|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$535.70 |
| Max. Negotiated Rate |
$1,775.11 |
| Rate for Payer: Aetna Commercial |
$1,113.33
|
| Rate for Payer: Aetna Medicare |
$830.84
|
| Rate for Payer: BCBS Complete |
$562.49
|
| Rate for Payer: BCBS MAPPO |
$830.84
|
| Rate for Payer: BCN Commercial |
$1,334.10
|
| Rate for Payer: BCN Medicare Advantage |
$830.84
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$1,196.41
|
| Rate for Payer: Cofinity Commercial |
$1,113.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.84
|
| Rate for Payer: Healthscope Commercial |
$997.01
|
| Rate for Payer: Healthscope Whirlpool |
$997.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.38
|
| Rate for Payer: Meridian Medicaid |
$562.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$913.92
|
| Rate for Payer: Nomi Health Commercial |
$997.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: PACE SWMI |
$830.84
|
| Rate for Payer: PHP Medicare Advantage |
$830.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,775.11
|
| Rate for Payer: Priority Health Medicare |
$830.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,775.11
|
| Rate for Payer: Railroad Medicare Medicare |
$830.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,559.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$830.84
|
| Rate for Payer: UHC Exchange |
$1,559.39
|
| Rate for Payer: UHC Medicaid |
$535.70
|
| Rate for Payer: UHCCP DNSP |
$830.84
|
| Rate for Payer: UHCCP Medicaid |
$535.70
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$429.62 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna Commercial |
$890.74
|
| Rate for Payer: Aetna Medicare |
$664.73
|
| Rate for Payer: BCBS Complete |
$451.10
|
| Rate for Payer: BCBS MAPPO |
$664.73
|
| Rate for Payer: BCN Commercial |
$1,062.20
|
| Rate for Payer: BCN Medicare Advantage |
$664.73
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cofinity Commercial |
$957.21
|
| Rate for Payer: Cofinity Commercial |
$890.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.73
|
| Rate for Payer: Healthscope Commercial |
$797.68
|
| Rate for Payer: Healthscope Whirlpool |
$797.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.97
|
| Rate for Payer: Meridian Medicaid |
$451.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$731.20
|
| Rate for Payer: Nomi Health Commercial |
$797.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,624.50
|
| Rate for Payer: PACE SWMI |
$664.73
|
| Rate for Payer: PHP Medicare Advantage |
$664.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,413.33
|
| Rate for Payer: Priority Health Medicare |
$664.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.33
|
| Rate for Payer: Railroad Medicare Medicare |
$664.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,236.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.73
|
| Rate for Payer: UHC Exchange |
$1,236.44
|
| Rate for Payer: UHC Medicaid |
$429.62
|
| Rate for Payer: UHCCP DNSP |
$664.73
|
| Rate for Payer: UHCCP Medicaid |
$429.62
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$5.32
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: ASR ASR |
$5.16
|
| Rate for Payer: BCBS Complete |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.39
|
| Rate for Payer: BCN Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.26
|
| Rate for Payer: Healthscope Commercial |
$5.16
|
| Rate for Payer: Healthscope Whirlpool |
$5.32
|
| Rate for Payer: Mclaren Commercial |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.53
|
| Rate for Payer: Nomi Health Commercial |
$4.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.66
|
| Rate for Payer: Priority Health Narrow Network |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.69
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$5.32
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: ASR ASR |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.26
|
| Rate for Payer: Healthscope Commercial |
$5.16
|
| Rate for Payer: Healthscope Whirlpool |
$5.32
|
| Rate for Payer: Mclaren Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.53
|
| Rate for Payer: Nomi Health Commercial |
$4.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.69
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 70377006611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$233.51
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 70756042911
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$105.21
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$234.45
|
| Rate for Payer: BCN Commercial |
$234.45
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 70756042911
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.26 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$233.51
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$532.32
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$399.24 |
| Max. Negotiated Rate |
$532.32 |
| Rate for Payer: Aetna Commercial |
$479.09
|
| Rate for Payer: ASR ASR |
$516.35
|
| Rate for Payer: BCBS Trust/PPO |
$437.14
|
| Rate for Payer: BCN Commercial |
$437.14
|
| Rate for Payer: Cash Price |
$425.86
|
| Rate for Payer: Cofinity Commercial |
$500.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.86
|
| Rate for Payer: Healthscope Commercial |
$516.35
|
| Rate for Payer: Healthscope Whirlpool |
$532.32
|
| Rate for Payer: Mclaren Commercial |
$479.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.47
|
| Rate for Payer: Nomi Health Commercial |
$436.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$468.44
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$532.32
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.96 |
| Max. Negotiated Rate |
$532.32 |
| Rate for Payer: Aetna Commercial |
$479.09
|
| Rate for Payer: Aetna Medicare |
$196.96
|
| Rate for Payer: ASR ASR |
$516.35
|
| Rate for Payer: BCBS Complete |
$212.93
|
| Rate for Payer: BCBS Trust/PPO |
$438.90
|
| Rate for Payer: BCN Commercial |
$438.90
|
| Rate for Payer: Cash Price |
$425.86
|
| Rate for Payer: Cofinity Commercial |
$500.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.86
|
| Rate for Payer: Healthscope Commercial |
$516.35
|
| Rate for Payer: Healthscope Whirlpool |
$532.32
|
| Rate for Payer: Mclaren Commercial |
$479.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.47
|
| Rate for Payer: Nomi Health Commercial |
$436.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$466.42
|
| Rate for Payer: Priority Health Narrow Network |
$373.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$468.44
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 70377006611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$105.21
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$234.45
|
| Rate for Payer: BCN Commercial |
$234.45
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Whirlpool |
$284.35
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$679.26 |
| Max. Negotiated Rate |
$2,064.27 |
| Rate for Payer: Aetna Commercial |
$1,405.27
|
| Rate for Payer: Aetna Medicare |
$1,048.71
|
| Rate for Payer: BCBS Complete |
$713.22
|
| Rate for Payer: BCBS MAPPO |
$1,048.71
|
| Rate for Payer: BCN Commercial |
$1,770.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.71
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Cofinity Commercial |
$1,405.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.71
|
| Rate for Payer: Healthscope Commercial |
$1,258.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,101.15
|
| Rate for Payer: Meridian Medicaid |
$713.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,153.58
|
| Rate for Payer: Nomi Health Commercial |
$1,258.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,679.25
|
| Rate for Payer: PACE SWMI |
$1,048.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,892.43
|
| Rate for Payer: Priority Health Medicare |
$1,048.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,892.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,064.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,048.71
|
| Rate for Payer: UHC Exchange |
$2,064.27
|
| Rate for Payer: UHC Medicaid |
$679.26
|
| Rate for Payer: UHCCP DNSP |
$1,048.71
|
| Rate for Payer: UHCCP Medicaid |
$679.26
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$210.75 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$173.84
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.97
|
| Rate for Payer: UHC Exchange |
$163.97
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$987.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: BCBS Complete |
$394.80
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.25
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.50
|
|
|
PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35475
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: BCBS Complete |
$840.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.00
|
|
|
PR BALLN ANGIOPLASTY,PERC VENOUS
|
Professional
|
Both
|
$3,544.00
|
|
|
Service Code
|
HCPCS 35476
|
| Min. Negotiated Rate |
$1,417.60 |
| Max. Negotiated Rate |
$2,658.00 |
| Rate for Payer: BCBS Complete |
$1,417.60
|
| Rate for Payer: Cash Price |
$2,835.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,658.00
|
|
|
PR BALLN ANGIOPLASTY PERC,VISCERAL
|
Professional
|
Both
|
$2,943.00
|
|
|
Service Code
|
HCPCS 35471
|
| Min. Negotiated Rate |
$1,177.20 |
| Max. Negotiated Rate |
$2,207.25 |
| Rate for Payer: BCBS Complete |
$1,177.20
|
| Rate for Payer: Cash Price |
$2,354.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,207.25
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$5,070.00
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$1,257.13 |
| Max. Negotiated Rate |
$3,802.50 |
| Rate for Payer: Aetna Commercial |
$1,684.55
|
| Rate for Payer: Aetna Medicare |
$1,257.13
|
| Rate for Payer: BCBS Complete |
$2,028.00
|
| Rate for Payer: BCBS MAPPO |
$1,257.13
|
| Rate for Payer: BCN Commercial |
$2,048.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.13
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cofinity Commercial |
$1,810.27
|
| Rate for Payer: Cofinity Commercial |
$1,684.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.13
|
| Rate for Payer: Healthscope Commercial |
$1,508.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,508.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,382.84
|
| Rate for Payer: Nomi Health Commercial |
$1,508.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.50
|
| Rate for Payer: PACE SWMI |
$1,257.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,378.94
|
| Rate for Payer: Priority Health Medicare |
$1,257.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,378.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,257.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,419.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,257.13
|
| Rate for Payer: UHC Exchange |
$2,419.84
|
| Rate for Payer: UHCCP DNSP |
$1,257.13
|
|
|
PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 47542
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$157.45
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCN Commercial |
$197.20
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$141.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.25
|
| Rate for Payer: Nomi Health Commercial |
$141.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$240.27
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$240.27
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.50
|
| Rate for Payer: UHC Exchange |
$244.12
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP DNSP |
$117.50
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 61640
|
| Min. Negotiated Rate |
$406.40 |
| Max. Negotiated Rate |
$879.66 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: BCBS Complete |
$406.40
|
| Rate for Payer: BCN Commercial |
$697.67
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$810.32
|
| Rate for Payer: Priority Health Narrow Network |
$810.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$879.66
|
| Rate for Payer: UHC Exchange |
$879.66
|
|
|
PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 50706
|
| Min. Negotiated Rate |
$99.05 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Aetna Commercial |
$208.42
|
| Rate for Payer: Aetna Medicare |
$155.54
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS MAPPO |
$155.54
|
| Rate for Payer: BCN Commercial |
$263.44
|
| Rate for Payer: BCN Medicare Advantage |
$155.54
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cofinity Commercial |
$223.98
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.54
|
| Rate for Payer: Healthscope Commercial |
$186.65
|
| Rate for Payer: Healthscope Whirlpool |
$186.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$104.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.09
|
| Rate for Payer: Nomi Health Commercial |
$186.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.25
|
| Rate for Payer: PACE SWMI |
$155.54
|
| Rate for Payer: PHP Medicare Advantage |
$155.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$286.96
|
| Rate for Payer: Priority Health Medicare |
$155.54
|
| Rate for Payer: Priority Health Narrow Network |
$286.96
|
| Rate for Payer: Railroad Medicare Medicare |
$155.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.54
|
| Rate for Payer: UHC Exchange |
$326.60
|
| Rate for Payer: UHC Medicaid |
$99.05
|
| Rate for Payer: UHCCP DNSP |
$155.54
|
| Rate for Payer: UHCCP Medicaid |
$99.05
|
|
|
PR BCG LIVE INTRAVESICAL 1MG
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J9030
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: BCBS MAPPO |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: BCN Medicare Advantage |
$3.39
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$4.88
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Healthscope Whirlpool |
$4.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.73
|
| Rate for Payer: Nomi Health Commercial |
$4.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PACE SWMI |
$3.39
|
| Rate for Payer: PHP Medicare Advantage |
$3.39
|
| Rate for Payer: Priority Health Medicare |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.39
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UHCCP DNSP |
$3.39
|
|
|
PR BCG LIVE INTRAVESICAL VAC
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS J9031
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.75
|
|
|
PR BCN APNEALINK PLUS
|
Professional
|
Both
|
$776.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: BCBS Complete |
$310.40
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.00
|
|
|
PR BCN WATCHPAT
|
Professional
|
Both
|
$576.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.00
|
|
