|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19318
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,509.61 |
| Rate for Payer: Aetna Commercial |
$1,404.78
|
| Rate for Payer: Aetna Medicare |
$1,048.34
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$1,048.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.34
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,509.61
|
| Rate for Payer: Cofinity Commercial |
$1,404.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.34
|
| Rate for Payer: Healthscope Commercial |
$1,258.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.76
|
| Rate for Payer: Nomi Health Commercial |
$1,258.01
|
| Rate for Payer: PACE SWMI |
$1,048.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$1,048.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.34
|
| Rate for Payer: UHCCP DNSP |
$1,048.34
|
|
|
PR BREAST REDUCTION
|
Facility
|
IP
|
$1,938.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$1,259.70 |
| Max. Negotiated Rate |
$1,938.00 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: ASR ASR |
$1,879.86
|
| Rate for Payer: ASR Commercial |
$1,879.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.28
|
| Rate for Payer: BCN Commercial |
$1,502.53
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,821.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.40
|
| Rate for Payer: Healthscope Commercial |
$1,938.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,879.86
|
| Rate for Payer: Mclaren Commercial |
$1,744.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.30
|
| Rate for Payer: Nomi Health Commercial |
$1,589.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.44
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 91065
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$78.39
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$58.50
|
| Rate for Payer: BCN Medicare Advantage |
$58.50
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| Rate for Payer: Cofinity Commercial |
$78.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.50
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Healthscope Whirlpool |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.42
|
| Rate for Payer: Nomi Health Commercial |
$70.20
|
| Rate for Payer: PACE SWMI |
$58.50
|
| Rate for Payer: PHP Medicare Advantage |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$58.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.50
|
| Rate for Payer: UHC Medicare Advantage |
$58.50
|
| Rate for Payer: UHCCP DNSP |
$58.50
|
|
|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 94450
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$105.85
|
| Rate for Payer: Aetna Medicare |
$78.99
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$78.99
|
| Rate for Payer: BCN Medicare Advantage |
$78.99
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$113.75
|
| Rate for Payer: Cofinity Commercial |
$105.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.99
|
| Rate for Payer: Healthscope Commercial |
$94.79
|
| Rate for Payer: Healthscope Whirlpool |
$94.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$94.79
|
| Rate for Payer: PACE SWMI |
$78.99
|
| Rate for Payer: PHP Medicare Advantage |
$78.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health Medicare |
$78.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.99
|
| Rate for Payer: UHC Medicare Advantage |
$78.99
|
| Rate for Payer: UHCCP DNSP |
$78.99
|
|
|
PR BRIEF CHECK IN BY MD/QHP
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G2012
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
|
|
PR BRIEF COMMUNICATION TECH-BSD SVC EST PT 5-10 MIN
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 98016
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$19.15
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$17.15
|
| Rate for Payer: Healthscope Whirlpool |
$17.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.00
|
| Rate for Payer: Nomi Health Commercial |
$17.15
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$14.29
|
| Rate for Payer: UHCCP DNSP |
$14.29
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94060
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna Medicare |
$35.28
|
| Rate for Payer: Aetna Medicare |
$35.28
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCBS MAPPO |
$35.28
|
| Rate for Payer: BCN Medicare Advantage |
$35.28
|
| Rate for Payer: BCN Medicare Advantage |
$35.28
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.28
|
| Rate for Payer: Healthscope Commercial |
$42.34
|
| Rate for Payer: Healthscope Commercial |
$42.34
|
| Rate for Payer: Healthscope Whirlpool |
$42.34
|
| Rate for Payer: Healthscope Whirlpool |
$42.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.04
|
| Rate for Payer: Nomi Health Commercial |
$42.34
|
| Rate for Payer: Nomi Health Commercial |
$42.34
|
| Rate for Payer: PACE SWMI |
$35.28
|
| Rate for Payer: PACE SWMI |
$35.28
|
| Rate for Payer: PHP Medicare Advantage |
$35.28
|
| Rate for Payer: PHP Medicare Advantage |
$35.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.28
|
| Rate for Payer: UHC Medicare Advantage |
$35.28
|
| Rate for Payer: UHC Medicare Advantage |
$35.28
|
| Rate for Payer: UHCCP DNSP |
$35.28
|
| Rate for Payer: UHCCP DNSP |
$35.28
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$123.86 |
| Max. Negotiated Rate |
$421.85 |
| Rate for Payer: Aetna Commercial |
$165.97
|
| Rate for Payer: Aetna Medicare |
$123.86
|
| Rate for Payer: BCBS Complete |
$259.60
|
| Rate for Payer: BCBS MAPPO |
$123.86
|
| Rate for Payer: BCN Medicare Advantage |
$123.86
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cofinity Commercial |
$178.36
|
| Rate for Payer: Cofinity Commercial |
$165.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$148.63
|
| Rate for Payer: Healthscope Whirlpool |
$148.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$148.63
|
| Rate for Payer: PACE SWMI |
$123.86
|
| Rate for Payer: PHP Medicare Advantage |
$123.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.85
|
| Rate for Payer: Priority Health Medicare |
$123.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.86
|
| Rate for Payer: UHC Medicare Advantage |
$123.86
|
| Rate for Payer: UHCCP DNSP |
$123.86
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 31652
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$313.30 |
| Rate for Payer: Aetna Commercial |
$277.96
|
| Rate for Payer: Aetna Medicare |
$207.43
|
| Rate for Payer: BCBS Complete |
$192.80
|
| Rate for Payer: BCBS MAPPO |
$207.43
|
| Rate for Payer: BCN Medicare Advantage |
$207.43
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$277.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.43
|
| Rate for Payer: Healthscope Commercial |
$248.92
|
| Rate for Payer: Healthscope Whirlpool |
$248.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.80
|
| Rate for Payer: Nomi Health Commercial |
$248.92
|
| Rate for Payer: PACE SWMI |
$207.43
|
| Rate for Payer: PHP Medicare Advantage |
$207.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health Medicare |
$207.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.43
|
| Rate for Payer: UHC Medicare Advantage |
$207.43
|
| Rate for Payer: UHCCP DNSP |
$207.43
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 31653
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$308.21
|
| Rate for Payer: Aetna Medicare |
$230.01
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$230.01
|
| Rate for Payer: BCN Medicare Advantage |
$230.01
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$331.21
|
| Rate for Payer: Cofinity Commercial |
$308.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.01
|
| Rate for Payer: Healthscope Commercial |
$276.01
|
| Rate for Payer: Healthscope Whirlpool |
$276.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.51
|
| Rate for Payer: Nomi Health Commercial |
$276.01
|
| Rate for Payer: PACE SWMI |
$230.01
|
| Rate for Payer: PHP Medicare Advantage |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$230.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.01
|
| Rate for Payer: UHC Medicare Advantage |
$230.01
|
| Rate for Payer: UHCCP DNSP |
$230.01
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$124.67 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$167.06
|
| Rate for Payer: Aetna Medicare |
$124.67
|
| Rate for Payer: BCBS Complete |
$238.40
|
| Rate for Payer: BCBS MAPPO |
$124.67
|
| Rate for Payer: BCN Medicare Advantage |
$124.67
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.67
|
| Rate for Payer: Healthscope Commercial |
$149.60
|
| Rate for Payer: Healthscope Whirlpool |
$149.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.90
|
| Rate for Payer: Nomi Health Commercial |
$149.60
|
| Rate for Payer: PACE SWMI |
$124.67
|
| Rate for Payer: PHP Medicare Advantage |
$124.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health Medicare |
$124.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.67
|
| Rate for Payer: UHC Medicare Advantage |
$124.67
|
| Rate for Payer: UHCCP DNSP |
$124.67
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Aetna Commercial |
$168.45
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$168.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$150.85
|
| Rate for Payer: Healthscope Whirlpool |
$150.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Nomi Health Commercial |
$150.85
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
|
|
PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 31630
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$269.77 |
| Rate for Payer: Aetna Commercial |
$251.04
|
| Rate for Payer: Aetna Medicare |
$187.34
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$187.34
|
| Rate for Payer: BCN Medicare Advantage |
$187.34
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$269.77
|
| Rate for Payer: Cofinity Commercial |
$251.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.34
|
| Rate for Payer: Healthscope Commercial |
$224.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.71
|
| Rate for Payer: Nomi Health Commercial |
$224.81
|
| Rate for Payer: PACE SWMI |
$187.34
|
| Rate for Payer: PHP Medicare Advantage |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$187.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.34
|
| Rate for Payer: UHC Medicare Advantage |
$187.34
|
| Rate for Payer: UHCCP DNSP |
$187.34
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 94070
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Commercial |
$77.79
|
| Rate for Payer: Aetna Commercial |
$77.79
|
| Rate for Payer: Aetna Medicare |
$58.05
|
| Rate for Payer: Aetna Medicare |
$58.05
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$58.05
|
| Rate for Payer: BCBS MAPPO |
$58.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.05
|
| Rate for Payer: BCN Medicare Advantage |
$58.05
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$77.79
|
| Rate for Payer: Cofinity Commercial |
$83.59
|
| Rate for Payer: Cofinity Commercial |
$77.79
|
| Rate for Payer: Cofinity Commercial |
$83.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.05
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Whirlpool |
$69.66
|
| Rate for Payer: Healthscope Whirlpool |
$69.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.95
|
| Rate for Payer: Nomi Health Commercial |
$69.66
|
| Rate for Payer: Nomi Health Commercial |
$69.66
|
| Rate for Payer: PACE SWMI |
$58.05
|
| Rate for Payer: PACE SWMI |
$58.05
|
| Rate for Payer: PHP Medicare Advantage |
$58.05
|
| Rate for Payer: PHP Medicare Advantage |
$58.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Medicare |
$58.05
|
| Rate for Payer: Priority Health Medicare |
$58.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.05
|
| Rate for Payer: UHC Medicare Advantage |
$58.05
|
| Rate for Payer: UHC Medicare Advantage |
$58.05
|
| Rate for Payer: UHCCP DNSP |
$58.05
|
| Rate for Payer: UHCCP DNSP |
$58.05
|
|
|
PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 31654
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$84.27
|
| Rate for Payer: Aetna Medicare |
$62.89
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$62.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.89
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$90.56
|
| Rate for Payer: Cofinity Commercial |
$84.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$75.47
|
| Rate for Payer: Healthscope Whirlpool |
$75.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.03
|
| Rate for Payer: Nomi Health Commercial |
$75.47
|
| Rate for Payer: PACE SWMI |
$62.89
|
| Rate for Payer: PHP Medicare Advantage |
$62.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$62.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.89
|
| Rate for Payer: UHC Medicare Advantage |
$62.89
|
| Rate for Payer: UHCCP DNSP |
$62.89
|
|
|
PR BRONCHOPLASTY GRAFT REPAIR
|
Professional
|
Both
|
$2,953.00
|
|
|
Service Code
|
HCPCS 31770
|
| Min. Negotiated Rate |
$1,181.20 |
| Max. Negotiated Rate |
$1,919.45 |
| Rate for Payer: Aetna Commercial |
$1,710.70
|
| Rate for Payer: Aetna Medicare |
$1,276.64
|
| Rate for Payer: BCBS Complete |
$1,181.20
|
| Rate for Payer: BCBS MAPPO |
$1,276.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,276.64
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Cofinity Commercial |
$1,838.36
|
| Rate for Payer: Cofinity Commercial |
$1,710.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,276.64
|
| Rate for Payer: Healthscope Commercial |
$1,531.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,531.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,340.47
|
| Rate for Payer: Nomi Health Commercial |
$1,531.97
|
| Rate for Payer: PACE SWMI |
$1,276.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,276.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.45
|
| Rate for Payer: Priority Health Medicare |
$1,276.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,276.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,276.64
|
| Rate for Payer: UHCCP DNSP |
$1,276.64
|
|
|
PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 31625
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna Commercial |
$196.14
|
| Rate for Payer: Aetna Medicare |
$146.37
|
| Rate for Payer: BCBS Complete |
$259.20
|
| Rate for Payer: BCBS MAPPO |
$146.37
|
| Rate for Payer: BCN Medicare Advantage |
$146.37
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$210.77
|
| Rate for Payer: Cofinity Commercial |
$196.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.37
|
| Rate for Payer: Healthscope Commercial |
$175.64
|
| Rate for Payer: Healthscope Whirlpool |
$175.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.69
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: PACE SWMI |
$146.37
|
| Rate for Payer: PHP Medicare Advantage |
$146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.20
|
| Rate for Payer: Priority Health Medicare |
$146.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.37
|
| Rate for Payer: UHC Medicare Advantage |
$146.37
|
| Rate for Payer: UHCCP DNSP |
$146.37
|
|
|
PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 31629
|
| Min. Negotiated Rate |
$175.62 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$235.33
|
| Rate for Payer: Aetna Medicare |
$175.62
|
| Rate for Payer: BCBS Complete |
$503.60
|
| Rate for Payer: BCBS MAPPO |
$175.62
|
| Rate for Payer: BCN Medicare Advantage |
$175.62
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cofinity Commercial |
$252.89
|
| Rate for Payer: Cofinity Commercial |
$235.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$210.74
|
| Rate for Payer: Healthscope Whirlpool |
$210.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.40
|
| Rate for Payer: Nomi Health Commercial |
$210.74
|
| Rate for Payer: PACE SWMI |
$175.62
|
| Rate for Payer: PHP Medicare Advantage |
$175.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health Medicare |
$175.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.62
|
| Rate for Payer: UHC Medicare Advantage |
$175.62
|
| Rate for Payer: UHCCP DNSP |
$175.62
|
|
|
PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 31627
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$130.39 |
| Rate for Payer: Aetna Commercial |
$121.34
|
| Rate for Payer: Aetna Medicare |
$90.55
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS MAPPO |
$90.55
|
| Rate for Payer: BCN Medicare Advantage |
$90.55
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$130.39
|
| Rate for Payer: Cofinity Commercial |
$121.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.55
|
| Rate for Payer: Healthscope Commercial |
$108.66
|
| Rate for Payer: Healthscope Whirlpool |
$108.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.08
|
| Rate for Payer: Nomi Health Commercial |
$108.66
|
| Rate for Payer: PACE SWMI |
$90.55
|
| Rate for Payer: PHP Medicare Advantage |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health Medicare |
$90.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.55
|
| Rate for Payer: UHC Medicare Advantage |
$90.55
|
| Rate for Payer: UHCCP DNSP |
$90.55
|
|
|
PR BRONCHOSCOPY W/EXCISION TUMOR
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 31640
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$338.65 |
| Rate for Payer: Aetna Commercial |
$310.36
|
| Rate for Payer: Aetna Medicare |
$231.61
|
| Rate for Payer: BCBS Complete |
$208.40
|
| Rate for Payer: BCBS MAPPO |
$231.61
|
| Rate for Payer: BCN Medicare Advantage |
$231.61
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$333.52
|
| Rate for Payer: Cofinity Commercial |
$310.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.61
|
| Rate for Payer: Healthscope Commercial |
$277.93
|
| Rate for Payer: Healthscope Whirlpool |
$277.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$277.93
|
| Rate for Payer: PACE SWMI |
$231.61
|
| Rate for Payer: PHP Medicare Advantage |
$231.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health Medicare |
$231.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.61
|
| Rate for Payer: UHC Medicare Advantage |
$231.61
|
| Rate for Payer: UHCCP DNSP |
$231.61
|
|
|
PR BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 31631
|
| Min. Negotiated Rate |
$213.42 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$285.98
|
| Rate for Payer: Aetna Medicare |
$213.42
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$213.42
|
| Rate for Payer: BCN Medicare Advantage |
$213.42
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$307.32
|
| Rate for Payer: Cofinity Commercial |
$285.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.42
|
| Rate for Payer: Healthscope Commercial |
$256.10
|
| Rate for Payer: Healthscope Whirlpool |
$256.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.09
|
| Rate for Payer: Nomi Health Commercial |
$256.10
|
| Rate for Payer: PACE SWMI |
$213.42
|
| Rate for Payer: PHP Medicare Advantage |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$213.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.42
|
| Rate for Payer: UHC Medicare Advantage |
$213.42
|
| Rate for Payer: UHCCP DNSP |
$213.42
|
|
|
PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 31635
|
| Min. Negotiated Rate |
$164.95 |
| Max. Negotiated Rate |
$739.05 |
| Rate for Payer: Aetna Commercial |
$221.03
|
| Rate for Payer: Aetna Medicare |
$164.95
|
| Rate for Payer: BCBS Complete |
$454.80
|
| Rate for Payer: BCBS MAPPO |
$164.95
|
| Rate for Payer: BCN Medicare Advantage |
$164.95
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$237.53
|
| Rate for Payer: Cofinity Commercial |
$221.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.95
|
| Rate for Payer: Healthscope Commercial |
$197.94
|
| Rate for Payer: Healthscope Whirlpool |
$197.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.20
|
| Rate for Payer: Nomi Health Commercial |
$197.94
|
| Rate for Payer: PACE SWMI |
$164.95
|
| Rate for Payer: PHP Medicare Advantage |
$164.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health Medicare |
$164.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.95
|
| Rate for Payer: UHC Medicare Advantage |
$164.95
|
| Rate for Payer: UHCCP DNSP |
$164.95
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 31645
|
| Min. Negotiated Rate |
$138.26 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Commercial |
$185.27
|
| Rate for Payer: Aetna Medicare |
$138.26
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: BCBS MAPPO |
$138.26
|
| Rate for Payer: BCN Medicare Advantage |
$138.26
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$199.09
|
| Rate for Payer: Cofinity Commercial |
$185.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.26
|
| Rate for Payer: Healthscope Commercial |
$165.91
|
| Rate for Payer: Healthscope Whirlpool |
$165.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.17
|
| Rate for Payer: Nomi Health Commercial |
$165.91
|
| Rate for Payer: PACE SWMI |
$138.26
|
| Rate for Payer: PHP Medicare Advantage |
$138.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: Priority Health Medicare |
$138.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.26
|
| Rate for Payer: UHC Medicare Advantage |
$138.26
|
| Rate for Payer: UHCCP DNSP |
$138.26
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 31646
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$399.10 |
| Rate for Payer: Aetna Commercial |
$179.64
|
| Rate for Payer: Aetna Medicare |
$134.06
|
| Rate for Payer: BCBS Complete |
$245.60
|
| Rate for Payer: BCBS MAPPO |
$134.06
|
| Rate for Payer: BCN Medicare Advantage |
$134.06
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Cofinity Commercial |
$179.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.06
|
| Rate for Payer: Healthscope Commercial |
$160.87
|
| Rate for Payer: Healthscope Whirlpool |
$160.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.76
|
| Rate for Payer: Nomi Health Commercial |
$160.87
|
| Rate for Payer: PACE SWMI |
$134.06
|
| Rate for Payer: PHP Medicare Advantage |
$134.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health Medicare |
$134.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.06
|
| Rate for Payer: UHC Medicare Advantage |
$134.06
|
| Rate for Payer: UHCCP DNSP |
$134.06
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 31628
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna Commercial |
$220.35
|
| Rate for Payer: Aetna Medicare |
$164.44
|
| Rate for Payer: BCBS Complete |
$304.00
|
| Rate for Payer: BCBS MAPPO |
$164.44
|
| Rate for Payer: BCN Medicare Advantage |
$164.44
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$236.79
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.44
|
| Rate for Payer: Healthscope Commercial |
$197.33
|
| Rate for Payer: Healthscope Whirlpool |
$197.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.66
|
| Rate for Payer: Nomi Health Commercial |
$197.33
|
| Rate for Payer: PACE SWMI |
$164.44
|
| Rate for Payer: PHP Medicare Advantage |
$164.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health Medicare |
$164.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.44
|
| Rate for Payer: UHC Medicare Advantage |
$164.44
|
| Rate for Payer: UHCCP DNSP |
$164.44
|
|
