|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$556.23 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Aetna Medicare |
$46.64
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$44.85
|
| Rate for Payer: BCBS Trust/PPO |
$556.23
|
| Rate for Payer: BCN Commercial |
$138.30
|
| Rate for Payer: BCN Medicare Advantage |
$44.85
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$64.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.85
|
| Rate for Payer: Mclaren Medicaid |
$28.54
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.09
|
| Rate for Payer: PACE SWMI |
$44.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.08
|
| Rate for Payer: Priority Health Medicare |
$44.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.85
|
| Rate for Payer: UHC Medicare Advantage |
$46.20
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$193.79
|
| Rate for Payer: Aetna Medicare |
$150.40
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$144.62
|
| Rate for Payer: BCBS Trust/PPO |
$305.57
|
| Rate for Payer: BCN Commercial |
$339.63
|
| Rate for Payer: BCN Medicare Advantage |
$144.62
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cofinity Commercial |
$208.25
|
| Rate for Payer: Cofinity Commercial |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.62
|
| Rate for Payer: Mclaren Medicaid |
$91.59
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.85
|
| Rate for Payer: PACE SWMI |
$144.62
|
| Rate for Payer: PHP Medicare Advantage |
$144.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.74
|
| Rate for Payer: Priority Health Medicare |
$144.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.62
|
| Rate for Payer: UHC Medicare Advantage |
$148.96
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$260.40 |
| Rate for Payer: Aetna Commercial |
$97.61
|
| Rate for Payer: Aetna Medicare |
$75.75
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$72.84
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: BCN Medicare Advantage |
$72.84
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$97.61
|
| Rate for Payer: Cofinity Commercial |
$104.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.84
|
| Rate for Payer: Mclaren Medicaid |
$46.86
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.48
|
| Rate for Payer: PACE SWMI |
$72.84
|
| Rate for Payer: PHP Medicare Advantage |
$72.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.20
|
| Rate for Payer: Priority Health Medicare |
$72.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.84
|
| Rate for Payer: UHC Medicare Advantage |
$75.03
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$3,043.01 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$12.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,043.01
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.97
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.62
|
| Rate for Payer: PACE SWMI |
$12.97
|
| Rate for Payer: PHP Medicare Advantage |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.61
|
| Rate for Payer: Priority Health Medicare |
$12.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.97
|
| Rate for Payer: UHC Medicare Advantage |
$13.36
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$1,656.13 |
| Rate for Payer: Aetna Commercial |
$1,476.41
|
| Rate for Payer: Aetna Medicare |
$1,145.87
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,101.80
|
| Rate for Payer: BCBS Trust/PPO |
$896.53
|
| Rate for Payer: BCN Commercial |
$1,656.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,101.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cofinity Commercial |
$1,586.59
|
| Rate for Payer: Cofinity Commercial |
$1,476.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,101.80
|
| Rate for Payer: Mclaren Medicaid |
$720.37
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,156.89
|
| Rate for Payer: PACE SWMI |
$1,101.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,101.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,470.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,569.26
|
| Rate for Payer: Priority Health Medicare |
$1,101.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,569.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,101.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,101.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,134.85
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$750.83 |
| Max. Negotiated Rate |
$1,727.96 |
| Rate for Payer: Aetna Commercial |
$1,535.16
|
| Rate for Payer: Aetna Medicare |
$1,191.47
|
| Rate for Payer: BCBS Complete |
$788.37
|
| Rate for Payer: BCBS MAPPO |
$1,145.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.07
|
| Rate for Payer: BCN Commercial |
$1,727.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,145.64
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,535.16
|
| Rate for Payer: Cofinity Commercial |
$1,649.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,145.64
|
| Rate for Payer: Mclaren Medicaid |
$750.83
|
| Rate for Payer: Meridian Medicaid |
$788.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,202.92
|
| Rate for Payer: PACE SWMI |
$1,145.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,145.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$750.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,637.33
|
| Rate for Payer: Priority Health Medicare |
$1,145.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,637.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,145.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,145.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,180.01
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,615.00
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$792.45 |
| Max. Negotiated Rate |
$1,843.29 |
| Rate for Payer: Aetna Commercial |
$1,640.37
|
| Rate for Payer: Aetna Medicare |
$1,273.13
|
| Rate for Payer: BCBS Complete |
$840.47
|
| Rate for Payer: BCBS MAPPO |
$1,224.16
|
| Rate for Payer: BCBS Trust/PPO |
$792.45
|
| Rate for Payer: BCN Commercial |
$1,843.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,224.16
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Cofinity Commercial |
$1,762.79
|
| Rate for Payer: Cofinity Commercial |
$1,640.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,224.16
|
| Rate for Payer: Mclaren Medicaid |
$800.45
|
| Rate for Payer: Meridian Medicaid |
$840.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,224.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,224.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$800.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,830.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,746.61
|
| Rate for Payer: Priority Health Medicare |
$1,224.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,746.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,224.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,260.88
|
|
|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$382.55 |
| Max. Negotiated Rate |
$880.60 |
| Rate for Payer: Aetna Commercial |
$779.14
|
| Rate for Payer: Aetna Medicare |
$604.71
|
| Rate for Payer: BCBS Complete |
$401.68
|
| Rate for Payer: BCBS MAPPO |
$581.45
|
| Rate for Payer: BCBS Trust/PPO |
$854.26
|
| Rate for Payer: BCN Commercial |
$880.60
|
| Rate for Payer: BCN Medicare Advantage |
$581.45
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$837.29
|
| Rate for Payer: Cofinity Commercial |
$779.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.45
|
| Rate for Payer: Mclaren Medicaid |
$382.55
|
| Rate for Payer: Meridian Medicaid |
$401.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$610.52
|
| Rate for Payer: PACE SWMI |
$581.45
|
| Rate for Payer: PHP Medicare Advantage |
$581.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$771.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$834.41
|
| Rate for Payer: Priority Health Medicare |
$581.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$834.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.45
|
| Rate for Payer: UHC Medicare Advantage |
$598.89
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$2,220.00
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$700.77 |
| Max. Negotiated Rate |
$1,613.62 |
| Rate for Payer: Aetna Commercial |
$1,430.93
|
| Rate for Payer: Aetna Medicare |
$1,110.57
|
| Rate for Payer: BCBS Complete |
$735.81
|
| Rate for Payer: BCBS MAPPO |
$1,067.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.34
|
| Rate for Payer: BCN Commercial |
$1,613.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,067.86
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cofinity Commercial |
$1,430.93
|
| Rate for Payer: Cofinity Commercial |
$1,537.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,067.86
|
| Rate for Payer: Mclaren Medicaid |
$700.77
|
| Rate for Payer: Meridian Medicaid |
$735.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,121.25
|
| Rate for Payer: PACE SWMI |
$1,067.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,067.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$700.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.98
|
| Rate for Payer: Priority Health Medicare |
$1,067.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,528.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,067.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,067.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.90
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$306.72 |
| Max. Negotiated Rate |
$1,016.45 |
| Rate for Payer: Aetna Commercial |
$621.57
|
| Rate for Payer: Aetna Medicare |
$482.41
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: BCBS MAPPO |
$463.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.45
|
| Rate for Payer: BCN Commercial |
$707.61
|
| Rate for Payer: BCN Medicare Advantage |
$463.86
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$667.96
|
| Rate for Payer: Cofinity Commercial |
$621.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.86
|
| Rate for Payer: Mclaren Medicaid |
$306.72
|
| Rate for Payer: Meridian Medicaid |
$322.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$487.05
|
| Rate for Payer: PACE SWMI |
$463.86
|
| Rate for Payer: PHP Medicare Advantage |
$463.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$670.49
|
| Rate for Payer: Priority Health Medicare |
$463.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$670.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$463.86
|
| Rate for Payer: UHC Medicare Advantage |
$477.78
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$113.58 |
| Max. Negotiated Rate |
$645.06 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Aetna Medicare |
$355.58
|
| Rate for Payer: BCBS Complete |
$230.58
|
| Rate for Payer: BCBS MAPPO |
$341.90
|
| Rate for Payer: BCBS Trust/PPO |
$113.58
|
| Rate for Payer: BCN Commercial |
$645.06
|
| Rate for Payer: BCN Medicare Advantage |
$341.90
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$492.34
|
| Rate for Payer: Cofinity Commercial |
$458.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.90
|
| Rate for Payer: Mclaren Medicaid |
$219.60
|
| Rate for Payer: Meridian Medicaid |
$230.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.00
|
| Rate for Payer: PACE SWMI |
$341.90
|
| Rate for Payer: PHP Medicare Advantage |
$341.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.92
|
| Rate for Payer: Priority Health Medicare |
$341.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$495.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.90
|
| Rate for Payer: UHC Medicare Advantage |
$352.16
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$330.15 |
| Max. Negotiated Rate |
$938.26 |
| Rate for Payer: Aetna Commercial |
$665.95
|
| Rate for Payer: Aetna Medicare |
$516.86
|
| Rate for Payer: BCBS Complete |
$346.66
|
| Rate for Payer: BCBS MAPPO |
$496.98
|
| Rate for Payer: BCBS Trust/PPO |
$665.66
|
| Rate for Payer: BCN Commercial |
$938.26
|
| Rate for Payer: BCN Medicare Advantage |
$496.98
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cofinity Commercial |
$715.65
|
| Rate for Payer: Cofinity Commercial |
$665.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.98
|
| Rate for Payer: Mclaren Medicaid |
$330.15
|
| Rate for Payer: Meridian Medicaid |
$346.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.83
|
| Rate for Payer: PACE SWMI |
$496.98
|
| Rate for Payer: PHP Medicare Advantage |
$496.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$712.62
|
| Rate for Payer: Priority Health Medicare |
$496.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$712.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.98
|
| Rate for Payer: UHC Medicare Advantage |
$511.89
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$1,830.00
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$446.87 |
| Max. Negotiated Rate |
$1,281.00 |
| Rate for Payer: Aetna Commercial |
$908.63
|
| Rate for Payer: Aetna Medicare |
$705.20
|
| Rate for Payer: BCBS Complete |
$469.21
|
| Rate for Payer: BCBS MAPPO |
$678.08
|
| Rate for Payer: BCBS Trust/PPO |
$695.24
|
| Rate for Payer: BCN Commercial |
$1,029.65
|
| Rate for Payer: BCN Medicare Advantage |
$678.08
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cofinity Commercial |
$908.63
|
| Rate for Payer: Cofinity Commercial |
$976.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.08
|
| Rate for Payer: Mclaren Medicaid |
$446.87
|
| Rate for Payer: Meridian Medicaid |
$469.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$711.98
|
| Rate for Payer: PACE SWMI |
$678.08
|
| Rate for Payer: PHP Medicare Advantage |
$678.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,281.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.63
|
| Rate for Payer: Priority Health Medicare |
$678.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$975.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.08
|
| Rate for Payer: UHC Medicare Advantage |
$698.42
|
|
|
PR SKIN LESION SHAVE/EXCISION (15 MIN)
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00367
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR SKIN LESION SHAVE/EXCISION (30 MIN)
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 00368
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
|
|
PR SKYLA, 13.5 MG
|
Professional
|
Both
|
$1,433.00
|
|
|
Service Code
|
HCPCS J7301
|
| Min. Negotiated Rate |
$917.35 |
| Max. Negotiated Rate |
$1,003.10 |
| Rate for Payer: Aetna Commercial |
$917.35
|
| Rate for Payer: BCBS Complete |
$963.22
|
| Rate for Payer: BCBS Trust/PPO |
$925.78
|
| Rate for Payer: BCN Commercial |
$925.78
|
| Rate for Payer: Cash Price |
$1,146.40
|
| Rate for Payer: Cash Price |
$1,146.40
|
| Rate for Payer: Mclaren Medicaid |
$917.35
|
| Rate for Payer: Meridian Medicaid |
$963.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$917.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,003.10
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 36251
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$1,894.60 |
| Rate for Payer: Aetna Commercial |
$336.78
|
| Rate for Payer: Aetna Medicare |
$261.38
|
| Rate for Payer: BCBS Complete |
$166.84
|
| Rate for Payer: BCBS MAPPO |
$251.33
|
| Rate for Payer: BCBS Trust/PPO |
$555.24
|
| Rate for Payer: BCN Commercial |
$1,894.60
|
| Rate for Payer: BCN Medicare Advantage |
$251.33
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$361.92
|
| Rate for Payer: Cofinity Commercial |
$336.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.33
|
| Rate for Payer: Mclaren Medicaid |
$158.90
|
| Rate for Payer: Meridian Medicaid |
$166.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.90
|
| Rate for Payer: PACE SWMI |
$251.33
|
| Rate for Payer: PHP Medicare Advantage |
$251.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$397.91
|
| Rate for Payer: Priority Health Medicare |
$251.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$397.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.33
|
| Rate for Payer: UHC Medicare Advantage |
$258.87
|
|
|
PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 36252
|
| Min. Negotiated Rate |
$222.16 |
| Max. Negotiated Rate |
$2,039.26 |
| Rate for Payer: Aetna Commercial |
$468.33
|
| Rate for Payer: Aetna Medicare |
$363.48
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$349.50
|
| Rate for Payer: BCBS Trust/PPO |
$787.70
|
| Rate for Payer: BCN Commercial |
$2,039.26
|
| Rate for Payer: BCN Medicare Advantage |
$349.50
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$503.28
|
| Rate for Payer: Cofinity Commercial |
$468.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.50
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$366.98
|
| Rate for Payer: PACE SWMI |
$349.50
|
| Rate for Payer: PHP Medicare Advantage |
$349.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.24
|
| Rate for Payer: Priority Health Medicare |
$349.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.50
|
| Rate for Payer: UHC Medicare Advantage |
$359.98
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART
|
Professional
|
Both
|
$1,766.00
|
|
|
Service Code
|
HCPCS 36223
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$2,411.13 |
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Medicare |
$335.97
|
| Rate for Payer: BCBS Complete |
$217.61
|
| Rate for Payer: BCBS MAPPO |
$323.05
|
| Rate for Payer: BCBS Trust/PPO |
$927.17
|
| Rate for Payer: BCN Commercial |
$2,411.13
|
| Rate for Payer: BCN Medicare Advantage |
$323.05
|
| Rate for Payer: Cash Price |
$1,412.80
|
| Rate for Payer: Cash Price |
$1,412.80
|
| Rate for Payer: Cofinity Commercial |
$432.89
|
| Rate for Payer: Cofinity Commercial |
$465.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.05
|
| Rate for Payer: Mclaren Medicaid |
$207.25
|
| Rate for Payer: Meridian Medicaid |
$217.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$339.20
|
| Rate for Payer: PACE SWMI |
$323.05
|
| Rate for Payer: PHP Medicare Advantage |
$323.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.74
|
| Rate for Payer: Priority Health Medicare |
$323.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.05
|
| Rate for Payer: UHC Medicare Advantage |
$332.74
|
|
|
PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 36222
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$1,787.58 |
| Rate for Payer: Aetna Commercial |
$376.19
|
| Rate for Payer: Aetna Medicare |
$291.97
|
| Rate for Payer: BCBS Complete |
$188.32
|
| Rate for Payer: BCBS MAPPO |
$280.74
|
| Rate for Payer: BCBS Trust/PPO |
$470.19
|
| Rate for Payer: BCN Commercial |
$1,787.58
|
| Rate for Payer: BCN Medicare Advantage |
$280.74
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$404.27
|
| Rate for Payer: Cofinity Commercial |
$376.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.74
|
| Rate for Payer: Mclaren Medicaid |
$179.35
|
| Rate for Payer: Meridian Medicaid |
$188.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$294.78
|
| Rate for Payer: PACE SWMI |
$280.74
|
| Rate for Payer: PHP Medicare Advantage |
$280.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.19
|
| Rate for Payer: Priority Health Medicare |
$280.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.74
|
| Rate for Payer: UHC Medicare Advantage |
$289.16
|
|
|
PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY
|
Professional
|
Both
|
$989.00
|
|
|
Service Code
|
HCPCS 36014
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$1,156.70 |
| Rate for Payer: Aetna Commercial |
$198.57
|
| Rate for Payer: Aetna Medicare |
$154.12
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS MAPPO |
$148.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.43
|
| Rate for Payer: BCN Commercial |
$1,156.70
|
| Rate for Payer: BCN Medicare Advantage |
$148.19
|
| Rate for Payer: Cash Price |
$791.20
|
| Rate for Payer: Cash Price |
$791.20
|
| Rate for Payer: Cofinity Commercial |
$213.39
|
| Rate for Payer: Cofinity Commercial |
$198.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.19
|
| Rate for Payer: Mclaren Medicaid |
$93.93
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$155.60
|
| Rate for Payer: PACE SWMI |
$148.19
|
| Rate for Payer: PHP Medicare Advantage |
$148.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.12
|
| Rate for Payer: Priority Health Medicare |
$148.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.19
|
| Rate for Payer: UHC Medicare Advantage |
$152.64
|
|
|
PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
HCPCS 36228
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$1,848.67 |
| Rate for Payer: Aetna Commercial |
$327.09
|
| Rate for Payer: Aetna Medicare |
$253.86
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS MAPPO |
$244.10
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$1,848.67
|
| Rate for Payer: BCN Medicare Advantage |
$244.10
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$327.09
|
| Rate for Payer: Cofinity Commercial |
$351.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.10
|
| Rate for Payer: Mclaren Medicaid |
$157.19
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.30
|
| Rate for Payer: PACE SWMI |
$244.10
|
| Rate for Payer: PHP Medicare Advantage |
$244.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.20
|
| Rate for Payer: Priority Health Medicare |
$244.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.10
|
| Rate for Payer: UHC Medicare Advantage |
$251.42
|
|
|
PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART
|
Professional
|
Both
|
$1,233.00
|
|
|
Service Code
|
HCPCS 36224
|
| Min. Negotiated Rate |
$232.81 |
| Max. Negotiated Rate |
$2,995.59 |
| Rate for Payer: Aetna Commercial |
$487.05
|
| Rate for Payer: Aetna Medicare |
$378.01
|
| Rate for Payer: BCBS Complete |
$244.45
|
| Rate for Payer: BCBS MAPPO |
$363.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,419.54
|
| Rate for Payer: BCN Commercial |
$2,995.59
|
| Rate for Payer: BCN Medicare Advantage |
$363.47
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cofinity Commercial |
$487.05
|
| Rate for Payer: Cofinity Commercial |
$523.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.47
|
| Rate for Payer: Mclaren Medicaid |
$232.81
|
| Rate for Payer: Meridian Medicaid |
$244.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$381.64
|
| Rate for Payer: PACE SWMI |
$363.47
|
| Rate for Payer: PHP Medicare Advantage |
$363.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.11
|
| Rate for Payer: Priority Health Medicare |
$363.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$576.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.47
|
| Rate for Payer: UHC Medicare Advantage |
$374.37
|
|
|
PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 36216
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$1,608.60 |
| Rate for Payer: Aetna Commercial |
$355.66
|
| Rate for Payer: Aetna Medicare |
$276.04
|
| Rate for Payer: BCBS Complete |
$178.25
|
| Rate for Payer: BCBS MAPPO |
$265.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.56
|
| Rate for Payer: BCN Commercial |
$1,562.31
|
| Rate for Payer: BCN Medicare Advantage |
$265.42
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$382.20
|
| Rate for Payer: Cofinity Commercial |
$355.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.42
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$278.69
|
| Rate for Payer: PACE SWMI |
$265.42
|
| Rate for Payer: PHP Medicare Advantage |
$265.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.25
|
| Rate for Payer: Priority Health Medicare |
$265.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.42
|
| Rate for Payer: UHC Medicare Advantage |
$273.38
|
|
|
PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$1,022.00
|
|
|
Service Code
|
HCPCS 36246
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$1,388.37 |
| Rate for Payer: Aetna Commercial |
$330.86
|
| Rate for Payer: Aetna Medicare |
$256.79
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS MAPPO |
$246.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.37
|
| Rate for Payer: BCN Commercial |
$1,224.14
|
| Rate for Payer: BCN Medicare Advantage |
$246.91
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Cofinity Commercial |
$355.55
|
| Rate for Payer: Cofinity Commercial |
$330.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.91
|
| Rate for Payer: Mclaren Medicaid |
$157.19
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$259.26
|
| Rate for Payer: PACE SWMI |
$246.91
|
| Rate for Payer: PHP Medicare Advantage |
$246.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.92
|
| Rate for Payer: Priority Health Medicare |
$246.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.91
|
| Rate for Payer: UHC Medicare Advantage |
$254.32
|
|
