|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$5,215.40 |
| Rate for Payer: Aetna Commercial |
$278.43
|
| Rate for Payer: Aetna Medicare |
$216.09
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS MAPPO |
$207.78
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$857.63
|
| Rate for Payer: BCN Medicare Advantage |
$207.78
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$299.20
|
| Rate for Payer: Cofinity Commercial |
$278.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.78
|
| Rate for Payer: Mclaren Medicaid |
$134.19
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.17
|
| Rate for Payer: PACE SWMI |
$207.78
|
| Rate for Payer: PHP Medicare Advantage |
$207.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.17
|
| Rate for Payer: Priority Health Medicare |
$207.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.78
|
| Rate for Payer: UHC Medicare Advantage |
$214.01
|
|
|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,781.00
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$221.09 |
| Max. Negotiated Rate |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$455.01
|
| Rate for Payer: Aetna Medicare |
$353.14
|
| Rate for Payer: BCBS Complete |
$232.14
|
| Rate for Payer: BCBS MAPPO |
$339.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,940.00
|
| Rate for Payer: BCN Commercial |
$828.31
|
| Rate for Payer: BCN Medicare Advantage |
$339.56
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cofinity Commercial |
$488.97
|
| Rate for Payer: Cofinity Commercial |
$455.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.56
|
| Rate for Payer: Mclaren Medicaid |
$221.09
|
| Rate for Payer: Meridian Medicaid |
$232.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.54
|
| Rate for Payer: PACE SWMI |
$339.56
|
| Rate for Payer: PHP Medicare Advantage |
$339.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.97
|
| Rate for Payer: Priority Health Medicare |
$339.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$525.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.56
|
| Rate for Payer: UHC Medicare Advantage |
$349.75
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$1,901.00
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$383.19 |
| Max. Negotiated Rate |
$5,215.40 |
| Rate for Payer: Aetna Commercial |
$796.51
|
| Rate for Payer: Aetna Medicare |
$618.19
|
| Rate for Payer: BCBS Complete |
$402.35
|
| Rate for Payer: BCBS MAPPO |
$594.41
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$872.77
|
| Rate for Payer: BCN Medicare Advantage |
$594.41
|
| Rate for Payer: Cash Price |
$1,520.80
|
| Rate for Payer: Cash Price |
$1,520.80
|
| Rate for Payer: Cofinity Commercial |
$796.51
|
| Rate for Payer: Cofinity Commercial |
$855.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.41
|
| Rate for Payer: Mclaren Medicaid |
$383.19
|
| Rate for Payer: Meridian Medicaid |
$402.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$624.13
|
| Rate for Payer: PACE SWMI |
$594.41
|
| Rate for Payer: PHP Medicare Advantage |
$594.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$912.03
|
| Rate for Payer: Priority Health Medicare |
$594.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$912.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$594.41
|
| Rate for Payer: UHC Medicare Advantage |
$612.24
|
|
|
PR EXPLORATION POPLITEAL ARTERY
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 35741
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$740.60 |
| Rate for Payer: BCBS Complete |
$423.20
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.60
|
|
|
PR EXPLORATION SPINAL FUSION
|
Professional
|
Both
|
$5,074.00
|
|
|
Service Code
|
HCPCS 22830
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$3,551.80 |
| Rate for Payer: Aetna Commercial |
$1,094.10
|
| Rate for Payer: Aetna Medicare |
$849.15
|
| Rate for Payer: BCBS Complete |
$559.58
|
| Rate for Payer: BCBS MAPPO |
$816.49
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,209.96
|
| Rate for Payer: BCN Medicare Advantage |
$816.49
|
| Rate for Payer: Cash Price |
$4,059.20
|
| Rate for Payer: Cash Price |
$4,059.20
|
| Rate for Payer: Cofinity Commercial |
$1,175.75
|
| Rate for Payer: Cofinity Commercial |
$1,094.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.49
|
| Rate for Payer: Mclaren Medicaid |
$532.93
|
| Rate for Payer: Meridian Medicaid |
$559.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$857.31
|
| Rate for Payer: PACE SWMI |
$816.49
|
| Rate for Payer: PHP Medicare Advantage |
$816.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,551.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.37
|
| Rate for Payer: Priority Health Medicare |
$816.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,264.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.49
|
| Rate for Payer: UHC Medicare Advantage |
$840.98
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$492.03 |
| Max. Negotiated Rate |
$1,614.90 |
| Rate for Payer: Aetna Commercial |
$1,022.13
|
| Rate for Payer: Aetna Medicare |
$793.29
|
| Rate for Payer: BCBS Complete |
$516.63
|
| Rate for Payer: BCBS MAPPO |
$762.78
|
| Rate for Payer: BCBS Trust/PPO |
$576.90
|
| Rate for Payer: BCN Commercial |
$1,122.01
|
| Rate for Payer: BCN Medicare Advantage |
$762.78
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$1,022.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.78
|
| Rate for Payer: Mclaren Medicaid |
$492.03
|
| Rate for Payer: Meridian Medicaid |
$516.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$800.92
|
| Rate for Payer: PACE SWMI |
$762.78
|
| Rate for Payer: PHP Medicare Advantage |
$762.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,614.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,349.99
|
| Rate for Payer: Priority Health Medicare |
$762.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,349.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.78
|
| Rate for Payer: UHC Medicare Advantage |
$785.66
|
|
|
PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 20102
|
| Min. Negotiated Rate |
$164.22 |
| Max. Negotiated Rate |
$1,395.80 |
| Rate for Payer: Aetna Commercial |
$336.39
|
| Rate for Payer: Aetna Medicare |
$261.08
|
| Rate for Payer: BCBS Complete |
$172.43
|
| Rate for Payer: BCBS MAPPO |
$251.04
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: BCN Medicare Advantage |
$251.04
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cofinity Commercial |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$336.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.04
|
| Rate for Payer: Mclaren Medicaid |
$164.22
|
| Rate for Payer: Meridian Medicaid |
$172.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.59
|
| Rate for Payer: PACE SWMI |
$251.04
|
| Rate for Payer: PHP Medicare Advantage |
$251.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.07
|
| Rate for Payer: Priority Health Medicare |
$251.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.04
|
| Rate for Payer: UHC Medicare Advantage |
$258.57
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
HCPCS 35840
|
| Min. Negotiated Rate |
$771.06 |
| Max. Negotiated Rate |
$1,913.45 |
| Rate for Payer: Aetna Commercial |
$1,608.48
|
| Rate for Payer: Aetna Medicare |
$1,248.37
|
| Rate for Payer: BCBS Complete |
$809.61
|
| Rate for Payer: BCBS MAPPO |
$1,200.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.11
|
| Rate for Payer: BCN Commercial |
$1,757.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,200.36
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cofinity Commercial |
$1,728.52
|
| Rate for Payer: Cofinity Commercial |
$1,608.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,200.36
|
| Rate for Payer: Mclaren Medicaid |
$771.06
|
| Rate for Payer: Meridian Medicaid |
$809.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,260.38
|
| Rate for Payer: PACE SWMI |
$1,200.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,200.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$771.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,614.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.45
|
| Rate for Payer: Priority Health Medicare |
$1,200.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,913.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,200.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,200.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,236.37
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH
|
Professional
|
Both
|
$5,481.00
|
|
|
Service Code
|
HCPCS 35820
|
| Min. Negotiated Rate |
$1,168.60 |
| Max. Negotiated Rate |
$3,836.70 |
| Rate for Payer: Aetna Commercial |
$2,654.31
|
| Rate for Payer: Aetna Medicare |
$2,060.06
|
| Rate for Payer: BCBS Complete |
$1,324.23
|
| Rate for Payer: BCBS MAPPO |
$1,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,168.60
|
| Rate for Payer: BCN Commercial |
$2,883.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,980.83
|
| Rate for Payer: Cash Price |
$4,384.80
|
| Rate for Payer: Cash Price |
$4,384.80
|
| Rate for Payer: Cofinity Commercial |
$2,654.31
|
| Rate for Payer: Cofinity Commercial |
$2,852.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,980.83
|
| Rate for Payer: Mclaren Medicaid |
$1,261.17
|
| Rate for Payer: Meridian Medicaid |
$1,324.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,079.87
|
| Rate for Payer: PACE SWMI |
$1,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,261.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,836.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,139.08
|
| Rate for Payer: Priority Health Medicare |
$1,980.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,139.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,980.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,040.25
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK
|
Professional
|
Both
|
$1,483.00
|
|
|
Service Code
|
HCPCS 35800
|
| Min. Negotiated Rate |
$465.62 |
| Max. Negotiated Rate |
$1,156.48 |
| Rate for Payer: Aetna Commercial |
$965.20
|
| Rate for Payer: Aetna Medicare |
$749.11
|
| Rate for Payer: BCBS Complete |
$488.90
|
| Rate for Payer: BCBS MAPPO |
$720.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.18
|
| Rate for Payer: BCN Commercial |
$1,062.38
|
| Rate for Payer: BCN Medicare Advantage |
$720.30
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cash Price |
$1,186.40
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| Rate for Payer: Cofinity Commercial |
$1,037.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.30
|
| Rate for Payer: Mclaren Medicaid |
$465.62
|
| Rate for Payer: Meridian Medicaid |
$488.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$756.32
|
| Rate for Payer: PACE SWMI |
$720.30
|
| Rate for Payer: PHP Medicare Advantage |
$720.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,038.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.48
|
| Rate for Payer: Priority Health Medicare |
$720.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,156.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$720.30
|
| Rate for Payer: UHC Medicare Advantage |
$741.91
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$1,494.00
|
|
|
Service Code
|
HCPCS 35860
|
| Min. Negotiated Rate |
$528.24 |
| Max. Negotiated Rate |
$1,310.74 |
| Rate for Payer: Aetna Commercial |
$1,108.27
|
| Rate for Payer: Aetna Medicare |
$860.15
|
| Rate for Payer: BCBS Complete |
$554.65
|
| Rate for Payer: BCBS MAPPO |
$827.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$1,204.10
|
| Rate for Payer: BCN Medicare Advantage |
$827.07
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cofinity Commercial |
$1,190.98
|
| Rate for Payer: Cofinity Commercial |
$1,108.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.07
|
| Rate for Payer: Mclaren Medicaid |
$528.24
|
| Rate for Payer: Meridian Medicaid |
$554.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$868.42
|
| Rate for Payer: PACE SWMI |
$827.07
|
| Rate for Payer: PHP Medicare Advantage |
$827.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$528.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,045.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,310.74
|
| Rate for Payer: Priority Health Medicare |
$827.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,310.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.07
|
| Rate for Payer: UHC Medicare Advantage |
$851.88
|
|
|
PR EXPL RETROPERITONEUM W/WO BX SPX
|
Professional
|
Both
|
$1,992.00
|
|
|
Service Code
|
HCPCS 49010
|
| Min. Negotiated Rate |
$588.09 |
| Max. Negotiated Rate |
$1,612.82 |
| Rate for Payer: Aetna Commercial |
$1,227.27
|
| Rate for Payer: Aetna Medicare |
$952.50
|
| Rate for Payer: BCBS Complete |
$617.49
|
| Rate for Payer: BCBS MAPPO |
$915.87
|
| Rate for Payer: BCBS Trust/PPO |
$588.53
|
| Rate for Payer: BCN Commercial |
$1,340.45
|
| Rate for Payer: BCN Medicare Advantage |
$915.87
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cofinity Commercial |
$1,318.85
|
| Rate for Payer: Cofinity Commercial |
$1,227.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$915.87
|
| Rate for Payer: Mclaren Medicaid |
$588.09
|
| Rate for Payer: Meridian Medicaid |
$617.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$961.66
|
| Rate for Payer: PACE SWMI |
$915.87
|
| Rate for Payer: PHP Medicare Advantage |
$915.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$588.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,612.82
|
| Rate for Payer: Priority Health Medicare |
$915.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,612.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$915.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$915.87
|
| Rate for Payer: UHC Medicare Advantage |
$943.35
|
|
|
PR EXPL RPR & PRESACRAL DRG RECTAL INJURY
|
Professional
|
Both
|
$3,018.00
|
|
|
Service Code
|
HCPCS 45562
|
| Min. Negotiated Rate |
$748.06 |
| Max. Negotiated Rate |
$2,112.60 |
| Rate for Payer: Aetna Commercial |
$1,499.58
|
| Rate for Payer: Aetna Medicare |
$1,163.85
|
| Rate for Payer: BCBS Complete |
$785.46
|
| Rate for Payer: BCBS MAPPO |
$1,119.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.03
|
| Rate for Payer: BCN Commercial |
$1,652.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,119.09
|
| Rate for Payer: Cash Price |
$2,414.40
|
| Rate for Payer: Cash Price |
$2,414.40
|
| Rate for Payer: Cofinity Commercial |
$1,499.58
|
| Rate for Payer: Cofinity Commercial |
$1,611.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,119.09
|
| Rate for Payer: Mclaren Medicaid |
$748.06
|
| Rate for Payer: Meridian Medicaid |
$785.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,175.04
|
| Rate for Payer: PACE SWMI |
$1,119.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,119.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$748.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,112.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,988.53
|
| Rate for Payer: Priority Health Medicare |
$1,119.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,988.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,119.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,119.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.66
|
|
|
PR EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 54560
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$3,980.21 |
| Rate for Payer: Aetna Commercial |
$900.35
|
| Rate for Payer: Aetna Medicare |
$698.78
|
| Rate for Payer: BCBS Complete |
$460.05
|
| Rate for Payer: BCBS MAPPO |
$671.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,980.21
|
| Rate for Payer: BCN Commercial |
$993.00
|
| Rate for Payer: BCN Medicare Advantage |
$671.90
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$900.35
|
| Rate for Payer: Cofinity Commercial |
$967.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.90
|
| Rate for Payer: Mclaren Medicaid |
$438.14
|
| Rate for Payer: Meridian Medicaid |
$460.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$705.50
|
| Rate for Payer: PACE SWMI |
$671.90
|
| Rate for Payer: PHP Medicare Advantage |
$671.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,098.01
|
| Rate for Payer: Priority Health Medicare |
$671.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,098.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$671.90
|
| Rate for Payer: UHC Medicare Advantage |
$692.06
|
|
|
PR EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 54550
|
| Min. Negotiated Rate |
$314.60 |
| Max. Negotiated Rate |
$2,742.41 |
| Rate for Payer: Aetna Commercial |
$643.37
|
| Rate for Payer: Aetna Medicare |
$499.34
|
| Rate for Payer: BCBS Complete |
$330.33
|
| Rate for Payer: BCBS MAPPO |
$480.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,742.41
|
| Rate for Payer: BCN Commercial |
$711.03
|
| Rate for Payer: BCN Medicare Advantage |
$480.13
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cofinity Commercial |
$691.39
|
| Rate for Payer: Cofinity Commercial |
$643.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.13
|
| Rate for Payer: Mclaren Medicaid |
$314.60
|
| Rate for Payer: Meridian Medicaid |
$330.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.14
|
| Rate for Payer: PACE SWMI |
$480.13
|
| Rate for Payer: PHP Medicare Advantage |
$480.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$314.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.22
|
| Rate for Payer: Priority Health Medicare |
$480.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$786.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.13
|
| Rate for Payer: UHC Medicare Advantage |
$494.53
|
|
|
PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 25248
|
| Min. Negotiated Rate |
$277.33 |
| Max. Negotiated Rate |
$1,918.26 |
| Rate for Payer: Aetna Commercial |
$550.63
|
| Rate for Payer: Aetna Medicare |
$427.36
|
| Rate for Payer: BCBS Complete |
$291.20
|
| Rate for Payer: BCBS MAPPO |
$410.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,918.26
|
| Rate for Payer: BCN Commercial |
$615.74
|
| Rate for Payer: BCN Medicare Advantage |
$410.92
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cofinity Commercial |
$591.72
|
| Rate for Payer: Cofinity Commercial |
$550.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.92
|
| Rate for Payer: Mclaren Medicaid |
$277.33
|
| Rate for Payer: Meridian Medicaid |
$291.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$431.47
|
| Rate for Payer: PACE SWMI |
$410.92
|
| Rate for Payer: PHP Medicare Advantage |
$410.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.42
|
| Rate for Payer: Priority Health Medicare |
$410.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$643.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$410.92
|
| Rate for Payer: UHC Medicare Advantage |
$423.25
|
|
|
PR EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 55860
|
| Min. Negotiated Rate |
$555.29 |
| Max. Negotiated Rate |
$2,253.73 |
| Rate for Payer: Aetna Commercial |
$1,145.53
|
| Rate for Payer: Aetna Medicare |
$889.06
|
| Rate for Payer: BCBS Complete |
$583.05
|
| Rate for Payer: BCBS MAPPO |
$854.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,253.73
|
| Rate for Payer: BCN Commercial |
$1,260.78
|
| Rate for Payer: BCN Medicare Advantage |
$854.87
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$1,231.01
|
| Rate for Payer: Cofinity Commercial |
$1,145.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.87
|
| Rate for Payer: Mclaren Medicaid |
$555.29
|
| Rate for Payer: Meridian Medicaid |
$583.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$897.61
|
| Rate for Payer: PACE SWMI |
$854.87
|
| Rate for Payer: PHP Medicare Advantage |
$854.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,148.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,394.12
|
| Rate for Payer: Priority Health Medicare |
$854.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,394.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.87
|
| Rate for Payer: UHC Medicare Advantage |
$880.52
|
|
|
PR EXPRESS FACIAL REFINEMENT OR RELAXATION
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 0296T
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
|
|
PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 0298T
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
|
|
PR EXTENDED ABDOMINOPLASTY
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 00366
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,080.00 |
| Max. Negotiated Rate |
$3,640.00 |
| Rate for Payer: BCBS Complete |
$2,080.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,640.00
|
|
|
PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 59412
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$279.47 |
| Rate for Payer: Aetna Commercial |
$137.73
|
| Rate for Payer: Aetna Medicare |
$106.89
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$102.78
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: BCN Commercial |
$150.03
|
| Rate for Payer: BCN Medicare Advantage |
$102.78
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$137.73
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.78
|
| Rate for Payer: Mclaren Medicaid |
$95.21
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.92
|
| Rate for Payer: PACE SWMI |
$102.78
|
| Rate for Payer: PHP Medicare Advantage |
$102.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.95
|
| Rate for Payer: Priority Health Medicare |
$102.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.78
|
| Rate for Payer: UHC Medicare Advantage |
$105.86
|
|
|
PR EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN
|
Professional
|
Both
|
$3,021.00
|
|
|
Service Code
|
HCPCS 48510
|
| Min. Negotiated Rate |
$250.41 |
| Max. Negotiated Rate |
$2,114.70 |
| Rate for Payer: Aetna Commercial |
$1,460.68
|
| Rate for Payer: Aetna Medicare |
$1,133.66
|
| Rate for Payer: BCBS Complete |
$737.59
|
| Rate for Payer: BCBS MAPPO |
$1,090.06
|
| Rate for Payer: BCBS Trust/PPO |
$250.41
|
| Rate for Payer: BCN Commercial |
$1,605.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,090.06
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cofinity Commercial |
$1,569.69
|
| Rate for Payer: Cofinity Commercial |
$1,460.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,090.06
|
| Rate for Payer: Mclaren Medicaid |
$702.47
|
| Rate for Payer: Meridian Medicaid |
$737.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,144.56
|
| Rate for Payer: PACE SWMI |
$1,090.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,090.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$702.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,114.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,931.48
|
| Rate for Payer: Priority Health Medicare |
$1,090.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,931.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,090.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,122.76
|
|
|
PR EXTERNAL ECG REC>48HR<7D RECORDING
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 93242
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$526.19 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Aetna Medicare |
$11.62
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$11.17
|
| Rate for Payer: BCBS Trust/PPO |
$526.19
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Medicare Advantage |
$11.17
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.73
|
| Rate for Payer: PACE SWMI |
$11.17
|
| Rate for Payer: PHP Medicare Advantage |
$11.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.02
|
| Rate for Payer: Priority Health Medicare |
$11.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.17
|
| Rate for Payer: UHC Medicare Advantage |
$11.51
|
|
|
PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 93244
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$533.05 |
| Rate for Payer: Aetna Commercial |
$30.71
|
| Rate for Payer: Aetna Medicare |
$23.84
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: BCN Commercial |
$27.09
|
| Rate for Payer: BCN Medicare Advantage |
$22.92
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$30.71
|
| Rate for Payer: Cofinity Commercial |
$33.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.92
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.07
|
| Rate for Payer: PACE SWMI |
$22.92
|
| Rate for Payer: PHP Medicare Advantage |
$22.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.62
|
| Rate for Payer: Priority Health Medicare |
$22.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.92
|
| Rate for Payer: UHC Medicare Advantage |
$23.61
|
|
