|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Medicare |
$141.56
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS MAPPO |
$136.12
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$136.12
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.12
|
| Rate for Payer: Mclaren Medicaid |
$87.12
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.93
|
| Rate for Payer: PACE SWMI |
$136.12
|
| Rate for Payer: PHP Medicare Advantage |
$136.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.08
|
| Rate for Payer: Priority Health Medicare |
$136.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.12
|
| Rate for Payer: UHC Medicare Advantage |
$140.20
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$182.36 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: BCBS Trust/PPO |
$231.07
|
| Rate for Payer: BCN Commercial |
$231.07
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.12
|
| Rate for Payer: UHC Core |
$249.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna Medicare |
$77.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.44
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$74.75
|
| Rate for Payer: BCBS Trust/PPO |
$232.47
|
| Rate for Payer: BCN Commercial |
$232.47
|
| Rate for Payer: BCN Medicare Advantage |
$74.75
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.75
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.15
|
| Rate for Payer: PACE Senior Care Partners |
$71.01
|
| Rate for Payer: PACE SWMI |
$74.75
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: PHP Medicare Advantage |
$74.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.13
|
| Rate for Payer: Priority Health Medicare |
$74.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.12
|
| Rate for Payer: UHC Core |
$249.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.75
|
| Rate for Payer: UHC Medicare Advantage |
$76.99
|
| Rate for Payer: VA VA |
$74.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$438.49 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Medicare |
$141.56
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS MAPPO |
$136.12
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$136.12
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$196.01
|
| Rate for Payer: Cofinity Commercial |
$182.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.12
|
| Rate for Payer: Mclaren Medicaid |
$87.12
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.93
|
| Rate for Payer: PACE SWMI |
$136.12
|
| Rate for Payer: PHP Medicare Advantage |
$136.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.08
|
| Rate for Payer: Priority Health Medicare |
$136.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.12
|
| Rate for Payer: UHC Medicare Advantage |
$140.20
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$369.69
|
| Rate for Payer: Aetna Medicare |
$286.93
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS MAPPO |
$275.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$621.60
|
| Rate for Payer: BCN Medicare Advantage |
$275.89
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$369.69
|
| Rate for Payer: Cofinity Commercial |
$397.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.89
|
| Rate for Payer: Mclaren Medicaid |
$183.18
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.68
|
| Rate for Payer: PACE SWMI |
$275.89
|
| Rate for Payer: PHP Medicare Advantage |
$275.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.77
|
| Rate for Payer: Priority Health Medicare |
$275.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$499.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.89
|
| Rate for Payer: UHC Medicare Advantage |
$284.17
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$148.04 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Aetna Medicare |
$233.67
|
| Rate for Payer: BCBS Complete |
$155.44
|
| Rate for Payer: BCBS MAPPO |
$224.68
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$499.43
|
| Rate for Payer: BCN Medicare Advantage |
$224.68
|
| Rate for Payer: Cash Price |
$471.20
|
| Rate for Payer: Cash Price |
$471.20
|
| Rate for Payer: Cofinity Commercial |
$301.07
|
| Rate for Payer: Cofinity Commercial |
$323.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.68
|
| Rate for Payer: Mclaren Medicaid |
$148.04
|
| Rate for Payer: Meridian Medicaid |
$155.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$235.91
|
| Rate for Payer: PACE SWMI |
$224.68
|
| Rate for Payer: PHP Medicare Advantage |
$224.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.11
|
| Rate for Payer: Priority Health Medicare |
$224.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.68
|
| Rate for Payer: UHC Medicare Advantage |
$231.42
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$795.62 |
| Rate for Payer: Aetna Commercial |
$155.08
|
| Rate for Payer: Aetna Medicare |
$120.36
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$115.73
|
| Rate for Payer: BCBS Trust/PPO |
$795.62
|
| Rate for Payer: BCN Commercial |
$353.31
|
| Rate for Payer: BCN Medicare Advantage |
$115.73
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cofinity Commercial |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$155.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.73
|
| Rate for Payer: Mclaren Medicaid |
$74.55
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.52
|
| Rate for Payer: PACE SWMI |
$115.73
|
| Rate for Payer: PHP Medicare Advantage |
$115.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.09
|
| Rate for Payer: Priority Health Medicare |
$115.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.73
|
| Rate for Payer: UHC Medicare Advantage |
$119.20
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$165.50 |
| Max. Negotiated Rate |
$1,030.71 |
| Rate for Payer: Aetna Commercial |
$334.26
|
| Rate for Payer: Aetna Medicare |
$259.43
|
| Rate for Payer: BCBS Complete |
$173.78
|
| Rate for Payer: BCBS MAPPO |
$249.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$575.17
|
| Rate for Payer: BCN Medicare Advantage |
$249.45
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$359.21
|
| Rate for Payer: Cofinity Commercial |
$334.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.45
|
| Rate for Payer: Mclaren Medicaid |
$165.50
|
| Rate for Payer: Meridian Medicaid |
$173.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$261.92
|
| Rate for Payer: PACE SWMI |
$249.45
|
| Rate for Payer: PHP Medicare Advantage |
$249.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.97
|
| Rate for Payer: Priority Health Medicare |
$249.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$450.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.45
|
| Rate for Payer: UHC Medicare Advantage |
$256.93
|
|
|
PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 94610
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$1,160.68 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$81.12
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$79.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Mclaren Medicaid |
$35.57
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.55
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.19
|
| Rate for Payer: UHC Medicare Advantage |
$56.85
|
|
|
PR INTRAUT COPPER CONTRACEPTIVE
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS J7300
|
| Min. Negotiated Rate |
$896.88 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Aetna Commercial |
$1,085.00
|
| Rate for Payer: BCBS Complete |
$1,139.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.19
|
| Rate for Payer: BCN Commercial |
$896.88
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Mclaren Medicaid |
$1,085.00
|
| Rate for Payer: Meridian Medicaid |
$1,139.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,085.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Aetna Medicare |
$72.17
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$69.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$250.20
|
| Rate for Payer: BCN Medicare Advantage |
$69.39
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$99.92
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.39
|
| Rate for Payer: Mclaren Medicaid |
$43.88
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.86
|
| Rate for Payer: PACE SWMI |
$69.39
|
| Rate for Payer: PHP Medicare Advantage |
$69.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.59
|
| Rate for Payer: Priority Health Medicare |
$69.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.39
|
| Rate for Payer: UHC Medicare Advantage |
$71.47
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 37252
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$1,597.58 |
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna Medicare |
$91.16
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCBS MAPPO |
$87.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,597.58
|
| Rate for Payer: BCN Commercial |
$1,403.97
|
| Rate for Payer: BCN Medicare Advantage |
$87.65
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$126.22
|
| Rate for Payer: Cofinity Commercial |
$117.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.65
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.03
|
| Rate for Payer: PACE SWMI |
$87.65
|
| Rate for Payer: PHP Medicare Advantage |
$87.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.31
|
| Rate for Payer: Priority Health Medicare |
$87.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.65
|
| Rate for Payer: UHC Medicare Advantage |
$90.28
|
|
|
PR INTRAVASC US DURING DX EVAL/ INTERVENTION,EA ADDN VESSEL
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 37251
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
|
|
PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 93609
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$995.32 |
| Rate for Payer: Aetna Commercial |
$507.22
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS Trust/PPO |
$995.32
|
| Rate for Payer: BCN Commercial |
$544.39
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.24
|
|
|
PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 57180
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$527.77 |
| Rate for Payer: Aetna Commercial |
$159.94
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$119.36
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: BCN Medicare Advantage |
$119.36
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$171.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.36
|
| Rate for Payer: Mclaren Medicaid |
$77.96
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.33
|
| Rate for Payer: PACE SWMI |
$119.36
|
| Rate for Payer: PHP Medicare Advantage |
$119.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.28
|
| Rate for Payer: Priority Health Medicare |
$119.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.36
|
| Rate for Payer: UHC Medicare Advantage |
$122.94
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 36901
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$1,036.97 |
| Rate for Payer: Aetna Commercial |
$220.51
|
| Rate for Payer: Aetna Medicare |
$171.14
|
| Rate for Payer: BCBS Complete |
$109.59
|
| Rate for Payer: BCBS MAPPO |
$164.56
|
| Rate for Payer: BCBS Trust/PPO |
$647.17
|
| Rate for Payer: BCN Commercial |
$1,036.97
|
| Rate for Payer: BCN Medicare Advantage |
$164.56
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$236.97
|
| Rate for Payer: Cofinity Commercial |
$220.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.56
|
| Rate for Payer: Mclaren Medicaid |
$104.37
|
| Rate for Payer: Meridian Medicaid |
$109.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.79
|
| Rate for Payer: PACE SWMI |
$164.56
|
| Rate for Payer: PHP Medicare Advantage |
$164.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.20
|
| Rate for Payer: Priority Health Medicare |
$164.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.56
|
| Rate for Payer: UHC Medicare Advantage |
$169.50
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 36903
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$6,303.94 |
| Rate for Payer: Aetna Commercial |
$412.51
|
| Rate for Payer: Aetna Medicare |
$320.15
|
| Rate for Payer: BCBS Complete |
$205.54
|
| Rate for Payer: BCBS MAPPO |
$307.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.97
|
| Rate for Payer: BCN Commercial |
$6,303.94
|
| Rate for Payer: BCN Medicare Advantage |
$307.84
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$443.29
|
| Rate for Payer: Cofinity Commercial |
$412.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.84
|
| Rate for Payer: Mclaren Medicaid |
$195.75
|
| Rate for Payer: Meridian Medicaid |
$205.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$323.23
|
| Rate for Payer: PACE SWMI |
$307.84
|
| Rate for Payer: PHP Medicare Advantage |
$307.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.81
|
| Rate for Payer: Priority Health Medicare |
$307.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.84
|
| Rate for Payer: UHC Medicare Advantage |
$317.08
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 36902
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$313.44
|
| Rate for Payer: Aetna Medicare |
$243.27
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS MAPPO |
$233.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: BCN Commercial |
$1,774.88
|
| Rate for Payer: BCN Medicare Advantage |
$233.91
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$313.44
|
| Rate for Payer: Cofinity Commercial |
$336.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.91
|
| Rate for Payer: Mclaren Medicaid |
$148.89
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$245.61
|
| Rate for Payer: PACE SWMI |
$233.91
|
| Rate for Payer: PHP Medicare Advantage |
$233.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.30
|
| Rate for Payer: Priority Health Medicare |
$233.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.91
|
| Rate for Payer: UHC Medicare Advantage |
$240.93
|
|
|
PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 36013
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$1,157.67 |
| Rate for Payer: Aetna Commercial |
$163.72
|
| Rate for Payer: Aetna Medicare |
$127.07
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$122.18
|
| Rate for Payer: BCBS Trust/PPO |
$800.37
|
| Rate for Payer: BCN Commercial |
$1,157.67
|
| Rate for Payer: BCN Medicare Advantage |
$122.18
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$175.94
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.18
|
| Rate for Payer: Mclaren Medicaid |
$78.17
|
| Rate for Payer: Meridian Medicaid |
$82.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.29
|
| Rate for Payer: PACE SWMI |
$122.18
|
| Rate for Payer: PHP Medicare Advantage |
$122.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.17
|
| Rate for Payer: Priority Health Medicare |
$122.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.18
|
| Rate for Payer: UHC Medicare Advantage |
$125.85
|
|
|
PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 36010
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$1,275.84 |
| Rate for Payer: Aetna Commercial |
$142.38
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS MAPPO |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.84
|
| Rate for Payer: BCN Commercial |
$796.06
|
| Rate for Payer: BCN Medicare Advantage |
$106.25
|
| Rate for Payer: Cash Price |
$764.00
|
| Rate for Payer: Cash Price |
$764.00
|
| Rate for Payer: Cofinity Commercial |
$153.00
|
| Rate for Payer: Cofinity Commercial |
$142.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.25
|
| Rate for Payer: Mclaren Medicaid |
$67.52
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.56
|
| Rate for Payer: PACE SWMI |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$106.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.09
|
| Rate for Payer: Priority Health Medicare |
$106.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.25
|
| Rate for Payer: UHC Medicare Advantage |
$109.44
|
|
|
PR INTRODUCTION CATHETER AORTA
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 36200
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$1,527.32 |
| Rate for Payer: Aetna Commercial |
$183.15
|
| Rate for Payer: Aetna Medicare |
$142.15
|
| Rate for Payer: BCBS Complete |
$91.02
|
| Rate for Payer: BCBS MAPPO |
$136.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,527.32
|
| Rate for Payer: BCN Commercial |
$870.82
|
| Rate for Payer: BCN Medicare Advantage |
$136.68
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$196.82
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.68
|
| Rate for Payer: Mclaren Medicaid |
$86.69
|
| Rate for Payer: Meridian Medicaid |
$91.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.51
|
| Rate for Payer: PACE SWMI |
$136.68
|
| Rate for Payer: PHP Medicare Advantage |
$136.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.44
|
| Rate for Payer: Priority Health Medicare |
$136.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.68
|
| Rate for Payer: UHC Medicare Advantage |
$140.78
|
|
|
PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 44500
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$1,612.90 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$19.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.90
|
| Rate for Payer: BCN Commercial |
$27.85
|
| Rate for Payer: BCN Medicare Advantage |
$19.00
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.00
|
| Rate for Payer: Mclaren Medicaid |
$11.93
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.95
|
| Rate for Payer: PACE SWMI |
$19.00
|
| Rate for Payer: PHP Medicare Advantage |
$19.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.52
|
| Rate for Payer: Priority Health Medicare |
$19.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.00
|
| Rate for Payer: UHC Medicare Advantage |
$19.57
|
|
|
PR INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 36000
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$772.37 |
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$772.37
|
| Rate for Payer: BCN Commercial |
$35.73
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
|
|
PR INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY
|
Professional
|
Both
|
$721.00
|
|
|
Service Code
|
HCPCS 36100
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$1,575.39 |
| Rate for Payer: Aetna Commercial |
$203.22
|
| Rate for Payer: Aetna Medicare |
$157.73
|
| Rate for Payer: BCBS Complete |
$99.53
|
| Rate for Payer: BCBS MAPPO |
$151.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.39
|
| Rate for Payer: BCN Commercial |
$827.33
|
| Rate for Payer: BCN Medicare Advantage |
$151.66
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: Cash Price |
$576.80
|
| Rate for Payer: Cofinity Commercial |
$218.39
|
| Rate for Payer: Cofinity Commercial |
$203.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.66
|
| Rate for Payer: Mclaren Medicaid |
$94.79
|
| Rate for Payer: Meridian Medicaid |
$99.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.24
|
| Rate for Payer: PACE SWMI |
$151.66
|
| Rate for Payer: PHP Medicare Advantage |
$151.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.38
|
| Rate for Payer: Priority Health Medicare |
$151.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.66
|
| Rate for Payer: UHC Medicare Advantage |
$156.21
|
|
|
PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 36140
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$1,951.54 |
| Rate for Payer: Aetna Commercial |
$117.29
|
| Rate for Payer: Aetna Medicare |
$91.03
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$87.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,951.54
|
| Rate for Payer: BCN Commercial |
$749.63
|
| Rate for Payer: BCN Medicare Advantage |
$87.53
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$126.04
|
| Rate for Payer: Cofinity Commercial |
$117.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.53
|
| Rate for Payer: Mclaren Medicaid |
$55.38
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.91
|
| Rate for Payer: PACE SWMI |
$87.53
|
| Rate for Payer: PHP Medicare Advantage |
$87.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.31
|
| Rate for Payer: Priority Health Medicare |
$87.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.53
|
| Rate for Payer: UHC Medicare Advantage |
$90.16
|
|
