|
PR ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART
|
Professional
|
Both
|
$8,427.00
|
|
|
Service Code
|
HCPCS 61705
|
| Min. Negotiated Rate |
$2,581.80 |
| Max. Negotiated Rate |
$5,477.55 |
| Rate for Payer: Aetna Commercial |
$3,459.61
|
| Rate for Payer: Aetna Medicare |
$2,581.80
|
| Rate for Payer: BCBS Complete |
$3,370.80
|
| Rate for Payer: BCBS MAPPO |
$2,581.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,581.80
|
| Rate for Payer: Cash Price |
$6,741.60
|
| Rate for Payer: Cash Price |
$6,741.60
|
| Rate for Payer: Cofinity Commercial |
$3,717.79
|
| Rate for Payer: Cofinity Commercial |
$3,459.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,581.80
|
| Rate for Payer: Healthscope Commercial |
$3,098.16
|
| Rate for Payer: Healthscope Whirlpool |
$3,098.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,710.89
|
| Rate for Payer: Nomi Health Commercial |
$3,098.16
|
| Rate for Payer: PACE SWMI |
$2,581.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,581.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,477.55
|
| Rate for Payer: Priority Health Medicare |
$2,581.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,581.80
|
| Rate for Payer: UHC Medicare Advantage |
$2,581.80
|
| Rate for Payer: UHCCP DNSP |
$2,581.80
|
|
|
PR ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 31400
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,367.90 |
| Rate for Payer: Aetna Commercial |
$1,272.91
|
| Rate for Payer: Aetna Medicare |
$949.93
|
| Rate for Payer: BCBS Complete |
$834.80
|
| Rate for Payer: BCBS MAPPO |
$949.93
|
| Rate for Payer: BCN Medicare Advantage |
$949.93
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,367.90
|
| Rate for Payer: Cofinity Commercial |
$1,272.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$949.93
|
| Rate for Payer: Healthscope Commercial |
$1,139.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,139.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.43
|
| Rate for Payer: Nomi Health Commercial |
$1,139.92
|
| Rate for Payer: PACE SWMI |
$949.93
|
| Rate for Payer: PHP Medicare Advantage |
$949.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health Medicare |
$949.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$949.93
|
| Rate for Payer: UHC Medicare Advantage |
$949.93
|
| Rate for Payer: UHCCP DNSP |
$949.93
|
|
|
PR AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
|
Professional
|
Both
|
$6,622.00
|
|
|
Service Code
|
HCPCS 33863
|
| Min. Negotiated Rate |
$2,648.80 |
| Max. Negotiated Rate |
$4,337.29 |
| Rate for Payer: Aetna Commercial |
$4,036.09
|
| Rate for Payer: Aetna Medicare |
$3,012.01
|
| Rate for Payer: BCBS Complete |
$2,648.80
|
| Rate for Payer: BCBS MAPPO |
$3,012.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,012.01
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cofinity Commercial |
$4,337.29
|
| Rate for Payer: Cofinity Commercial |
$4,036.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,012.01
|
| Rate for Payer: Healthscope Commercial |
$3,614.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,614.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,162.61
|
| Rate for Payer: Nomi Health Commercial |
$3,614.41
|
| Rate for Payer: PACE SWMI |
$3,012.01
|
| Rate for Payer: PHP Medicare Advantage |
$3,012.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,304.30
|
| Rate for Payer: Priority Health Medicare |
$3,012.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,012.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,012.01
|
| Rate for Payer: UHCCP DNSP |
$3,012.01
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION
|
Professional
|
Both
|
$7,125.00
|
|
|
Service Code
|
HCPCS 33858
|
| Min. Negotiated Rate |
$2,850.00 |
| Max. Negotiated Rate |
$4,681.41 |
| Rate for Payer: Aetna Commercial |
$4,356.31
|
| Rate for Payer: Aetna Medicare |
$3,250.98
|
| Rate for Payer: BCBS Complete |
$2,850.00
|
| Rate for Payer: BCBS MAPPO |
$3,250.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,250.98
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cofinity Commercial |
$4,681.41
|
| Rate for Payer: Cofinity Commercial |
$4,356.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,250.98
|
| Rate for Payer: Healthscope Commercial |
$3,901.18
|
| Rate for Payer: Healthscope Whirlpool |
$3,901.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,413.53
|
| Rate for Payer: Nomi Health Commercial |
$3,901.18
|
| Rate for Payer: PACE SWMI |
$3,250.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,250.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.25
|
| Rate for Payer: Priority Health Medicare |
$3,250.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,250.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,250.98
|
| Rate for Payer: UHCCP DNSP |
$3,250.98
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ
|
Professional
|
Both
|
$5,111.00
|
|
|
Service Code
|
HCPCS 33859
|
| Min. Negotiated Rate |
$2,044.40 |
| Max. Negotiated Rate |
$3,362.27 |
| Rate for Payer: Aetna Commercial |
$3,128.78
|
| Rate for Payer: Aetna Medicare |
$2,334.91
|
| Rate for Payer: BCBS Complete |
$2,044.40
|
| Rate for Payer: BCBS MAPPO |
$2,334.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,334.91
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cofinity Commercial |
$3,362.27
|
| Rate for Payer: Cofinity Commercial |
$3,128.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,334.91
|
| Rate for Payer: Healthscope Commercial |
$2,801.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,801.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,451.66
|
| Rate for Payer: Nomi Health Commercial |
$2,801.89
|
| Rate for Payer: PACE SWMI |
$2,334.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,334.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,322.15
|
| Rate for Payer: Priority Health Medicare |
$2,334.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,334.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,334.91
|
| Rate for Payer: UHCCP DNSP |
$2,334.91
|
|
|
PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION
|
Professional
|
Both
|
$10,055.00
|
|
|
Service Code
|
HCPCS 33860
|
| Min. Negotiated Rate |
$4,022.00 |
| Max. Negotiated Rate |
$6,535.75 |
| Rate for Payer: Aetna Medicare |
$5,027.50
|
| Rate for Payer: BCBS Complete |
$4,022.00
|
| Rate for Payer: Cash Price |
$8,044.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,535.75
|
|
|
PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
|
Professional
|
Both
|
$5,228.00
|
|
|
Service Code
|
HCPCS 33864
|
| Min. Negotiated Rate |
$2,091.20 |
| Max. Negotiated Rate |
$4,434.38 |
| Rate for Payer: Aetna Commercial |
$4,126.44
|
| Rate for Payer: Aetna Medicare |
$3,079.43
|
| Rate for Payer: BCBS Complete |
$2,091.20
|
| Rate for Payer: BCBS MAPPO |
$3,079.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,079.43
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cofinity Commercial |
$4,434.38
|
| Rate for Payer: Cofinity Commercial |
$4,126.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,079.43
|
| Rate for Payer: Healthscope Commercial |
$3,695.32
|
| Rate for Payer: Healthscope Whirlpool |
$3,695.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,233.40
|
| Rate for Payer: Nomi Health Commercial |
$3,695.32
|
| Rate for Payer: PACE SWMI |
$3,079.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,079.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,398.20
|
| Rate for Payer: Priority Health Medicare |
$3,079.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,079.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,079.43
|
| Rate for Payer: UHCCP DNSP |
$3,079.43
|
|
|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$61.73
|
| Rate for Payer: Aetna Medicare |
$46.07
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: BCBS MAPPO |
$46.07
|
| Rate for Payer: BCN Medicare Advantage |
$46.07
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$66.34
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.07
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Healthscope Whirlpool |
$55.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.37
|
| Rate for Payer: Nomi Health Commercial |
$55.28
|
| Rate for Payer: PACE SWMI |
$46.07
|
| Rate for Payer: PHP Medicare Advantage |
$46.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$46.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.07
|
| Rate for Payer: UHC Medicare Advantage |
$46.07
|
| Rate for Payer: UHCCP DNSP |
$46.07
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: Aetna Medicare |
$134.29
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$134.29
|
| Rate for Payer: BCN Medicare Advantage |
$134.29
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$193.38
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$161.15
|
| Rate for Payer: Healthscope Whirlpool |
$161.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.00
|
| Rate for Payer: Nomi Health Commercial |
$161.15
|
| Rate for Payer: PACE SWMI |
$134.29
|
| Rate for Payer: PHP Medicare Advantage |
$134.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$134.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.29
|
| Rate for Payer: UHC Medicare Advantage |
$134.29
|
| Rate for Payer: UHCCP DNSP |
$134.29
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Medicare |
$37.28
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$37.28
|
| Rate for Payer: BCN Medicare Advantage |
$37.28
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$49.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.28
|
| Rate for Payer: Healthscope Commercial |
$44.74
|
| Rate for Payer: Healthscope Whirlpool |
$44.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.14
|
| Rate for Payer: Nomi Health Commercial |
$44.74
|
| Rate for Payer: PACE SWMI |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Medicare |
$37.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.28
|
| Rate for Payer: UHC Medicare Advantage |
$37.28
|
| Rate for Payer: UHCCP DNSP |
$37.28
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$65.43
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: BCBS Complete |
$154.80
|
| Rate for Payer: BCBS MAPPO |
$48.83
|
| Rate for Payer: BCN Medicare Advantage |
$48.83
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$70.32
|
| Rate for Payer: Cofinity Commercial |
$65.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.83
|
| Rate for Payer: Healthscope Commercial |
$58.60
|
| Rate for Payer: Healthscope Whirlpool |
$58.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.27
|
| Rate for Payer: Nomi Health Commercial |
$58.60
|
| Rate for Payer: PACE SWMI |
$48.83
|
| Rate for Payer: PHP Medicare Advantage |
$48.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health Medicare |
$48.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.83
|
| Rate for Payer: UHC Medicare Advantage |
$48.83
|
| Rate for Payer: UHCCP DNSP |
$48.83
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Aetna Medicare |
$39.40
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$39.40
|
| Rate for Payer: BCN Medicare Advantage |
$39.40
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$56.74
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.40
|
| Rate for Payer: Healthscope Commercial |
$47.28
|
| Rate for Payer: Healthscope Whirlpool |
$47.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.37
|
| Rate for Payer: Nomi Health Commercial |
$47.28
|
| Rate for Payer: PACE SWMI |
$39.40
|
| Rate for Payer: PHP Medicare Advantage |
$39.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$39.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.40
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
| Rate for Payer: UHCCP DNSP |
$39.40
|
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$121.94
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$91.00
|
| Rate for Payer: BCN Medicare Advantage |
$91.00
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$121.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$109.20
|
| Rate for Payer: Healthscope Whirlpool |
$109.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.55
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: PACE SWMI |
$91.00
|
| Rate for Payer: PHP Medicare Advantage |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$91.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.00
|
| Rate for Payer: UHC Medicare Advantage |
$91.00
|
| Rate for Payer: UHCCP DNSP |
$91.00
|
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS V5010
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Aetna Commercial |
$244.93
|
| Rate for Payer: Aetna Medicare |
$182.78
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$182.78
|
| Rate for Payer: BCN Medicare Advantage |
$182.78
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$244.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.78
|
| Rate for Payer: Healthscope Commercial |
$201.06
|
| Rate for Payer: Healthscope Whirlpool |
$201.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.92
|
| Rate for Payer: Nomi Health Commercial |
$219.34
|
| Rate for Payer: PACE SWMI |
$182.78
|
| Rate for Payer: PHP Medicare Advantage |
$182.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$182.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.78
|
| Rate for Payer: UHC Medicare Advantage |
$182.78
|
| Rate for Payer: UHCCP DNSP |
$182.78
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$109.72
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$98.75
|
| Rate for Payer: ASR ASR |
$106.43
|
| Rate for Payer: ASR Commercial |
$106.43
|
| Rate for Payer: BCBS Trust/PPO |
$89.41
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$103.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Healthscope Whirlpool |
$106.43
|
| Rate for Payer: Mclaren Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.55
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$109.72
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$98.75
|
| Rate for Payer: Aetna Medicare |
$54.86
|
| Rate for Payer: ASR ASR |
$106.43
|
| Rate for Payer: ASR Commercial |
$106.43
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: BCBS Trust/PPO |
$89.85
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$103.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Healthscope Whirlpool |
$106.43
|
| Rate for Payer: Mclaren Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.14
|
| Rate for Payer: Priority Health Narrow Network |
$76.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.55
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$558.60 |
| Max. Negotiated Rate |
$991.25 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Aetna Medicare |
$558.60
|
| Rate for Payer: BCBS Complete |
$610.00
|
| Rate for Payer: BCBS MAPPO |
$558.60
|
| Rate for Payer: BCN Medicare Advantage |
$558.60
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cofinity Commercial |
$804.38
|
| Rate for Payer: Cofinity Commercial |
$748.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.60
|
| Rate for Payer: Healthscope Commercial |
$670.32
|
| Rate for Payer: Healthscope Whirlpool |
$670.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.53
|
| Rate for Payer: Nomi Health Commercial |
$670.32
|
| Rate for Payer: PACE SWMI |
$558.60
|
| Rate for Payer: PHP Medicare Advantage |
$558.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.25
|
| Rate for Payer: Priority Health Medicare |
$558.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.60
|
| Rate for Payer: UHC Medicare Advantage |
$558.60
|
| Rate for Payer: UHCCP DNSP |
$558.60
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$811.34 |
| Max. Negotiated Rate |
$1,496.95 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Medicare |
$811.34
|
| Rate for Payer: BCBS Complete |
$921.20
|
| Rate for Payer: BCBS MAPPO |
$811.34
|
| Rate for Payer: BCN Medicare Advantage |
$811.34
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$1,168.33
|
| Rate for Payer: Cofinity Commercial |
$1,087.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.34
|
| Rate for Payer: Healthscope Commercial |
$973.61
|
| Rate for Payer: Healthscope Whirlpool |
$973.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.91
|
| Rate for Payer: Nomi Health Commercial |
$973.61
|
| Rate for Payer: PACE SWMI |
$811.34
|
| Rate for Payer: PHP Medicare Advantage |
$811.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.95
|
| Rate for Payer: Priority Health Medicare |
$811.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.34
|
| Rate for Payer: UHC Medicare Advantage |
$811.34
|
| Rate for Payer: UHCCP DNSP |
$811.34
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$68.23 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: Aetna Medicare |
$68.23
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$68.23
|
| Rate for Payer: BCN Medicare Advantage |
$68.23
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Commercial |
$91.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.23
|
| Rate for Payer: Healthscope Commercial |
$75.05
|
| Rate for Payer: Healthscope Whirlpool |
$75.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.64
|
| Rate for Payer: Nomi Health Commercial |
$81.88
|
| Rate for Payer: PACE SWMI |
$68.23
|
| Rate for Payer: PHP Medicare Advantage |
$68.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$68.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.23
|
| Rate for Payer: UHC Medicare Advantage |
$68.23
|
| Rate for Payer: UHCCP DNSP |
$68.23
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$178.44 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$178.44
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCN Medicare Advantage |
$178.44
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$256.95
|
| Rate for Payer: Cofinity Commercial |
$239.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.44
|
| Rate for Payer: Healthscope Commercial |
$214.13
|
| Rate for Payer: Healthscope Whirlpool |
$214.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.36
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health Medicare |
$178.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.44
|
| Rate for Payer: UHC Medicare Advantage |
$178.44
|
| Rate for Payer: UHCCP DNSP |
$178.44
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$483.60 |
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
|
