|
PR EP EVAL 1/2CHMB PACG CVDFB LDS TSTG OF PULSE GEN
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 93641
|
| Min. Negotiated Rate |
$190.64 |
| Max. Negotiated Rate |
$2,001.73 |
| Rate for Payer: Aetna Commercial |
$765.30
|
| Rate for Payer: Aetna Medicare |
$268.50
|
| Rate for Payer: BCBS Complete |
$200.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,001.73
|
| Rate for Payer: BCN Commercial |
$835.64
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Mclaren Medicaid |
$190.64
|
| Rate for Payer: Meridian Medicaid |
$200.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.05
|
| Rate for Payer: Priority Health HMO/PPO |
$422.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$422.34
|
| Rate for Payer: UHCCP Medicaid |
$190.64
|
|
|
PR EP EVAL 1/2 CHMB TRANSVNS PAC CVDFB
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 93642
|
| Min. Negotiated Rate |
$156.34 |
| Max. Negotiated Rate |
$2,287.54 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Medicare |
$321.82
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS MAPPO |
$309.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,287.54
|
| Rate for Payer: BCN Commercial |
$481.35
|
| Rate for Payer: BCN Medicare Advantage |
$309.44
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$445.59
|
| Rate for Payer: Cofinity Commercial |
$414.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.44
|
| Rate for Payer: Mclaren Medicaid |
$156.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.91
|
| Rate for Payer: Meridian Medicaid |
$164.16
|
| Rate for Payer: Nomi Health Commercial |
$371.33
|
| Rate for Payer: PACE SWMI |
$309.44
|
| Rate for Payer: PHP Medicare Advantage |
$309.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health HMO/PPO |
$344.65
|
| Rate for Payer: Priority Health Medicare |
$312.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.44
|
| Rate for Payer: UHC Exchange |
$309.44
|
| Rate for Payer: UHC Medicare Advantage |
$309.44
|
| Rate for Payer: UHCCP Medicaid |
$156.34
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/<
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
HCPCS 15115
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,172.34 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Medicare |
$697.81
|
| Rate for Payer: BCBS Complete |
$473.47
|
| Rate for Payer: BCBS MAPPO |
$670.97
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,172.34
|
| Rate for Payer: BCN Medicare Advantage |
$670.97
|
| Rate for Payer: Cash Price |
$1,174.40
|
| Rate for Payer: Cash Price |
$1,174.40
|
| Rate for Payer: Cofinity Commercial |
$966.20
|
| Rate for Payer: Cofinity Commercial |
$899.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$670.97
|
| Rate for Payer: Mclaren Medicaid |
$450.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.52
|
| Rate for Payer: Meridian Medicaid |
$473.47
|
| Rate for Payer: Nomi Health Commercial |
$805.16
|
| Rate for Payer: PACE SWMI |
$670.97
|
| Rate for Payer: PHP Medicare Advantage |
$670.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$450.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.20
|
| Rate for Payer: Priority Health HMO/PPO |
$943.67
|
| Rate for Payer: Priority Health Medicare |
$677.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$943.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$670.97
|
| Rate for Payer: UHC Exchange |
$670.97
|
| Rate for Payer: UHC Medicare Advantage |
$670.97
|
| Rate for Payer: UHCCP Medicaid |
$450.92
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 15116
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$281.44 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: Aetna Medicare |
$138.99
|
| Rate for Payer: BCBS Complete |
$92.37
|
| Rate for Payer: BCBS MAPPO |
$133.64
|
| Rate for Payer: BCBS Trust/PPO |
$281.44
|
| Rate for Payer: BCN Commercial |
$225.28
|
| Rate for Payer: BCN Medicare Advantage |
$133.64
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$192.44
|
| Rate for Payer: Cofinity Commercial |
$179.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.64
|
| Rate for Payer: Mclaren Medicaid |
$87.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.32
|
| Rate for Payer: Meridian Medicaid |
$92.37
|
| Rate for Payer: Nomi Health Commercial |
$160.37
|
| Rate for Payer: PACE SWMI |
$133.64
|
| Rate for Payer: PHP Medicare Advantage |
$133.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.10
|
| Rate for Payer: Priority Health HMO/PPO |
$185.57
|
| Rate for Payer: Priority Health Medicare |
$134.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.64
|
| Rate for Payer: UHC Exchange |
$133.64
|
| Rate for Payer: UHC Medicare Advantage |
$133.64
|
| Rate for Payer: UHCCP Medicaid |
$87.97
|
|
|
PR EPIDIDYMECTOMY BILATERAL
|
Professional
|
Both
|
$1,072.00
|
|
|
Service Code
|
HCPCS 54861
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$2,782.03 |
| Rate for Payer: Aetna Commercial |
$727.79
|
| Rate for Payer: Aetna Medicare |
$564.86
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS MAPPO |
$543.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,782.03
|
| Rate for Payer: BCN Commercial |
$821.46
|
| Rate for Payer: BCN Medicare Advantage |
$543.13
|
| Rate for Payer: Cash Price |
$857.60
|
| Rate for Payer: Cash Price |
$857.60
|
| Rate for Payer: Cofinity Commercial |
$782.11
|
| Rate for Payer: Cofinity Commercial |
$727.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.13
|
| Rate for Payer: Mclaren Medicaid |
$365.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$570.29
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Nomi Health Commercial |
$651.76
|
| Rate for Payer: PACE SWMI |
$543.13
|
| Rate for Payer: PHP Medicare Advantage |
$543.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.80
|
| Rate for Payer: Priority Health HMO/PPO |
$909.15
|
| Rate for Payer: Priority Health Medicare |
$548.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$909.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$543.13
|
| Rate for Payer: UHC Exchange |
$543.13
|
| Rate for Payer: UHC Medicare Advantage |
$543.13
|
| Rate for Payer: UHCCP Medicaid |
$365.30
|
|
|
PR EPIDIDYMECTOMY UNILATERAL
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 54860
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$1,211.92 |
| Rate for Payer: Aetna Commercial |
$537.33
|
| Rate for Payer: Aetna Medicare |
$417.03
|
| Rate for Payer: BCBS Complete |
$283.82
|
| Rate for Payer: BCBS MAPPO |
$400.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.92
|
| Rate for Payer: BCN Commercial |
$606.94
|
| Rate for Payer: BCN Medicare Advantage |
$400.99
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$577.43
|
| Rate for Payer: Cofinity Commercial |
$537.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.99
|
| Rate for Payer: Mclaren Medicaid |
$270.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.04
|
| Rate for Payer: Meridian Medicaid |
$283.82
|
| Rate for Payer: Nomi Health Commercial |
$481.19
|
| Rate for Payer: PACE SWMI |
$400.99
|
| Rate for Payer: PHP Medicare Advantage |
$400.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO |
$671.62
|
| Rate for Payer: Priority Health Medicare |
$405.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.99
|
| Rate for Payer: UHC Exchange |
$400.99
|
| Rate for Payer: UHC Medicare Advantage |
$400.99
|
| Rate for Payer: UHCCP Medicaid |
$270.30
|
|
|
PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 54900
|
| Min. Negotiated Rate |
$513.12 |
| Max. Negotiated Rate |
$2,046.63 |
| Rate for Payer: Aetna Commercial |
$1,025.54
|
| Rate for Payer: Aetna Medicare |
$795.94
|
| Rate for Payer: BCBS Complete |
$538.78
|
| Rate for Payer: BCBS MAPPO |
$765.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.63
|
| Rate for Payer: BCN Commercial |
$1,154.74
|
| Rate for Payer: BCN Medicare Advantage |
$765.33
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$1,102.08
|
| Rate for Payer: Cofinity Commercial |
$1,025.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.33
|
| Rate for Payer: Mclaren Medicaid |
$513.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$803.60
|
| Rate for Payer: Meridian Medicaid |
$538.78
|
| Rate for Payer: Nomi Health Commercial |
$918.40
|
| Rate for Payer: PACE SWMI |
$765.33
|
| Rate for Payer: PHP Medicare Advantage |
$765.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,273.44
|
| Rate for Payer: Priority Health Medicare |
$772.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,273.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.33
|
| Rate for Payer: UHC Exchange |
$765.33
|
| Rate for Payer: UHC Medicare Advantage |
$765.33
|
| Rate for Payer: UHCCP Medicaid |
$513.12
|
|
|
PR EPIDRM AGRFT T/A/L 1ST 100 SQCM/</1% INFT/CHLD
|
Professional
|
Both
|
$1,608.00
|
|
|
Service Code
|
HCPCS 15110
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,219.74 |
| Rate for Payer: Aetna Commercial |
$918.62
|
| Rate for Payer: Aetna Medicare |
$712.96
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCBS MAPPO |
$685.54
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,219.74
|
| Rate for Payer: BCN Medicare Advantage |
$685.54
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cofinity Commercial |
$987.18
|
| Rate for Payer: Cofinity Commercial |
$918.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.54
|
| Rate for Payer: Mclaren Medicaid |
$459.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.82
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Nomi Health Commercial |
$822.65
|
| Rate for Payer: PACE SWMI |
$685.54
|
| Rate for Payer: PHP Medicare Advantage |
$685.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,045.20
|
| Rate for Payer: Priority Health HMO/PPO |
$969.86
|
| Rate for Payer: Priority Health Medicare |
$692.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$969.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.54
|
| Rate for Payer: UHC Exchange |
$685.54
|
| Rate for Payer: UHC Medicare Advantage |
$685.54
|
| Rate for Payer: UHCCP Medicaid |
$459.65
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$406.19 |
| Max. Negotiated Rate |
$3,253.04 |
| Rate for Payer: Aetna Commercial |
$802.85
|
| Rate for Payer: Aetna Medicare |
$623.11
|
| Rate for Payer: BCBS Complete |
$426.50
|
| Rate for Payer: BCBS MAPPO |
$599.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.04
|
| Rate for Payer: BCN Commercial |
$913.83
|
| Rate for Payer: BCN Medicare Advantage |
$599.14
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cofinity Commercial |
$862.76
|
| Rate for Payer: Cofinity Commercial |
$802.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.14
|
| Rate for Payer: Mclaren Medicaid |
$406.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.10
|
| Rate for Payer: Meridian Medicaid |
$426.50
|
| Rate for Payer: Nomi Health Commercial |
$718.97
|
| Rate for Payer: PACE SWMI |
$599.14
|
| Rate for Payer: PHP Medicare Advantage |
$599.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO |
$961.24
|
| Rate for Payer: Priority Health Medicare |
$605.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$961.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.14
|
| Rate for Payer: UHC Exchange |
$599.14
|
| Rate for Payer: UHC Medicare Advantage |
$599.14
|
| Rate for Payer: UHCCP Medicaid |
$406.19
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 27185
|
| Min. Negotiated Rate |
$469.88 |
| Max. Negotiated Rate |
$1,112.88 |
| Rate for Payer: Aetna Commercial |
$931.55
|
| Rate for Payer: Aetna Medicare |
$723.00
|
| Rate for Payer: BCBS Complete |
$493.37
|
| Rate for Payer: BCBS MAPPO |
$695.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.37
|
| Rate for Payer: BCN Commercial |
$1,059.45
|
| Rate for Payer: BCN Medicare Advantage |
$695.19
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$931.55
|
| Rate for Payer: Cofinity Commercial |
$1,001.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.19
|
| Rate for Payer: Mclaren Medicaid |
$469.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.95
|
| Rate for Payer: Meridian Medicaid |
$493.37
|
| Rate for Payer: Nomi Health Commercial |
$834.23
|
| Rate for Payer: PACE SWMI |
$695.19
|
| Rate for Payer: PHP Medicare Advantage |
$695.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$469.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,112.88
|
| Rate for Payer: Priority Health Medicare |
$702.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,112.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.19
|
| Rate for Payer: UHC Exchange |
$695.19
|
| Rate for Payer: UHC Medicare Advantage |
$695.19
|
| Rate for Payer: UHCCP Medicaid |
$469.88
|
|
|
PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 59300
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$439.02 |
| Rate for Payer: Aetna Commercial |
$192.80
|
| Rate for Payer: Aetna Medicare |
$149.64
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: BCBS MAPPO |
$143.88
|
| Rate for Payer: BCBS Trust/PPO |
$439.02
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: BCN Medicare Advantage |
$143.88
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.88
|
| Rate for Payer: Mclaren Medicaid |
$94.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.07
|
| Rate for Payer: Meridian Medicaid |
$99.30
|
| Rate for Payer: Nomi Health Commercial |
$172.66
|
| Rate for Payer: PACE SWMI |
$143.88
|
| Rate for Payer: PHP Medicare Advantage |
$143.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health HMO/PPO |
$207.26
|
| Rate for Payer: Priority Health Medicare |
$145.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.88
|
| Rate for Payer: UHC Exchange |
$143.88
|
| Rate for Payer: UHC Medicare Advantage |
$143.88
|
| Rate for Payer: UHCCP Medicaid |
$94.57
|
|
|
PR EPOETIN ALFA, NON-ESRD
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS J0885
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$7.68
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.68
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.06
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: PACE SWMI |
$7.68
|
| Rate for Payer: PHP Medicare Advantage |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$7.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.68
|
| Rate for Payer: UHC Exchange |
$7.68
|
| Rate for Payer: UHC Medicare Advantage |
$7.68
|
|
|
PR ERCP,ABLATION TUMOR
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 43272
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Medicare |
$827.50
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
|
|
PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 43277
|
| Min. Negotiated Rate |
$237.50 |
| Max. Negotiated Rate |
$947.77 |
| Rate for Payer: Aetna Commercial |
$476.09
|
| Rate for Payer: Aetna Medicare |
$369.50
|
| Rate for Payer: BCBS Complete |
$249.38
|
| Rate for Payer: BCBS MAPPO |
$355.29
|
| Rate for Payer: BCBS Trust/PPO |
$947.77
|
| Rate for Payer: BCN Commercial |
$540.97
|
| Rate for Payer: BCN Medicare Advantage |
$355.29
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$476.09
|
| Rate for Payer: Cofinity Commercial |
$511.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.29
|
| Rate for Payer: Mclaren Medicaid |
$237.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.05
|
| Rate for Payer: Meridian Medicaid |
$249.38
|
| Rate for Payer: Nomi Health Commercial |
$426.35
|
| Rate for Payer: PACE SWMI |
$355.29
|
| Rate for Payer: PHP Medicare Advantage |
$355.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health HMO/PPO |
$664.01
|
| Rate for Payer: Priority Health Medicare |
$358.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.29
|
| Rate for Payer: UHC Exchange |
$355.29
|
| Rate for Payer: UHC Medicare Advantage |
$355.29
|
| Rate for Payer: UHCCP Medicaid |
$237.50
|
|
|
PR ERCP,BALLOON DIL DUCTS
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
HCPCS 43271
|
| Min. Negotiated Rate |
$668.80 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna Medicare |
$836.00
|
| Rate for Payer: BCBS Complete |
$668.80
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.80
|
|
|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$301.82 |
| Max. Negotiated Rate |
$966.55 |
| Rate for Payer: Aetna Commercial |
$605.32
|
| Rate for Payer: Aetna Medicare |
$469.80
|
| Rate for Payer: BCBS Complete |
$316.91
|
| Rate for Payer: BCBS MAPPO |
$451.73
|
| Rate for Payer: BCBS Trust/PPO |
$841.58
|
| Rate for Payer: BCN Commercial |
$688.54
|
| Rate for Payer: BCN Medicare Advantage |
$451.73
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cofinity Commercial |
$650.49
|
| Rate for Payer: Cofinity Commercial |
$605.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.73
|
| Rate for Payer: Mclaren Medicaid |
$301.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.32
|
| Rate for Payer: Meridian Medicaid |
$316.91
|
| Rate for Payer: Nomi Health Commercial |
$542.08
|
| Rate for Payer: PACE SWMI |
$451.73
|
| Rate for Payer: PHP Medicare Advantage |
$451.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.55
|
| Rate for Payer: Priority Health HMO/PPO |
$845.37
|
| Rate for Payer: Priority Health Medicare |
$456.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$845.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.73
|
| Rate for Payer: UHC Exchange |
$451.73
|
| Rate for Payer: UHC Medicare Advantage |
$451.73
|
| Rate for Payer: UHCCP Medicaid |
$301.82
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$1,693.20 |
| Rate for Payer: Aetna Commercial |
$543.58
|
| Rate for Payer: Aetna Medicare |
$421.89
|
| Rate for Payer: BCBS Complete |
$284.71
|
| Rate for Payer: BCBS MAPPO |
$405.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.20
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: BCN Medicare Advantage |
$405.66
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cofinity Commercial |
$584.15
|
| Rate for Payer: Cofinity Commercial |
$543.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.66
|
| Rate for Payer: Mclaren Medicaid |
$271.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.94
|
| Rate for Payer: Meridian Medicaid |
$284.71
|
| Rate for Payer: Nomi Health Commercial |
$486.79
|
| Rate for Payer: PACE SWMI |
$405.66
|
| Rate for Payer: PHP Medicare Advantage |
$405.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health HMO/PPO |
$760.06
|
| Rate for Payer: Priority Health Medicare |
$409.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.66
|
| Rate for Payer: UHC Exchange |
$405.66
|
| Rate for Payer: UHC Medicare Advantage |
$405.66
|
| Rate for Payer: UHCCP Medicaid |
$271.15
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$949.92 |
| Rate for Payer: Aetna Commercial |
$405.93
|
| Rate for Payer: Aetna Medicare |
$315.05
|
| Rate for Payer: BCBS Complete |
$212.69
|
| Rate for Payer: BCBS MAPPO |
$302.93
|
| Rate for Payer: BCBS Trust/PPO |
$949.92
|
| Rate for Payer: BCN Commercial |
$460.83
|
| Rate for Payer: BCN Medicare Advantage |
$302.93
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$436.22
|
| Rate for Payer: Cofinity Commercial |
$405.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.93
|
| Rate for Payer: Mclaren Medicaid |
$202.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.08
|
| Rate for Payer: Meridian Medicaid |
$212.69
|
| Rate for Payer: Nomi Health Commercial |
$363.52
|
| Rate for Payer: PACE SWMI |
$302.93
|
| Rate for Payer: PHP Medicare Advantage |
$302.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO |
$566.76
|
| Rate for Payer: Priority Health Medicare |
$305.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$566.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.93
|
| Rate for Payer: UHC Exchange |
$302.93
|
| Rate for Payer: UHC Medicare Advantage |
$302.93
|
| Rate for Payer: UHCCP Medicaid |
$202.56
|
|
|
PR ERCP,INSERT STENT,BILIARY/PANC
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 43268
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$1,108.25 |
| Rate for Payer: Aetna Medicare |
$852.50
|
| Rate for Payer: BCBS Complete |
$682.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,108.25
|
|
|
PR ERCP,NASOBILIARY DRAIN TUBE
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
HCPCS 43267
|
| Min. Negotiated Rate |
$659.60 |
| Max. Negotiated Rate |
$1,071.85 |
| Rate for Payer: Aetna Medicare |
$824.50
|
| Rate for Payer: BCBS Complete |
$659.60
|
| Rate for Payer: Cash Price |
$1,319.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.85
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$458.63
|
| Rate for Payer: Aetna Medicare |
$355.95
|
| Rate for Payer: BCBS Complete |
$240.20
|
| Rate for Payer: BCBS MAPPO |
$342.26
|
| Rate for Payer: BCBS Trust/PPO |
$216.92
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: BCN Medicare Advantage |
$342.26
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cofinity Commercial |
$458.63
|
| Rate for Payer: Cofinity Commercial |
$492.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.26
|
| Rate for Payer: Mclaren Medicaid |
$228.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.37
|
| Rate for Payer: Meridian Medicaid |
$240.20
|
| Rate for Payer: Nomi Health Commercial |
$410.71
|
| Rate for Payer: PACE SWMI |
$342.26
|
| Rate for Payer: PHP Medicare Advantage |
$342.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health HMO/PPO |
$638.95
|
| Rate for Payer: Priority Health Medicare |
$345.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.26
|
| Rate for Payer: UHC Exchange |
$342.26
|
| Rate for Payer: UHC Medicare Advantage |
$342.26
|
| Rate for Payer: UHCCP Medicaid |
$228.76
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$933.51 |
| Rate for Payer: Aetna Commercial |
$473.57
|
| Rate for Payer: Aetna Medicare |
$367.55
|
| Rate for Payer: BCBS Complete |
$248.03
|
| Rate for Payer: BCBS MAPPO |
$353.41
|
| Rate for Payer: BCBS Trust/PPO |
$933.51
|
| Rate for Payer: BCN Commercial |
$537.55
|
| Rate for Payer: BCN Medicare Advantage |
$353.41
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$508.91
|
| Rate for Payer: Cofinity Commercial |
$473.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.41
|
| Rate for Payer: Mclaren Medicaid |
$236.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.08
|
| Rate for Payer: Meridian Medicaid |
$248.03
|
| Rate for Payer: Nomi Health Commercial |
$424.09
|
| Rate for Payer: PACE SWMI |
$353.41
|
| Rate for Payer: PHP Medicare Advantage |
$353.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health HMO/PPO |
$660.42
|
| Rate for Payer: Priority Health Medicare |
$356.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$660.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.41
|
| Rate for Payer: UHC Exchange |
$353.41
|
| Rate for Payer: UHC Medicare Advantage |
$353.41
|
| Rate for Payer: UHCCP Medicaid |
$236.22
|
|
|
PR ERCP,RMV F.B./CHANGE STENT
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 43269
|
| Min. Negotiated Rate |
$677.20 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Medicare |
$846.50
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$290.11 |
| Max. Negotiated Rate |
$928.85 |
| Rate for Payer: Aetna Commercial |
$581.88
|
| Rate for Payer: Aetna Medicare |
$451.61
|
| Rate for Payer: BCBS Complete |
$304.62
|
| Rate for Payer: BCBS MAPPO |
$434.24
|
| Rate for Payer: BCBS Trust/PPO |
$813.05
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: BCN Medicare Advantage |
$434.24
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cofinity Commercial |
$625.31
|
| Rate for Payer: Cofinity Commercial |
$581.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.24
|
| Rate for Payer: Mclaren Medicaid |
$290.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.95
|
| Rate for Payer: Meridian Medicaid |
$304.62
|
| Rate for Payer: Nomi Health Commercial |
$521.09
|
| Rate for Payer: PACE SWMI |
$434.24
|
| Rate for Payer: PHP Medicare Advantage |
$434.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.85
|
| Rate for Payer: Priority Health HMO/PPO |
$811.96
|
| Rate for Payer: Priority Health Medicare |
$438.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$811.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.24
|
| Rate for Payer: UHC Exchange |
$434.24
|
| Rate for Payer: UHC Medicare Advantage |
$434.24
|
| Rate for Payer: UHCCP Medicaid |
$290.11
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$876.20 |
| Rate for Payer: Aetna Commercial |
$544.68
|
| Rate for Payer: Aetna Medicare |
$422.74
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCBS MAPPO |
$406.48
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$618.18
|
| Rate for Payer: BCN Medicare Advantage |
$406.48
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$585.33
|
| Rate for Payer: Cofinity Commercial |
$544.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.48
|
| Rate for Payer: Mclaren Medicaid |
$271.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.80
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Nomi Health Commercial |
$487.78
|
| Rate for Payer: PACE SWMI |
$406.48
|
| Rate for Payer: PHP Medicare Advantage |
$406.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health HMO/PPO |
$760.06
|
| Rate for Payer: Priority Health Medicare |
$410.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$406.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.48
|
| Rate for Payer: UHC Exchange |
$406.48
|
| Rate for Payer: UHC Medicare Advantage |
$406.48
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
