|
PR DRAINAGE ABSCESS PALATE UVULA
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 42000
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial |
$138.07
|
| Rate for Payer: Aetna Medicare |
$107.16
|
| Rate for Payer: BCBS Complete |
$134.40
|
| Rate for Payer: BCBS MAPPO |
$103.04
|
| Rate for Payer: BCN Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cofinity Commercial |
$148.38
|
| Rate for Payer: Cofinity Commercial |
$138.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.19
|
| Rate for Payer: Nomi Health Commercial |
$123.65
|
| Rate for Payer: PACE SWMI |
$103.04
|
| Rate for Payer: PHP Medicare Advantage |
$103.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health Medicare |
$104.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.04
|
| Rate for Payer: UHC Exchange |
$103.04
|
| Rate for Payer: UHC Medicare Advantage |
$103.04
|
|
|
PR DRAINAGE ABSCESS PAROTID COMPLICATED
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
HCPCS 42305
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$595.57 |
| Rate for Payer: Aetna Commercial |
$554.21
|
| Rate for Payer: Aetna Medicare |
$430.13
|
| Rate for Payer: BCBS Complete |
$313.20
|
| Rate for Payer: BCBS MAPPO |
$413.59
|
| Rate for Payer: BCN Medicare Advantage |
$413.59
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cofinity Commercial |
$595.57
|
| Rate for Payer: Cofinity Commercial |
$554.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.27
|
| Rate for Payer: Nomi Health Commercial |
$496.31
|
| Rate for Payer: PACE SWMI |
$413.59
|
| Rate for Payer: PHP Medicare Advantage |
$413.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.95
|
| Rate for Payer: Priority Health Medicare |
$417.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.59
|
| Rate for Payer: UHC Exchange |
$413.59
|
| Rate for Payer: UHC Medicare Advantage |
$413.59
|
|
|
PR DRAINAGE ABSCESS PAROTID SIMPLE
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 42300
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$226.85 |
| Rate for Payer: Aetna Commercial |
$198.37
|
| Rate for Payer: Aetna Medicare |
$153.96
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$148.04
|
| Rate for Payer: BCN Medicare Advantage |
$148.04
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$213.18
|
| Rate for Payer: Cofinity Commercial |
$198.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.44
|
| Rate for Payer: Nomi Health Commercial |
$177.65
|
| Rate for Payer: PACE SWMI |
$148.04
|
| Rate for Payer: PHP Medicare Advantage |
$148.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$149.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.04
|
| Rate for Payer: UHC Exchange |
$148.04
|
| Rate for Payer: UHC Medicare Advantage |
$148.04
|
|
|
PR DRAINAGE DEEP PERIURETHRAL ABSCESS
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 53040
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Aetna Commercial |
$503.85
|
| Rate for Payer: Aetna Medicare |
$391.05
|
| Rate for Payer: BCBS Complete |
$326.00
|
| Rate for Payer: BCBS MAPPO |
$376.01
|
| Rate for Payer: BCN Medicare Advantage |
$376.01
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cofinity Commercial |
$541.45
|
| Rate for Payer: Cofinity Commercial |
$503.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$394.81
|
| Rate for Payer: Nomi Health Commercial |
$451.21
|
| Rate for Payer: PACE SWMI |
$376.01
|
| Rate for Payer: PHP Medicare Advantage |
$376.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.75
|
| Rate for Payer: Priority Health Medicare |
$379.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.01
|
| Rate for Payer: UHC Exchange |
$376.01
|
| Rate for Payer: UHC Medicare Advantage |
$376.01
|
|
|
PR DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 69020
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$180.06
|
| Rate for Payer: Aetna Medicare |
$139.74
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: BCBS MAPPO |
$134.37
|
| Rate for Payer: BCN Medicare Advantage |
$134.37
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$193.49
|
| Rate for Payer: Cofinity Commercial |
$180.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.09
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: PACE SWMI |
$134.37
|
| Rate for Payer: PHP Medicare Advantage |
$134.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.00
|
| Rate for Payer: Priority Health Medicare |
$135.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.37
|
| Rate for Payer: UHC Exchange |
$134.37
|
| Rate for Payer: UHC Medicare Advantage |
$134.37
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA COMP
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 69005
|
| Min. Negotiated Rate |
$153.41 |
| Max. Negotiated Rate |
$250.25 |
| Rate for Payer: Aetna Commercial |
$205.57
|
| Rate for Payer: Aetna Medicare |
$159.55
|
| Rate for Payer: BCBS Complete |
$154.00
|
| Rate for Payer: BCBS MAPPO |
$153.41
|
| Rate for Payer: BCN Medicare Advantage |
$153.41
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cofinity Commercial |
$220.91
|
| Rate for Payer: Cofinity Commercial |
$205.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.08
|
| Rate for Payer: Nomi Health Commercial |
$184.09
|
| Rate for Payer: PACE SWMI |
$153.41
|
| Rate for Payer: PHP Medicare Advantage |
$153.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.25
|
| Rate for Payer: Priority Health Medicare |
$154.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.41
|
| Rate for Payer: UHC Exchange |
$153.41
|
| Rate for Payer: UHC Medicare Advantage |
$153.41
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 69000
|
| Min. Negotiated Rate |
$118.16 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$158.33
|
| Rate for Payer: Aetna Medicare |
$122.89
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$118.16
|
| Rate for Payer: BCN Medicare Advantage |
$118.16
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$170.15
|
| Rate for Payer: Cofinity Commercial |
$158.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.07
|
| Rate for Payer: Nomi Health Commercial |
$141.79
|
| Rate for Payer: PACE SWMI |
$118.16
|
| Rate for Payer: PHP Medicare Advantage |
$118.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$119.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.16
|
| Rate for Payer: UHC Exchange |
$118.16
|
| Rate for Payer: UHC Medicare Advantage |
$118.16
|
|
|
PR DRAINAGE FINGER ABSCESS COMPLICATED
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 26011
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$527.15 |
| Rate for Payer: Aetna Commercial |
$237.69
|
| Rate for Payer: Aetna Medicare |
$184.48
|
| Rate for Payer: BCBS Complete |
$324.40
|
| Rate for Payer: BCBS MAPPO |
$177.38
|
| Rate for Payer: BCN Medicare Advantage |
$177.38
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$255.43
|
| Rate for Payer: Cofinity Commercial |
$237.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.25
|
| Rate for Payer: Nomi Health Commercial |
$212.86
|
| Rate for Payer: PACE SWMI |
$177.38
|
| Rate for Payer: PHP Medicare Advantage |
$177.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.15
|
| Rate for Payer: Priority Health Medicare |
$179.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.38
|
| Rate for Payer: UHC Exchange |
$177.38
|
| Rate for Payer: UHC Medicare Advantage |
$177.38
|
|
|
PR DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 26010
|
| Min. Negotiated Rate |
$133.96 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna Medicare |
$139.32
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: BCBS MAPPO |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$133.96
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$192.90
|
| Rate for Payer: Cofinity Commercial |
$179.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.66
|
| Rate for Payer: Nomi Health Commercial |
$160.75
|
| Rate for Payer: PACE SWMI |
$133.96
|
| Rate for Payer: PHP Medicare Advantage |
$133.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health Medicare |
$135.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.96
|
| Rate for Payer: UHC Exchange |
$133.96
|
| Rate for Payer: UHC Medicare Advantage |
$133.96
|
|
|
PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA
|
Professional
|
Both
|
$3,178.00
|
|
|
Service Code
|
HCPCS 26030
|
| Min. Negotiated Rate |
$475.90 |
| Max. Negotiated Rate |
$2,065.70 |
| Rate for Payer: Aetna Commercial |
$637.71
|
| Rate for Payer: Aetna Medicare |
$494.94
|
| Rate for Payer: BCBS Complete |
$1,271.20
|
| Rate for Payer: BCBS MAPPO |
$475.90
|
| Rate for Payer: BCN Medicare Advantage |
$475.90
|
| Rate for Payer: Cash Price |
$2,542.40
|
| Rate for Payer: Cash Price |
$2,542.40
|
| Rate for Payer: Cofinity Commercial |
$685.30
|
| Rate for Payer: Cofinity Commercial |
$637.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$499.69
|
| Rate for Payer: Nomi Health Commercial |
$571.08
|
| Rate for Payer: PACE SWMI |
$475.90
|
| Rate for Payer: PHP Medicare Advantage |
$475.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.70
|
| Rate for Payer: Priority Health Medicare |
$480.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$475.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.90
|
| Rate for Payer: UHC Exchange |
$475.90
|
| Rate for Payer: UHC Medicare Advantage |
$475.90
|
|
|
PR DRAINAGE OF PALMAR BURSA SINGLE BURSA
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 26025
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Commercial |
$541.29
|
| Rate for Payer: Aetna Medicare |
$420.11
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$403.95
|
| Rate for Payer: BCN Medicare Advantage |
$403.95
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$581.69
|
| Rate for Payer: Cofinity Commercial |
$541.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.15
|
| Rate for Payer: Nomi Health Commercial |
$484.74
|
| Rate for Payer: PACE SWMI |
$403.95
|
| Rate for Payer: PHP Medicare Advantage |
$403.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$407.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.95
|
| Rate for Payer: UHC Exchange |
$403.95
|
| Rate for Payer: UHC Medicare Advantage |
$403.95
|
|
|
PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
|
Professional
|
Both
|
$2,249.00
|
|
|
Service Code
|
HCPCS 49060
|
| Min. Negotiated Rate |
$899.60 |
| Max. Negotiated Rate |
$1,540.86 |
| Rate for Payer: Aetna Commercial |
$1,433.85
|
| Rate for Payer: Aetna Medicare |
$1,112.84
|
| Rate for Payer: BCBS Complete |
$899.60
|
| Rate for Payer: BCBS MAPPO |
$1,070.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,070.04
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Cash Price |
$1,799.20
|
| Rate for Payer: Cofinity Commercial |
$1,540.86
|
| Rate for Payer: Cofinity Commercial |
$1,433.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,070.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,123.54
|
| Rate for Payer: Nomi Health Commercial |
$1,284.05
|
| Rate for Payer: PACE SWMI |
$1,070.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,070.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,461.85
|
| Rate for Payer: Priority Health Medicare |
$1,080.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,070.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,070.04
|
| Rate for Payer: UHC Exchange |
$1,070.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,070.04
|
|
|
PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 58822
|
| Min. Negotiated Rate |
$684.92 |
| Max. Negotiated Rate |
$1,121.25 |
| Rate for Payer: Aetna Commercial |
$917.79
|
| Rate for Payer: Aetna Medicare |
$712.32
|
| Rate for Payer: BCBS Complete |
$690.00
|
| Rate for Payer: BCBS MAPPO |
$684.92
|
| Rate for Payer: BCN Medicare Advantage |
$684.92
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cofinity Commercial |
$986.28
|
| Rate for Payer: Cofinity Commercial |
$917.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.17
|
| Rate for Payer: Nomi Health Commercial |
$821.90
|
| Rate for Payer: PACE SWMI |
$684.92
|
| Rate for Payer: PHP Medicare Advantage |
$684.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.25
|
| Rate for Payer: Priority Health Medicare |
$691.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.92
|
| Rate for Payer: UHC Exchange |
$684.92
|
| Rate for Payer: UHC Medicare Advantage |
$684.92
|
|
|
PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 58820
|
| Min. Negotiated Rate |
$322.35 |
| Max. Negotiated Rate |
$583.05 |
| Rate for Payer: Aetna Commercial |
$431.95
|
| Rate for Payer: Aetna Medicare |
$335.24
|
| Rate for Payer: BCBS Complete |
$358.80
|
| Rate for Payer: BCBS MAPPO |
$322.35
|
| Rate for Payer: BCN Medicare Advantage |
$322.35
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cofinity Commercial |
$464.18
|
| Rate for Payer: Cofinity Commercial |
$431.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.47
|
| Rate for Payer: Nomi Health Commercial |
$386.82
|
| Rate for Payer: PACE SWMI |
$322.35
|
| Rate for Payer: PHP Medicare Advantage |
$322.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.05
|
| Rate for Payer: Priority Health Medicare |
$325.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.35
|
| Rate for Payer: UHC Exchange |
$322.35
|
| Rate for Payer: UHC Medicare Advantage |
$322.35
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 58805
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$1,047.80 |
| Rate for Payer: Aetna Commercial |
$546.29
|
| Rate for Payer: Aetna Medicare |
$423.99
|
| Rate for Payer: BCBS Complete |
$644.80
|
| Rate for Payer: BCBS MAPPO |
$407.68
|
| Rate for Payer: BCN Medicare Advantage |
$407.68
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$587.06
|
| Rate for Payer: Cofinity Commercial |
$546.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.06
|
| Rate for Payer: Nomi Health Commercial |
$489.22
|
| Rate for Payer: PACE SWMI |
$407.68
|
| Rate for Payer: PHP Medicare Advantage |
$407.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.80
|
| Rate for Payer: Priority Health Medicare |
$411.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.68
|
| Rate for Payer: UHC Exchange |
$407.68
|
| Rate for Payer: UHC Medicare Advantage |
$407.68
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$301.71 |
| Max. Negotiated Rate |
$645.45 |
| Rate for Payer: Aetna Commercial |
$404.29
|
| Rate for Payer: Aetna Medicare |
$313.78
|
| Rate for Payer: BCBS Complete |
$397.20
|
| Rate for Payer: BCBS MAPPO |
$301.71
|
| Rate for Payer: BCN Medicare Advantage |
$301.71
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$434.46
|
| Rate for Payer: Cofinity Commercial |
$404.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.80
|
| Rate for Payer: Nomi Health Commercial |
$362.05
|
| Rate for Payer: PACE SWMI |
$301.71
|
| Rate for Payer: PHP Medicare Advantage |
$301.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health Medicare |
$304.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.71
|
| Rate for Payer: UHC Exchange |
$301.71
|
| Rate for Payer: UHC Medicare Advantage |
$301.71
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$2,828.00
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$2,223.45 |
| Rate for Payer: Aetna Commercial |
$2,069.04
|
| Rate for Payer: Aetna Medicare |
$1,605.82
|
| Rate for Payer: BCBS Complete |
$1,131.20
|
| Rate for Payer: BCBS MAPPO |
$1,544.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,544.06
|
| Rate for Payer: Cash Price |
$2,262.40
|
| Rate for Payer: Cash Price |
$2,262.40
|
| Rate for Payer: Cofinity Commercial |
$2,223.45
|
| Rate for Payer: Cofinity Commercial |
$2,069.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,544.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,621.26
|
| Rate for Payer: Nomi Health Commercial |
$1,852.87
|
| Rate for Payer: PACE SWMI |
$1,544.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,544.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.20
|
| Rate for Payer: Priority Health Medicare |
$1,559.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,544.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,544.06
|
| Rate for Payer: UHC Exchange |
$1,544.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,544.06
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$215.31
|
| Rate for Payer: Aetna Medicare |
$167.11
|
| Rate for Payer: BCBS Complete |
$159.60
|
| Rate for Payer: BCBS MAPPO |
$160.68
|
| Rate for Payer: BCN Medicare Advantage |
$160.68
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$231.38
|
| Rate for Payer: Cofinity Commercial |
$215.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.71
|
| Rate for Payer: Nomi Health Commercial |
$192.82
|
| Rate for Payer: PACE SWMI |
$160.68
|
| Rate for Payer: PHP Medicare Advantage |
$160.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.35
|
| Rate for Payer: Priority Health Medicare |
$162.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.68
|
| Rate for Payer: UHC Exchange |
$160.68
|
| Rate for Payer: UHC Medicare Advantage |
$160.68
|
|
|
PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
|
Professional
|
Both
|
$2,224.00
|
|
|
Service Code
|
HCPCS 49040
|
| Min. Negotiated Rate |
$889.60 |
| Max. Negotiated Rate |
$1,445.60 |
| Rate for Payer: Aetna Commercial |
$1,307.34
|
| Rate for Payer: Aetna Medicare |
$1,014.66
|
| Rate for Payer: BCBS Complete |
$889.60
|
| Rate for Payer: BCBS MAPPO |
$975.63
|
| Rate for Payer: BCN Medicare Advantage |
$975.63
|
| Rate for Payer: Cash Price |
$1,779.20
|
| Rate for Payer: Cash Price |
$1,779.20
|
| Rate for Payer: Cofinity Commercial |
$1,404.91
|
| Rate for Payer: Cofinity Commercial |
$1,307.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$975.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,024.41
|
| Rate for Payer: Nomi Health Commercial |
$1,170.76
|
| Rate for Payer: PACE SWMI |
$975.63
|
| Rate for Payer: PHP Medicare Advantage |
$975.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.60
|
| Rate for Payer: Priority Health Medicare |
$985.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$975.63
|
| Rate for Payer: UHC Exchange |
$975.63
|
| Rate for Payer: UHC Medicare Advantage |
$975.63
|
|
|
PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 26020
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$773.65 |
| Rate for Payer: Aetna Commercial |
$719.93
|
| Rate for Payer: Aetna Medicare |
$558.75
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$537.26
|
| Rate for Payer: BCN Medicare Advantage |
$537.26
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$773.65
|
| Rate for Payer: Cofinity Commercial |
$719.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.12
|
| Rate for Payer: Nomi Health Commercial |
$644.71
|
| Rate for Payer: PACE SWMI |
$537.26
|
| Rate for Payer: PHP Medicare Advantage |
$537.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$542.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$537.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.26
|
| Rate for Payer: UHC Exchange |
$537.26
|
| Rate for Payer: UHC Medicare Advantage |
$537.26
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$42.77
|
| Rate for Payer: BCN Medicare Advantage |
$42.77
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$57.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.91
|
| Rate for Payer: Nomi Health Commercial |
$51.32
|
| Rate for Payer: PACE SWMI |
$42.77
|
| Rate for Payer: PHP Medicare Advantage |
$42.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$43.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.77
|
| Rate for Payer: UHC Exchange |
$42.77
|
| Rate for Payer: UHC Medicare Advantage |
$42.77
|
|
|
PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$147.26 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Aetna Medicare |
$153.15
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$147.26
|
| Rate for Payer: BCN Medicare Advantage |
$147.26
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$212.05
|
| Rate for Payer: Cofinity Commercial |
$197.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.62
|
| Rate for Payer: Nomi Health Commercial |
$176.71
|
| Rate for Payer: PACE SWMI |
$147.26
|
| Rate for Payer: PHP Medicare Advantage |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.70
|
| Rate for Payer: Priority Health Medicare |
$148.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.26
|
| Rate for Payer: UHC Exchange |
$147.26
|
| Rate for Payer: UHC Medicare Advantage |
$147.26
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 40801
|
| Min. Negotiated Rate |
$190.29 |
| Max. Negotiated Rate |
$410.80 |
| Rate for Payer: Aetna Commercial |
$254.99
|
| Rate for Payer: Aetna Medicare |
$197.90
|
| Rate for Payer: BCBS Complete |
$252.80
|
| Rate for Payer: BCBS MAPPO |
$190.29
|
| Rate for Payer: BCN Medicare Advantage |
$190.29
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$274.02
|
| Rate for Payer: Cofinity Commercial |
$254.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.80
|
| Rate for Payer: Nomi Health Commercial |
$228.35
|
| Rate for Payer: PACE SWMI |
$190.29
|
| Rate for Payer: PHP Medicare Advantage |
$190.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: Priority Health Medicare |
$192.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.29
|
| Rate for Payer: UHC Exchange |
$190.29
|
| Rate for Payer: UHC Medicare Advantage |
$190.29
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$690.15 |
| Rate for Payer: Aetna Commercial |
$642.22
|
| Rate for Payer: Aetna Medicare |
$498.44
|
| Rate for Payer: BCBS Complete |
$423.20
|
| Rate for Payer: BCBS MAPPO |
$479.27
|
| Rate for Payer: BCN Medicare Advantage |
$479.27
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cofinity Commercial |
$690.15
|
| Rate for Payer: Cofinity Commercial |
$642.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.23
|
| Rate for Payer: Nomi Health Commercial |
$575.12
|
| Rate for Payer: PACE SWMI |
$479.27
|
| Rate for Payer: PHP Medicare Advantage |
$479.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.70
|
| Rate for Payer: Priority Health Medicare |
$484.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.27
|
| Rate for Payer: UHC Exchange |
$479.27
|
| Rate for Payer: UHC Medicare Advantage |
$479.27
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Commercial |
$269.42
|
| Rate for Payer: Aetna Medicare |
$209.10
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: BCBS MAPPO |
$201.06
|
| Rate for Payer: BCN Medicare Advantage |
$201.06
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$289.53
|
| Rate for Payer: Cofinity Commercial |
$269.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.11
|
| Rate for Payer: Nomi Health Commercial |
$241.27
|
| Rate for Payer: PACE SWMI |
$201.06
|
| Rate for Payer: PHP Medicare Advantage |
$201.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: Priority Health Medicare |
$203.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.06
|
| Rate for Payer: UHC Exchange |
$201.06
|
| Rate for Payer: UHC Medicare Advantage |
$201.06
|
|
