|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$892.30 |
| Rate for Payer: Aetna Commercial |
$228.93
|
| Rate for Payer: Aetna Medicare |
$177.67
|
| Rate for Payer: BCBS Complete |
$114.73
|
| Rate for Payer: BCBS MAPPO |
$170.84
|
| Rate for Payer: BCBS Trust/PPO |
$892.30
|
| Rate for Payer: BCN Commercial |
$251.18
|
| Rate for Payer: BCN Medicare Advantage |
$170.84
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$246.01
|
| Rate for Payer: Cofinity Commercial |
$228.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.84
|
| Rate for Payer: Mclaren Medicaid |
$109.27
|
| Rate for Payer: Meridian Medicaid |
$114.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.38
|
| Rate for Payer: PACE SWMI |
$170.84
|
| Rate for Payer: PHP Medicare Advantage |
$170.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.04
|
| Rate for Payer: Priority Health Medicare |
$170.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.84
|
| Rate for Payer: UHC Medicare Advantage |
$175.97
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$8,153.00
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$5,707.10 |
| Rate for Payer: Aetna Commercial |
$408.27
|
| Rate for Payer: Aetna Medicare |
$316.87
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$304.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.60
|
| Rate for Payer: BCN Commercial |
$442.25
|
| Rate for Payer: BCN Medicare Advantage |
$304.68
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cofinity Commercial |
$438.74
|
| Rate for Payer: Cofinity Commercial |
$408.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.68
|
| Rate for Payer: Mclaren Medicaid |
$194.26
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$319.91
|
| Rate for Payer: PACE SWMI |
$304.68
|
| Rate for Payer: PHP Medicare Advantage |
$304.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.43
|
| Rate for Payer: Priority Health Medicare |
$304.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.68
|
| Rate for Payer: UHC Medicare Advantage |
$313.82
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$8,153.00
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$140.58 |
| Max. Negotiated Rate |
$5,707.10 |
| Rate for Payer: Aetna Commercial |
$295.03
|
| Rate for Payer: Aetna Medicare |
$228.98
|
| Rate for Payer: BCBS Complete |
$147.61
|
| Rate for Payer: BCBS MAPPO |
$220.17
|
| Rate for Payer: BCBS Trust/PPO |
$828.37
|
| Rate for Payer: BCN Commercial |
$319.60
|
| Rate for Payer: BCN Medicare Advantage |
$220.17
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cash Price |
$6,522.40
|
| Rate for Payer: Cofinity Commercial |
$317.04
|
| Rate for Payer: Cofinity Commercial |
$295.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.17
|
| Rate for Payer: Mclaren Medicaid |
$140.58
|
| Rate for Payer: Meridian Medicaid |
$147.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$231.18
|
| Rate for Payer: PACE SWMI |
$220.17
|
| Rate for Payer: PHP Medicare Advantage |
$220.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.31
|
| Rate for Payer: Priority Health Medicare |
$220.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.17
|
| Rate for Payer: UHC Medicare Advantage |
$226.78
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$137.81 |
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna Medicare |
$57.73
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$55.51
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$137.81
|
| Rate for Payer: BCN Medicare Advantage |
$55.51
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$79.93
|
| Rate for Payer: Cofinity Commercial |
$74.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.51
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.29
|
| Rate for Payer: PACE SWMI |
$55.51
|
| Rate for Payer: PHP Medicare Advantage |
$55.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.23
|
| Rate for Payer: Priority Health Medicare |
$55.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.51
|
| Rate for Payer: UHC Medicare Advantage |
$57.18
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$461.73 |
| Rate for Payer: Aetna Commercial |
$152.32
|
| Rate for Payer: Aetna Medicare |
$118.22
|
| Rate for Payer: BCBS Complete |
$77.16
|
| Rate for Payer: BCBS MAPPO |
$113.67
|
| Rate for Payer: BCBS Trust/PPO |
$461.73
|
| Rate for Payer: BCN Commercial |
$231.18
|
| Rate for Payer: BCN Medicare Advantage |
$113.67
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.67
|
| Rate for Payer: Mclaren Medicaid |
$73.49
|
| Rate for Payer: Meridian Medicaid |
$77.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.35
|
| Rate for Payer: PACE SWMI |
$113.67
|
| Rate for Payer: PHP Medicare Advantage |
$113.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.09
|
| Rate for Payer: Priority Health Medicare |
$113.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.67
|
| Rate for Payer: UHC Medicare Advantage |
$117.08
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$505.29 |
| Rate for Payer: Aetna Commercial |
$296.65
|
| Rate for Payer: Aetna Medicare |
$230.24
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$221.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: BCN Medicare Advantage |
$221.38
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$296.65
|
| Rate for Payer: Cofinity Commercial |
$318.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.38
|
| Rate for Payer: Mclaren Medicaid |
$140.79
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.45
|
| Rate for Payer: PACE SWMI |
$221.38
|
| Rate for Payer: PHP Medicare Advantage |
$221.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.34
|
| Rate for Payer: Priority Health Medicare |
$221.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.38
|
| Rate for Payer: UHC Medicare Advantage |
$228.02
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$139.76 |
| Rate for Payer: Aetna Commercial |
$73.73
|
| Rate for Payer: Aetna Medicare |
$57.22
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$55.02
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: BCN Medicare Advantage |
$55.02
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$73.73
|
| Rate for Payer: Cofinity Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.02
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.77
|
| Rate for Payer: PACE SWMI |
$55.02
|
| Rate for Payer: PHP Medicare Advantage |
$55.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.82
|
| Rate for Payer: Priority Health Medicare |
$55.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.02
|
| Rate for Payer: UHC Medicare Advantage |
$56.67
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$231.63 |
| Rate for Payer: Aetna Commercial |
$122.58
|
| Rate for Payer: Aetna Medicare |
$95.14
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS MAPPO |
$91.48
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$231.63
|
| Rate for Payer: BCN Medicare Advantage |
$91.48
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$131.73
|
| Rate for Payer: Cofinity Commercial |
$122.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.48
|
| Rate for Payer: Mclaren Medicaid |
$59.00
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.05
|
| Rate for Payer: PACE SWMI |
$91.48
|
| Rate for Payer: PHP Medicare Advantage |
$91.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.04
|
| Rate for Payer: Priority Health Medicare |
$91.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.48
|
| Rate for Payer: UHC Medicare Advantage |
$94.22
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$590.36 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna Medicare |
$25.73
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$590.36
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Medicare Advantage |
$24.74
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$35.63
|
| Rate for Payer: Cofinity Commercial |
$33.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.74
|
| Rate for Payer: Mclaren Medicaid |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.98
|
| Rate for Payer: PACE SWMI |
$24.74
|
| Rate for Payer: PHP Medicare Advantage |
$24.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.42
|
| Rate for Payer: Priority Health Medicare |
$24.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.74
|
| Rate for Payer: UHC Medicare Advantage |
$25.48
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$241.54 |
| Max. Negotiated Rate |
$1,358.04 |
| Rate for Payer: Aetna Commercial |
$487.60
|
| Rate for Payer: Aetna Medicare |
$378.44
|
| Rate for Payer: BCBS Complete |
$253.62
|
| Rate for Payer: BCBS MAPPO |
$363.88
|
| Rate for Payer: BCBS Trust/PPO |
$901.28
|
| Rate for Payer: BCN Commercial |
$1,358.04
|
| Rate for Payer: BCN Medicare Advantage |
$363.88
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$523.99
|
| Rate for Payer: Cofinity Commercial |
$487.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.88
|
| Rate for Payer: Mclaren Medicaid |
$241.54
|
| Rate for Payer: Meridian Medicaid |
$253.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$382.07
|
| Rate for Payer: PACE SWMI |
$363.88
|
| Rate for Payer: PHP Medicare Advantage |
$363.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$667.94
|
| Rate for Payer: Priority Health Medicare |
$363.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$667.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.88
|
| Rate for Payer: UHC Medicare Advantage |
$374.80
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$855.85 |
| Rate for Payer: Aetna Commercial |
$235.42
|
| Rate for Payer: Aetna Medicare |
$182.72
|
| Rate for Payer: BCBS Complete |
$119.21
|
| Rate for Payer: BCBS MAPPO |
$175.69
|
| Rate for Payer: BCBS Trust/PPO |
$855.85
|
| Rate for Payer: BCN Commercial |
$437.37
|
| Rate for Payer: BCN Medicare Advantage |
$175.69
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cofinity Commercial |
$252.99
|
| Rate for Payer: Cofinity Commercial |
$235.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.69
|
| Rate for Payer: Mclaren Medicaid |
$113.53
|
| Rate for Payer: Meridian Medicaid |
$119.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.47
|
| Rate for Payer: PACE SWMI |
$175.69
|
| Rate for Payer: PHP Medicare Advantage |
$175.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.34
|
| Rate for Payer: Priority Health Medicare |
$175.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.69
|
| Rate for Payer: UHC Medicare Advantage |
$180.96
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$53.89
|
| Rate for Payer: Aetna Medicare |
$41.83
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS MAPPO |
$40.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$59.13
|
| Rate for Payer: BCN Medicare Advantage |
$40.22
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$53.89
|
| Rate for Payer: Cofinity Commercial |
$57.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.22
|
| Rate for Payer: Mclaren Medicaid |
$25.77
|
| Rate for Payer: Meridian Medicaid |
$27.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.23
|
| Rate for Payer: PACE SWMI |
$40.22
|
| Rate for Payer: PHP Medicare Advantage |
$40.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.82
|
| Rate for Payer: Priority Health Medicare |
$40.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.22
|
| Rate for Payer: UHC Medicare Advantage |
$41.43
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$250.94 |
| Max. Negotiated Rate |
$570.02 |
| Rate for Payer: Aetna Commercial |
$509.17
|
| Rate for Payer: Aetna Medicare |
$395.18
|
| Rate for Payer: BCBS Complete |
$381.08
|
| Rate for Payer: BCBS MAPPO |
$379.98
|
| Rate for Payer: BCBS Trust/PPO |
$250.94
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$379.98
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cofinity Commercial |
$547.17
|
| Rate for Payer: Cofinity Commercial |
$509.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.98
|
| Rate for Payer: Mclaren Medicaid |
$362.93
|
| Rate for Payer: Meridian Medicaid |
$381.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$398.98
|
| Rate for Payer: PACE SWMI |
$379.98
|
| Rate for Payer: PHP Medicare Advantage |
$379.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.02
|
| Rate for Payer: Priority Health Medicare |
$379.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.98
|
| Rate for Payer: UHC Medicare Advantage |
$391.38
|
|
|
PR SUBSEQUENT INJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00672
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$113.79 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$159.96
|
| Rate for Payer: Aetna Medicare |
$124.14
|
| Rate for Payer: BCBS Complete |
$119.48
|
| Rate for Payer: BCBS MAPPO |
$119.37
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$175.44
|
| Rate for Payer: BCN Medicare Advantage |
$119.37
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$171.89
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.37
|
| Rate for Payer: Mclaren Medicaid |
$113.79
|
| Rate for Payer: Meridian Medicaid |
$119.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.34
|
| Rate for Payer: PACE SWMI |
$119.37
|
| Rate for Payer: PHP Medicare Advantage |
$119.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.77
|
| Rate for Payer: Priority Health Medicare |
$119.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.37
|
| Rate for Payer: UHC Medicare Advantage |
$122.95
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$125.22 |
| Max. Negotiated Rate |
$192.54 |
| Rate for Payer: Aetna Commercial |
$175.53
|
| Rate for Payer: Aetna Medicare |
$136.23
|
| Rate for Payer: BCBS Complete |
$131.48
|
| Rate for Payer: BCBS MAPPO |
$130.99
|
| Rate for Payer: BCBS Trust/PPO |
$188.05
|
| Rate for Payer: BCN Commercial |
$192.54
|
| Rate for Payer: BCN Medicare Advantage |
$130.99
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Cofinity Commercial |
$188.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.99
|
| Rate for Payer: Mclaren Medicaid |
$125.22
|
| Rate for Payer: Meridian Medicaid |
$131.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.54
|
| Rate for Payer: PACE SWMI |
$130.99
|
| Rate for Payer: PHP Medicare Advantage |
$130.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.76
|
| Rate for Payer: Priority Health Medicare |
$130.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.99
|
| Rate for Payer: UHC Medicare Advantage |
$134.92
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$471.24 |
| Rate for Payer: Aetna Commercial |
$154.18
|
| Rate for Payer: Aetna Medicare |
$119.66
|
| Rate for Payer: BCBS Complete |
$114.87
|
| Rate for Payer: BCBS MAPPO |
$115.06
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: BCN Medicare Advantage |
$115.06
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$165.69
|
| Rate for Payer: Cofinity Commercial |
$154.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.06
|
| Rate for Payer: Mclaren Medicaid |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$114.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.81
|
| Rate for Payer: PACE SWMI |
$115.06
|
| Rate for Payer: PHP Medicare Advantage |
$115.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.20
|
| Rate for Payer: Priority Health Medicare |
$115.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.51
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$139.66 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna Medicare |
$343.18
|
| Rate for Payer: BCBS Complete |
$331.55
|
| Rate for Payer: BCBS MAPPO |
$329.98
|
| Rate for Payer: BCBS Trust/PPO |
$139.66
|
| Rate for Payer: BCN Commercial |
$485.26
|
| Rate for Payer: BCN Medicare Advantage |
$329.98
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$442.17
|
| Rate for Payer: Cofinity Commercial |
$475.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.98
|
| Rate for Payer: Mclaren Medicaid |
$315.76
|
| Rate for Payer: Meridian Medicaid |
$331.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$346.48
|
| Rate for Payer: PACE SWMI |
$329.98
|
| Rate for Payer: PHP Medicare Advantage |
$329.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$425.32
|
| Rate for Payer: Priority Health Medicare |
$329.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$425.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.98
|
| Rate for Payer: UHC Medicare Advantage |
$339.88
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$709.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$590.46 |
| Rate for Payer: Aetna Commercial |
$516.24
|
| Rate for Payer: Aetna Medicare |
$400.66
|
| Rate for Payer: BCBS Complete |
$391.38
|
| Rate for Payer: BCBS MAPPO |
$385.25
|
| Rate for Payer: BCBS Trust/PPO |
$67.62
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$385.25
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cash Price |
$567.20
|
| Rate for Payer: Cofinity Commercial |
$554.76
|
| Rate for Payer: Cofinity Commercial |
$516.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$385.25
|
| Rate for Payer: Mclaren Medicaid |
$372.74
|
| Rate for Payer: Meridian Medicaid |
$391.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$404.51
|
| Rate for Payer: PACE SWMI |
$385.25
|
| Rate for Payer: PHP Medicare Advantage |
$385.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.46
|
| Rate for Payer: Priority Health Medicare |
$385.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$385.25
|
| Rate for Payer: UHC Medicare Advantage |
$396.81
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$4,153.00
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$470.19 |
| Max. Negotiated Rate |
$2,953.76 |
| Rate for Payer: Aetna Commercial |
$1,944.72
|
| Rate for Payer: Aetna Medicare |
$1,509.33
|
| Rate for Payer: BCBS Complete |
$983.39
|
| Rate for Payer: BCBS MAPPO |
$1,451.28
|
| Rate for Payer: BCBS Trust/PPO |
$470.19
|
| Rate for Payer: BCN Commercial |
$2,953.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.28
|
| Rate for Payer: Cash Price |
$3,322.40
|
| Rate for Payer: Cash Price |
$3,322.40
|
| Rate for Payer: Cofinity Commercial |
$2,089.84
|
| Rate for Payer: Cofinity Commercial |
$1,944.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.28
|
| Rate for Payer: Mclaren Medicaid |
$936.56
|
| Rate for Payer: Meridian Medicaid |
$983.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,523.84
|
| Rate for Payer: PACE SWMI |
$1,451.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$936.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,907.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,467.04
|
| Rate for Payer: Priority Health Medicare |
$1,451.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,467.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,451.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,494.82
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$367.50
|
| Rate for Payer: BCBS Complete |
$538.54
|
| Rate for Payer: BCBS Trust/PPO |
$438.68
|
| Rate for Payer: BCN Commercial |
$873.51
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Mclaren Medicaid |
$512.90
|
| Rate for Payer: Meridian Medicaid |
$538.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.36
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: BCBS Complete |
$1,240.00
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$890.53
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.36
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,890.00 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: BCBS Complete |
$1,080.00
|
| Rate for Payer: BCBS Trust/PPO |
$438.68
|
| Rate for Payer: BCN Commercial |
$882.90
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,890.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.36
|
|
|
PR SUMATRIPTAN SUCCINATE / 6 MG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS J3030
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$60.24
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$1,432.75 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.75
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.53
|
|
