Payer: Cofinity Commercial |
$125.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.68
|
| Rate for Payer: PACE SWMI |
$93.98
|
| Rate for Payer: PHP Medicare Advantage |
$93.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.19
|
| Rate for Payer: Priority Health Medicare |
$93.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.98
|
| Rate for Payer: UHC Medicare Advantage |
$96.80
|
|
|
PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 96411
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$1,466.56 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$53.83
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS MAPPO |
$51.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,466.56
|
| Rate for Payer: BCN Commercial |
$80.63
|
| Rate for Payer: BCN Medicare Advantage |
$51.76
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$74.53
|
| Rate for Payer: Cofinity Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.35
|
| Rate for Payer: PACE SWMI |
$51.76
|
| Rate for Payer: PHP Medicare Advantage |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$51.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.76
|
| Rate for Payer: UHC Medicare Advantage |
$53.31
|
|
|
PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 96402
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$1,217.73 |
| Rate for Payer: Aetna Commercial |
$42.69
|
| Rate for Payer: Aetna Medicare |
$33.13
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$31.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.73
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: BCN Medicare Advantage |
$31.86
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$42.69
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.45
|
| Rate for Payer: PACE SWMI |
$31.86
|
| Rate for Payer: PHP Medicare Advantage |
$31.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Medicare |
$31.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.86
|
| Rate for Payer: UHC Medicare Advantage |
$32.82
|
|
|
PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 96401
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$1,111.54 |
| Rate for Payer: Aetna Commercial |
$90.92
|
| Rate for Payer: Aetna Medicare |
$70.56
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$67.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.54
|
| Rate for Payer: BCN Commercial |
$106.04
|
| Rate for Payer: BCN Medicare Advantage |
$67.85
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$97.70
|
| Rate for Payer: Cofinity Commercial |
$90.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.24
|
| Rate for Payer: PACE SWMI |
$67.85
|
| Rate for Payer: PHP Medicare Advantage |
$67.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.47
|
| Rate for Payer: Priority Health Medicare |
$67.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.85
|
| Rate for Payer: UHC Medicare Advantage |
$69.89
|
|
|
PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 96542
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$1,570.64 |
| Rate for Payer: Aetna Commercial |
$54.78
|
| Rate for Payer: Aetna Medicare |
$42.52
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$40.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,570.64
|
| Rate for Payer: BCN Commercial |
$189.12
|
| Rate for Payer: BCN Medicare Advantage |
$40.88
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$58.87
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.88
|
| Rate for Payer: Mclaren Medicaid |
$26.63
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.92
|
| Rate for Payer: PACE SWMI |
$40.88
|
| Rate for Payer: PHP Medicare Advantage |
$40.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.69
|
| Rate for Payer: Priority Health Medicare |
$40.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.88
|
| Rate for Payer: UHC Medicare Advantage |
$42.11
|
|
|
PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 98941
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$583.77 |
| Rate for Payer: Aetna Commercial |
$44.31
|
| Rate for Payer: Aetna Medicare |
$34.39
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$33.07
|
| Rate for Payer: BCBS Trust/PPO |
$583.77
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Medicare Advantage |
$33.07
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$47.62
|
| Rate for Payer: Cofinity Commercial |
$44.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.72
|
| Rate for Payer: PACE SWMI |
$33.07
|
| Rate for Payer: PHP Medicare Advantage |
$33.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.92
|
| Rate for Payer: Priority Health Medicare |
$33.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.07
|
| Rate for Payer: UHC Medicare Advantage |
$34.06
|
|
