|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$840.07 |
| Max. Negotiated Rate |
$2,342.82 |
| Rate for Payer: Aetna Commercial |
$1,703.74
|
| Rate for Payer: Aetna Medicare |
$1,322.31
|
| Rate for Payer: BCBS Complete |
$882.07
|
| Rate for Payer: BCBS MAPPO |
$1,271.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.94
|
| Rate for Payer: BCN Commercial |
$1,905.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,271.45
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,830.89
|
| Rate for Payer: Cofinity Commercial |
$1,703.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,271.45
|
| Rate for Payer: Mclaren Medicaid |
$840.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,335.02
|
| Rate for Payer: Meridian Medicaid |
$882.07
|
| Rate for Payer: Nomi Health Commercial |
$1,525.74
|
| Rate for Payer: PACE SWMI |
$1,271.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,271.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,342.82
|
| Rate for Payer: Priority Health Medicare |
$1,284.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,342.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,271.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,271.45
|
| Rate for Payer: UHC Exchange |
$1,271.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,271.45
|
| Rate for Payer: UHCCP Medicaid |
$840.07
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$272.07 |
| Max. Negotiated Rate |
$2,314.79 |
| Rate for Payer: Aetna Commercial |
$1,683.67
|
| Rate for Payer: Aetna Medicare |
$1,306.73
|
| Rate for Payer: BCBS Complete |
$871.34
|
| Rate for Payer: BCBS MAPPO |
$1,256.47
|
| Rate for Payer: BCBS Trust/PPO |
$272.07
|
| Rate for Payer: BCN Commercial |
$1,883.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,256.47
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,683.67
|
| Rate for Payer: Cofinity Commercial |
$1,809.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,256.47
|
| Rate for Payer: Mclaren Medicaid |
$829.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.29
|
| Rate for Payer: Meridian Medicaid |
$871.34
|
| Rate for Payer: Nomi Health Commercial |
$1,507.76
|
| Rate for Payer: PACE SWMI |
$1,256.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,256.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health HMO/PPO |
$2,314.79
|
| Rate for Payer: Priority Health Medicare |
$1,269.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,314.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,256.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,256.47
|
| Rate for Payer: UHC Exchange |
$1,256.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.47
|
| Rate for Payer: UHCCP Medicaid |
$829.85
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$200.46 |
| Rate for Payer: Aetna Commercial |
$147.72
|
| Rate for Payer: Aetna Medicare |
$114.65
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCBS MAPPO |
$110.24
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: BCN Medicare Advantage |
$110.24
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$147.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.24
|
| Rate for Payer: Mclaren Medicaid |
$71.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.75
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Nomi Health Commercial |
$132.29
|
| Rate for Payer: PACE SWMI |
$110.24
|
| Rate for Payer: PHP Medicare Advantage |
$110.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO |
$200.46
|
| Rate for Payer: Priority Health Medicare |
$111.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.24
|
| Rate for Payer: UHC Exchange |
$110.24
|
| Rate for Payer: UHC Medicare Advantage |
$110.24
|
| Rate for Payer: UHCCP Medicaid |
$71.78
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$932.98 |
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Commercial |
$462.58
|
| Rate for Payer: Aetna Medicare |
$359.02
|
| Rate for Payer: Aetna Medicare |
$359.02
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCBS MAPPO |
$345.21
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$345.21
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Cofinity Commercial |
$462.58
|
| Rate for Payer: Cofinity Commercial |
$497.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.21
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.47
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: Nomi Health Commercial |
$414.25
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PACE SWMI |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: PHP Medicare Advantage |
$345.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health HMO/PPO |
$73.73
|
| Rate for Payer: Priority Health HMO/PPO |
$73.73
|
| Rate for Payer: Priority Health Medicare |
$348.66
|
| Rate for Payer: Priority Health Medicare |
$348.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.21
|
| Rate for Payer: UHC Exchange |
$345.21
|
| Rate for Payer: UHC Exchange |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHC Medicare Advantage |
$345.21
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Aetna Medicare |
$131.33
|
| Rate for Payer: BCBS Complete |
$89.01
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: BCN Commercial |
$603.52
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$181.84
|
| Rate for Payer: Cofinity Commercial |
$169.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Mclaren Medicaid |
$84.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.59
|
| Rate for Payer: Meridian Medicaid |
$89.01
|
| Rate for Payer: Nomi Health Commercial |
$151.54
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health HMO/PPO |
$235.66
|
| Rate for Payer: Priority Health Medicare |
$127.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.28
|
| Rate for Payer: UHC Exchange |
$126.28
|
| Rate for Payer: UHC Medicare Advantage |
$126.28
|
| Rate for Payer: UHCCP Medicaid |
$84.77
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$177.26
|
| Rate for Payer: Aetna Medicare |
$137.57
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS MAPPO |
$132.28
|
| Rate for Payer: BCBS Trust/PPO |
$278.94
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: BCN Medicare Advantage |
$132.28
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$190.48
|
| Rate for Payer: Cofinity Commercial |
$177.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.28
|
| Rate for Payer: Mclaren Medicaid |
$88.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.89
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$158.74
|
| Rate for Payer: PACE SWMI |
$132.28
|
| Rate for Payer: PHP Medicare Advantage |
$132.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$133.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.28
|
| Rate for Payer: UHC Exchange |
$132.28
|
| Rate for Payer: UHC Medicare Advantage |
$132.28
|
| Rate for Payer: UHCCP Medicaid |
$88.82
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,658.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$1,290.11 |
| Max. Negotiated Rate |
$5,185.60 |
| Rate for Payer: Aetna Commercial |
$3,779.36
|
| Rate for Payer: Aetna Medicare |
$2,933.24
|
| Rate for Payer: BCBS Complete |
$1,955.37
|
| Rate for Payer: BCBS MAPPO |
$2,820.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.11
|
| Rate for Payer: BCN Commercial |
$4,222.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,820.42
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cofinity Commercial |
$4,061.40
|
| Rate for Payer: Cofinity Commercial |
$3,779.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,820.42
|
| Rate for Payer: Mclaren Medicaid |
$1,862.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,961.44
|
| Rate for Payer: Meridian Medicaid |
$1,955.37
|
| Rate for Payer: Nomi Health Commercial |
$3,384.50
|
| Rate for Payer: PACE SWMI |
$2,820.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,820.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,862.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,327.70
|
| Rate for Payer: Priority Health HMO/PPO |
$5,185.60
|
| Rate for Payer: Priority Health Medicare |
$2,848.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,185.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,820.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,820.42
|
| Rate for Payer: UHC Exchange |
$2,820.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,820.42
|
| Rate for Payer: UHCCP Medicaid |
$1,862.26
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,567.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$5,547.72 |
| Rate for Payer: Aetna Commercial |
$4,050.31
|
| Rate for Payer: Aetna Medicare |
$3,143.52
|
| Rate for Payer: BCBS Complete |
$2,089.78
|
| Rate for Payer: BCBS MAPPO |
$3,022.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,288.00
|
| Rate for Payer: BCN Commercial |
$4,525.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,022.62
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cofinity Commercial |
$4,352.57
|
| Rate for Payer: Cofinity Commercial |
$4,050.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,022.62
|
| Rate for Payer: Mclaren Medicaid |
$1,990.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,173.75
|
| Rate for Payer: Meridian Medicaid |
$2,089.78
|
| Rate for Payer: Nomi Health Commercial |
$3,627.14
|
| Rate for Payer: PACE SWMI |
$3,022.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,022.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,990.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,918.55
|
| Rate for Payer: Priority Health HMO/PPO |
$5,547.72
|
| Rate for Payer: Priority Health Medicare |
$3,052.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,547.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,022.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,022.62
|
| Rate for Payer: UHC Exchange |
$3,022.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,022.62
|
| Rate for Payer: UHCCP Medicaid |
$1,990.27
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$1,573.28 |
| Rate for Payer: Aetna Commercial |
$802.47
|
| Rate for Payer: Aetna Medicare |
$622.81
|
| Rate for Payer: BCBS Complete |
$425.39
|
| Rate for Payer: BCBS MAPPO |
$598.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.28
|
| Rate for Payer: BCN Commercial |
$919.69
|
| Rate for Payer: BCN Medicare Advantage |
$598.86
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cofinity Commercial |
$802.47
|
| Rate for Payer: Cofinity Commercial |
$862.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.86
|
| Rate for Payer: Mclaren Medicaid |
$405.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$628.80
|
| Rate for Payer: Meridian Medicaid |
$425.39
|
| Rate for Payer: Nomi Health Commercial |
$718.63
|
| Rate for Payer: PACE SWMI |
$598.86
|
| Rate for Payer: PHP Medicare Advantage |
$598.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,130.55
|
| Rate for Payer: Priority Health Medicare |
$604.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.86
|
| Rate for Payer: UHC Exchange |
$598.86
|
| Rate for Payer: UHC Medicare Advantage |
$598.86
|
| Rate for Payer: UHCCP Medicaid |
$405.13
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$703.75 |
| Max. Negotiated Rate |
$1,965.18 |
| Rate for Payer: Aetna Commercial |
$1,404.21
|
| Rate for Payer: Aetna Medicare |
$1,089.84
|
| Rate for Payer: BCBS Complete |
$738.94
|
| Rate for Payer: BCBS MAPPO |
$1,047.92
|
| Rate for Payer: BCN Commercial |
$1,603.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,047.92
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,509.00
|
| Rate for Payer: Cofinity Commercial |
$1,404.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,047.92
|
| Rate for Payer: Mclaren Medicaid |
$703.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.32
|
| Rate for Payer: Meridian Medicaid |
$738.94
|
| Rate for Payer: Nomi Health Commercial |
$1,257.50
|
| Rate for Payer: PACE SWMI |
$1,047.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,047.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,965.18
|
| Rate for Payer: Priority Health Medicare |
$1,058.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,965.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,047.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,047.92
|
| Rate for Payer: UHC Exchange |
$1,047.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,047.92
|
| Rate for Payer: UHCCP Medicaid |
$703.75
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,977.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$937.84 |
| Max. Negotiated Rate |
$3,235.05 |
| Rate for Payer: Aetna Commercial |
$1,912.92
|
| Rate for Payer: Aetna Medicare |
$1,484.65
|
| Rate for Payer: BCBS Complete |
$984.73
|
| Rate for Payer: BCBS MAPPO |
$1,427.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$2,135.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.55
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cofinity Commercial |
$2,055.67
|
| Rate for Payer: Cofinity Commercial |
$1,912.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.55
|
| Rate for Payer: Mclaren Medicaid |
$937.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,498.93
|
| Rate for Payer: Meridian Medicaid |
$984.73
|
| Rate for Payer: Nomi Health Commercial |
$1,713.06
|
| Rate for Payer: PACE SWMI |
$1,427.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$937.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,235.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,618.45
|
| Rate for Payer: Priority Health Medicare |
$1,441.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,618.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,427.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,427.55
|
| Rate for Payer: UHC Exchange |
$1,427.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,427.55
|
| Rate for Payer: UHCCP Medicaid |
$937.84
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,000.04 |
| Max. Negotiated Rate |
$2,795.64 |
| Rate for Payer: Aetna Commercial |
$2,047.94
|
| Rate for Payer: Aetna Medicare |
$1,589.44
|
| Rate for Payer: BCBS Complete |
$1,050.04
|
| Rate for Payer: BCBS MAPPO |
$1,528.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.03
|
| Rate for Payer: BCN Commercial |
$2,281.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,528.31
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$2,200.77
|
| Rate for Payer: Cofinity Commercial |
$2,047.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,528.31
|
| Rate for Payer: Mclaren Medicaid |
$1,000.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,604.73
|
| Rate for Payer: Meridian Medicaid |
$1,050.04
|
| Rate for Payer: Nomi Health Commercial |
$1,833.97
|
| Rate for Payer: PACE SWMI |
$1,528.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,528.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,180.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2,795.64
|
| Rate for Payer: Priority Health Medicare |
$1,543.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,795.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,528.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,528.31
|
| Rate for Payer: UHC Exchange |
$1,528.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,528.31
|
| Rate for Payer: UHCCP Medicaid |
$1,000.04
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$77.13 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.15
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.15
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.61
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Nomi Health Commercial |
$10.98
|
| Rate for Payer: PACE SWMI |
$9.15
|
| Rate for Payer: PHP Medicare Advantage |
$9.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO |
$12.66
|
| Rate for Payer: Priority Health Medicare |
$9.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.15
|
| Rate for Payer: UHC Exchange |
$9.15
|
| Rate for Payer: UHC Medicare Advantage |
$9.15
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$291.25 |
| Rate for Payer: Aetna Commercial |
$256.23
|
| Rate for Payer: Aetna Medicare |
$198.87
|
| Rate for Payer: BCBS Complete |
$135.98
|
| Rate for Payer: BCBS MAPPO |
$191.22
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: BCN Medicare Advantage |
$191.22
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$275.36
|
| Rate for Payer: Cofinity Commercial |
$256.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.22
|
| Rate for Payer: Mclaren Medicaid |
$129.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.78
|
| Rate for Payer: Meridian Medicaid |
$135.98
|
| Rate for Payer: Nomi Health Commercial |
$229.46
|
| Rate for Payer: PACE SWMI |
$191.22
|
| Rate for Payer: PHP Medicare Advantage |
$191.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health HMO/PPO |
$272.29
|
| Rate for Payer: Priority Health Medicare |
$193.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.22
|
| Rate for Payer: UHC Exchange |
$191.22
|
| Rate for Payer: UHC Medicare Advantage |
$191.22
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$423.20
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Mclaren Medicaid |
$187.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health HMO/PPO |
$394.42
|
| Rate for Payer: Priority Health Medicare |
$280.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$394.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Exchange |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$225.78 |
| Max. Negotiated Rate |
$508.71 |
| Rate for Payer: Aetna Commercial |
$449.45
|
| Rate for Payer: Aetna Medicare |
$348.83
|
| Rate for Payer: BCBS Complete |
$237.07
|
| Rate for Payer: BCBS MAPPO |
$335.41
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$335.41
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$482.99
|
| Rate for Payer: Cofinity Commercial |
$449.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.41
|
| Rate for Payer: Mclaren Medicaid |
$225.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.18
|
| Rate for Payer: Meridian Medicaid |
$237.07
|
| Rate for Payer: Nomi Health Commercial |
$402.49
|
| Rate for Payer: PACE SWMI |
$335.41
|
| Rate for Payer: PHP Medicare Advantage |
$335.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO |
$474.93
|
| Rate for Payer: Priority Health Medicare |
$338.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.41
|
| Rate for Payer: UHC Exchange |
$335.41
|
| Rate for Payer: UHC Medicare Advantage |
$335.41
|
| Rate for Payer: UHCCP Medicaid |
$225.78
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$422.71 |
| Rate for Payer: Aetna Commercial |
$372.64
|
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$278.09
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: BCN Commercial |
$422.71
|
| Rate for Payer: BCN Medicare Advantage |
$278.09
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$372.64
|
| Rate for Payer: Cofinity Commercial |
$400.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.09
|
| Rate for Payer: Mclaren Medicaid |
$187.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.99
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Nomi Health Commercial |
$333.71
|
| Rate for Payer: PACE SWMI |
$278.09
|
| Rate for Payer: PHP Medicare Advantage |
$278.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO |
$394.42
|
| Rate for Payer: Priority Health Medicare |
$280.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$394.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.09
|
| Rate for Payer: UHC Exchange |
$278.09
|
| Rate for Payer: UHC Medicare Advantage |
$278.09
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,655.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$132.14 |
| Max. Negotiated Rate |
$2,753.41 |
| Rate for Payer: Aetna Commercial |
$391.44
|
| Rate for Payer: Aetna Medicare |
$1,327.50
|
| Rate for Payer: BCBS Complete |
$1,062.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Cash Price |
$2,124.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.75
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$398.74 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Aetna Commercial |
$764.36
|
| Rate for Payer: Aetna Medicare |
$593.24
|
| Rate for Payer: BCBS Complete |
$418.68
|
| Rate for Payer: BCBS MAPPO |
$570.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$920.18
|
| Rate for Payer: BCN Medicare Advantage |
$570.42
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$821.40
|
| Rate for Payer: Cofinity Commercial |
$764.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.42
|
| Rate for Payer: Mclaren Medicaid |
$398.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.94
|
| Rate for Payer: Meridian Medicaid |
$418.68
|
| Rate for Payer: Nomi Health Commercial |
$684.50
|
| Rate for Payer: PACE SWMI |
$570.42
|
| Rate for Payer: PHP Medicare Advantage |
$570.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health HMO/PPO |
$875.95
|
| Rate for Payer: Priority Health Medicare |
$576.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$875.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.42
|
| Rate for Payer: UHC Exchange |
$570.42
|
| Rate for Payer: UHC Medicare Advantage |
$570.42
|
| Rate for Payer: UHCCP Medicaid |
$398.74
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$498.21 |
| Max. Negotiated Rate |
$1,178.69 |
| Rate for Payer: Aetna Commercial |
$970.96
|
| Rate for Payer: Aetna Medicare |
$753.58
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: BCBS MAPPO |
$724.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.51
|
| Rate for Payer: BCN Commercial |
$1,178.69
|
| Rate for Payer: BCN Medicare Advantage |
$724.60
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cofinity Commercial |
$970.96
|
| Rate for Payer: Cofinity Commercial |
$1,043.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.60
|
| Rate for Payer: Mclaren Medicaid |
$498.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.83
|
| Rate for Payer: Meridian Medicaid |
$523.12
|
| Rate for Payer: Nomi Health Commercial |
$869.52
|
| Rate for Payer: PACE SWMI |
$724.60
|
| Rate for Payer: PHP Medicare Advantage |
$724.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,091.46
|
| Rate for Payer: Priority Health Medicare |
$731.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.60
|
| Rate for Payer: UHC Exchange |
$724.60
|
| Rate for Payer: UHC Medicare Advantage |
$724.60
|
| Rate for Payer: UHCCP Medicaid |
$498.21
|
|
|
PR ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$681.50 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,092.48
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.77
|
| Rate for Payer: BCN Commercial |
$1,107.77
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Mclaren Medicaid |
$1,287.51
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
|
PR EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Commercial |
$153.41
|
| Rate for Payer: Aetna Medicare |
$119.06
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS MAPPO |
$114.48
|
| Rate for Payer: BCBS Trust/PPO |
$129.70
|
| Rate for Payer: BCN Commercial |
$137.68
|
| Rate for Payer: BCN Medicare Advantage |
$114.48
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Cofinity Commercial |
$164.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.21
|
| Rate for Payer: Nomi Health Commercial |
$137.38
|
| Rate for Payer: PACE SWMI |
$114.48
|
| Rate for Payer: PHP Medicare Advantage |
$114.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health Medicare |
$115.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.48
|
| Rate for Payer: UHC Exchange |
$114.48
|
| Rate for Payer: UHC Medicare Advantage |
$114.48
|
|
|
PR EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 11740
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$30.49
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: BCN Medicare Advantage |
$30.49
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$40.86
|
| Rate for Payer: Cofinity Commercial |
$43.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.49
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.01
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$36.59
|
| Rate for Payer: PACE SWMI |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$30.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO |
$43.80
|
| Rate for Payer: Priority Health Medicare |
$30.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.49
|
| Rate for Payer: UHC Exchange |
$30.49
|
| Rate for Payer: UHC Medicare Advantage |
$30.49
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 92626
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$126.57 |
| Rate for Payer: Aetna Commercial |
$93.52
|
| Rate for Payer: Aetna Medicare |
$72.58
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: BCN Medicare Advantage |
$69.79
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$100.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.79
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.28
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Nomi Health Commercial |
$83.75
|
| Rate for Payer: PACE SWMI |
$69.79
|
| Rate for Payer: PHP Medicare Advantage |
$69.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO |
$99.51
|
| Rate for Payer: Priority Health Medicare |
$70.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.79
|
| Rate for Payer: UHC Exchange |
$69.79
|
| Rate for Payer: UHC Medicare Advantage |
$69.79
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
|
|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 92627
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$29.81 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Meridian Medicaid |
$11.63
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO |
$23.52
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$11.08
|
|
