|
PR CERVICAL LYMPHADENECTOMY
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 38720
|
| Min. Negotiated Rate |
$977.60 |
| Max. Negotiated Rate |
$1,858.65 |
| Rate for Payer: Aetna Commercial |
$1,729.58
|
| Rate for Payer: Aetna Medicare |
$1,290.73
|
| Rate for Payer: BCBS Complete |
$977.60
|
| Rate for Payer: BCBS MAPPO |
$1,290.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,290.73
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Cofinity Commercial |
$1,858.65
|
| Rate for Payer: Cofinity Commercial |
$1,729.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,290.73
|
| Rate for Payer: Healthscope Commercial |
$1,548.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,548.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,355.27
|
| Rate for Payer: Nomi Health Commercial |
$1,548.88
|
| Rate for Payer: PACE SWMI |
$1,290.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,290.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
| Rate for Payer: Priority Health Medicare |
$1,290.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,290.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,290.73
|
| Rate for Payer: UHCCP DNSP |
$1,290.73
|
|
|
PR CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,499.00
|
|
|
Service Code
|
HCPCS 59620
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$1,624.35 |
| Rate for Payer: Aetna Commercial |
$1,233.28
|
| Rate for Payer: Aetna Medicare |
$920.36
|
| Rate for Payer: BCBS Complete |
$999.60
|
| Rate for Payer: BCBS MAPPO |
$920.36
|
| Rate for Payer: BCN Medicare Advantage |
$920.36
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Cofinity Commercial |
$1,325.32
|
| Rate for Payer: Cofinity Commercial |
$1,233.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$920.36
|
| Rate for Payer: Healthscope Commercial |
$1,104.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,104.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$966.38
|
| Rate for Payer: Nomi Health Commercial |
$1,104.43
|
| Rate for Payer: PACE SWMI |
$920.36
|
| Rate for Payer: PHP Medicare Advantage |
$920.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,624.35
|
| Rate for Payer: Priority Health Medicare |
$920.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$920.36
|
| Rate for Payer: UHC Medicare Advantage |
$920.36
|
| Rate for Payer: UHCCP DNSP |
$920.36
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,321.00
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$888.51 |
| Max. Negotiated Rate |
$1,508.65 |
| Rate for Payer: Aetna Commercial |
$1,190.60
|
| Rate for Payer: Aetna Medicare |
$888.51
|
| Rate for Payer: BCBS Complete |
$928.40
|
| Rate for Payer: BCBS MAPPO |
$888.51
|
| Rate for Payer: BCN Medicare Advantage |
$888.51
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cash Price |
$1,856.80
|
| Rate for Payer: Cofinity Commercial |
$1,279.45
|
| Rate for Payer: Cofinity Commercial |
$1,190.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.51
|
| Rate for Payer: Healthscope Commercial |
$1,066.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,066.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$932.94
|
| Rate for Payer: Nomi Health Commercial |
$1,066.21
|
| Rate for Payer: PACE SWMI |
$888.51
|
| Rate for Payer: PHP Medicare Advantage |
$888.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,508.65
|
| Rate for Payer: Priority Health Medicare |
$888.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$888.51
|
| Rate for Payer: UHC Medicare Advantage |
$888.51
|
| Rate for Payer: UHCCP DNSP |
$888.51
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,593.00
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$1,037.20 |
| Max. Negotiated Rate |
$1,888.01 |
| Rate for Payer: Aetna Commercial |
$1,756.90
|
| Rate for Payer: Aetna Medicare |
$1,311.12
|
| Rate for Payer: BCBS Complete |
$1,037.20
|
| Rate for Payer: BCBS MAPPO |
$1,311.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,311.12
|
| Rate for Payer: Cash Price |
$2,074.40
|
| Rate for Payer: Cash Price |
$2,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,888.01
|
| Rate for Payer: Cofinity Commercial |
$1,756.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,311.12
|
| Rate for Payer: Healthscope Commercial |
$1,573.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,573.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,376.68
|
| Rate for Payer: Nomi Health Commercial |
$1,573.34
|
| Rate for Payer: PACE SWMI |
$1,311.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,311.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,685.45
|
| Rate for Payer: Priority Health Medicare |
$1,311.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,311.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,311.12
|
| Rate for Payer: UHCCP DNSP |
$1,311.12
|
|
|
PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$2,771.00
|
|
|
Service Code
|
HCPCS 59622
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$1,952.31 |
| Rate for Payer: Aetna Commercial |
$1,816.73
|
| Rate for Payer: Aetna Medicare |
$1,355.77
|
| Rate for Payer: BCBS Complete |
$1,108.40
|
| Rate for Payer: BCBS MAPPO |
$1,355.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.77
|
| Rate for Payer: Cash Price |
$2,216.80
|
| Rate for Payer: Cash Price |
$2,216.80
|
| Rate for Payer: Cofinity Commercial |
$1,952.31
|
| Rate for Payer: Cofinity Commercial |
$1,816.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.77
|
| Rate for Payer: Healthscope Commercial |
$1,626.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,626.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,423.56
|
| Rate for Payer: Nomi Health Commercial |
$1,626.92
|
| Rate for Payer: PACE SWMI |
$1,355.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.15
|
| Rate for Payer: Priority Health Medicare |
$1,355.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,355.77
|
| Rate for Payer: UHCCP DNSP |
$1,355.77
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$168.52 |
| Rate for Payer: Aetna Commercial |
$156.82
|
| Rate for Payer: Aetna Medicare |
$117.03
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$117.03
|
| Rate for Payer: BCN Medicare Advantage |
$117.03
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$168.52
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.03
|
| Rate for Payer: Healthscope Commercial |
$140.44
|
| Rate for Payer: Healthscope Whirlpool |
$140.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.88
|
| Rate for Payer: Nomi Health Commercial |
$140.44
|
| Rate for Payer: PACE SWMI |
$117.03
|
| Rate for Payer: PHP Medicare Advantage |
$117.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$117.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.03
|
| Rate for Payer: UHC Medicare Advantage |
$117.03
|
| Rate for Payer: UHCCP DNSP |
$117.03
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$75.96 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna Commercial |
$101.79
|
| Rate for Payer: Aetna Medicare |
$75.96
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: BCBS MAPPO |
$75.96
|
| Rate for Payer: BCN Medicare Advantage |
$75.96
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Cofinity Commercial |
$101.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.96
|
| Rate for Payer: Healthscope Commercial |
$91.15
|
| Rate for Payer: Healthscope Whirlpool |
$91.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$91.15
|
| Rate for Payer: PACE SWMI |
$75.96
|
| Rate for Payer: PHP Medicare Advantage |
$75.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
| Rate for Payer: Priority Health Medicare |
$75.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.96
|
| Rate for Payer: UHC Medicare Advantage |
$75.96
|
| Rate for Payer: UHCCP DNSP |
$75.96
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna Commercial |
$66.83
|
| Rate for Payer: Aetna Medicare |
$49.87
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: BCBS MAPPO |
$49.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.87
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$66.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.87
|
| Rate for Payer: Healthscope Commercial |
$59.84
|
| Rate for Payer: Healthscope Whirlpool |
$59.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.36
|
| Rate for Payer: Nomi Health Commercial |
$59.84
|
| Rate for Payer: PACE SWMI |
$49.87
|
| Rate for Payer: PHP Medicare Advantage |
$49.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health Medicare |
$49.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.87
|
| Rate for Payer: UHC Medicare Advantage |
$49.87
|
| Rate for Payer: UHCCP DNSP |
$49.87
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: Aetna Commercial |
$751.50
|
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: ASR ASR |
$809.95
|
| Rate for Payer: ASR Commercial |
$809.95
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: BCBS Trust/PPO |
$683.78
|
| Rate for Payer: BCN Commercial |
$647.38
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$784.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.00
|
| Rate for Payer: Healthscope Commercial |
$835.00
|
| Rate for Payer: Healthscope Whirlpool |
$809.95
|
| Rate for Payer: Mclaren Commercial |
$751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.75
|
| Rate for Payer: Nomi Health Commercial |
$684.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.63
|
| Rate for Payer: Priority Health Narrow Network |
$585.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.80
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 43760
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$542.75 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: Aetna Commercial |
$751.50
|
| Rate for Payer: ASR ASR |
$809.95
|
| Rate for Payer: ASR Commercial |
$809.95
|
| Rate for Payer: BCBS Trust/PPO |
$680.44
|
| Rate for Payer: BCN Commercial |
$647.38
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$784.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.00
|
| Rate for Payer: Healthscope Commercial |
$835.00
|
| Rate for Payer: Healthscope Whirlpool |
$809.95
|
| Rate for Payer: Mclaren Commercial |
$751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.75
|
| Rate for Payer: Nomi Health Commercial |
$684.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.80
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$47.34
|
| Rate for Payer: Aetna Medicare |
$35.33
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$42.40
|
| Rate for Payer: Healthscope Whirlpool |
$42.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Nomi Health Commercial |
$42.40
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$35.33
|
| Rate for Payer: UHCCP DNSP |
$35.33
|
|
|
PR CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
HCPCS 15788
|
| Min. Negotiated Rate |
$202.16 |
| Max. Negotiated Rate |
$579.15 |
| Rate for Payer: Aetna Commercial |
$270.89
|
| Rate for Payer: Aetna Medicare |
$202.16
|
| Rate for Payer: BCBS Complete |
$356.40
|
| Rate for Payer: BCBS MAPPO |
$202.16
|
| Rate for Payer: BCN Medicare Advantage |
$202.16
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cofinity Commercial |
$291.11
|
| Rate for Payer: Cofinity Commercial |
$270.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.16
|
| Rate for Payer: Healthscope Commercial |
$242.59
|
| Rate for Payer: Healthscope Whirlpool |
$242.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.27
|
| Rate for Payer: Nomi Health Commercial |
$242.59
|
| Rate for Payer: PACE SWMI |
$202.16
|
| Rate for Payer: PHP Medicare Advantage |
$202.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.15
|
| Rate for Payer: Priority Health Medicare |
$202.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.16
|
| Rate for Payer: UHC Medicare Advantage |
$202.16
|
| Rate for Payer: UHCCP DNSP |
$202.16
|
|
|
PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 64644
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$149.77
|
| Rate for Payer: Aetna Medicare |
$111.77
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$111.77
|
| Rate for Payer: BCN Medicare Advantage |
$111.77
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$160.95
|
| Rate for Payer: Cofinity Commercial |
$149.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.77
|
| Rate for Payer: Healthscope Commercial |
$134.12
|
| Rate for Payer: Healthscope Whirlpool |
$134.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.36
|
| Rate for Payer: Nomi Health Commercial |
$134.12
|
| Rate for Payer: PACE SWMI |
$111.77
|
| Rate for Payer: PHP Medicare Advantage |
$111.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$111.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.77
|
| Rate for Payer: UHC Medicare Advantage |
$111.77
|
| Rate for Payer: UHCCP DNSP |
$111.77
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 64643
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$89.44
|
| Rate for Payer: Aetna Medicare |
$66.75
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$66.75
|
| Rate for Payer: BCN Medicare Advantage |
$66.75
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$96.12
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.75
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Healthscope Whirlpool |
$80.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.09
|
| Rate for Payer: Nomi Health Commercial |
$80.10
|
| Rate for Payer: PACE SWMI |
$66.75
|
| Rate for Payer: PHP Medicare Advantage |
$66.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$66.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.75
|
| Rate for Payer: UHC Medicare Advantage |
$66.75
|
| Rate for Payer: UHCCP DNSP |
$66.75
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64645
|
| Min. Negotiated Rate |
$78.70 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$105.46
|
| Rate for Payer: Aetna Medicare |
$78.70
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$78.70
|
| Rate for Payer: BCN Medicare Advantage |
$78.70
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$113.33
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.70
|
| Rate for Payer: Healthscope Commercial |
$94.44
|
| Rate for Payer: Healthscope Whirlpool |
$94.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.64
|
| Rate for Payer: Nomi Health Commercial |
$94.44
|
| Rate for Payer: PACE SWMI |
$78.70
|
| Rate for Payer: PHP Medicare Advantage |
$78.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$78.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.70
|
| Rate for Payer: UHC Medicare Advantage |
$78.70
|
| Rate for Payer: UHCCP DNSP |
$78.70
|
|
|
PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 64614
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Aetna Medicare |
$234.50
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.85
|
|
|
PR CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 46505
|
| Min. Negotiated Rate |
$235.92 |
| Max. Negotiated Rate |
$484.25 |
| Rate for Payer: Aetna Commercial |
$316.13
|
| Rate for Payer: Aetna Medicare |
$235.92
|
| Rate for Payer: BCBS Complete |
$298.00
|
| Rate for Payer: BCBS MAPPO |
$235.92
|
| Rate for Payer: BCN Medicare Advantage |
$235.92
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$339.72
|
| Rate for Payer: Cofinity Commercial |
$316.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.92
|
| Rate for Payer: Healthscope Commercial |
$283.10
|
| Rate for Payer: Healthscope Whirlpool |
$283.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.72
|
| Rate for Payer: Nomi Health Commercial |
$283.10
|
| Rate for Payer: PACE SWMI |
$235.92
|
| Rate for Payer: PHP Medicare Advantage |
$235.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.25
|
| Rate for Payer: Priority Health Medicare |
$235.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.92
|
| Rate for Payer: UHC Medicare Advantage |
$235.92
|
| Rate for Payer: UHCCP DNSP |
$235.92
|
|
|
PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 64617
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$139.24
|
| Rate for Payer: Aetna Medicare |
$103.91
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$103.91
|
| Rate for Payer: BCN Medicare Advantage |
$103.91
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$149.63
|
| Rate for Payer: Cofinity Commercial |
$139.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.91
|
| Rate for Payer: Healthscope Commercial |
$124.69
|
| Rate for Payer: Healthscope Whirlpool |
$124.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.11
|
| Rate for Payer: Nomi Health Commercial |
$124.69
|
| Rate for Payer: PACE SWMI |
$103.91
|
| Rate for Payer: PHP Medicare Advantage |
$103.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$103.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.91
|
| Rate for Payer: UHC Medicare Advantage |
$103.91
|
| Rate for Payer: UHCCP DNSP |
$103.91
|
|
|
PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$106.94 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$143.30
|
| Rate for Payer: Aetna Medicare |
$106.94
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$106.94
|
| Rate for Payer: BCN Medicare Advantage |
$106.94
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$153.99
|
| Rate for Payer: Cofinity Commercial |
$143.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.94
|
| Rate for Payer: Healthscope Commercial |
$128.33
|
| Rate for Payer: Healthscope Whirlpool |
$128.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.29
|
| Rate for Payer: Nomi Health Commercial |
$128.33
|
| Rate for Payer: PACE SWMI |
$106.94
|
| Rate for Payer: PHP Medicare Advantage |
$106.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$106.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.94
|
| Rate for Payer: UHC Medicare Advantage |
$106.94
|
| Rate for Payer: UHCCP DNSP |
$106.94
|
|
|
PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 64646
|
| Min. Negotiated Rate |
$113.15 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$151.62
|
| Rate for Payer: Aetna Medicare |
$113.15
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$113.15
|
| Rate for Payer: BCN Medicare Advantage |
$113.15
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Cofinity Commercial |
$151.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.15
|
| Rate for Payer: Healthscope Commercial |
$135.78
|
| Rate for Payer: Healthscope Whirlpool |
$135.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.81
|
| Rate for Payer: Nomi Health Commercial |
$135.78
|
| Rate for Payer: PACE SWMI |
$113.15
|
| Rate for Payer: PHP Medicare Advantage |
$113.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health Medicare |
$113.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.15
|
| Rate for Payer: UHC Medicare Advantage |
$113.15
|
| Rate for Payer: UHCCP DNSP |
$113.15
|
|
|
PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 64642
|
| Min. Negotiated Rate |
$103.24 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna Medicare |
$103.24
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$103.24
|
| Rate for Payer: BCN Medicare Advantage |
$103.24
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$148.67
|
| Rate for Payer: Cofinity Commercial |
$138.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.24
|
| Rate for Payer: Healthscope Commercial |
$123.89
|
| Rate for Payer: Healthscope Whirlpool |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.40
|
| Rate for Payer: Nomi Health Commercial |
$123.89
|
| Rate for Payer: PACE SWMI |
$103.24
|
| Rate for Payer: PHP Medicare Advantage |
$103.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Medicare |
$103.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.24
|
| Rate for Payer: UHC Medicare Advantage |
$103.24
|
| Rate for Payer: UHCCP DNSP |
$103.24
|
|
|
PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 64611
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$154.57 |
| Rate for Payer: Aetna Commercial |
$143.84
|
| Rate for Payer: Aetna Medicare |
$107.34
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$107.34
|
| Rate for Payer: BCN Medicare Advantage |
$107.34
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$154.57
|
| Rate for Payer: Cofinity Commercial |
$143.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.34
|
| Rate for Payer: Healthscope Commercial |
$128.81
|
| Rate for Payer: Healthscope Whirlpool |
$128.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.71
|
| Rate for Payer: Nomi Health Commercial |
$128.81
|
| Rate for Payer: PACE SWMI |
$107.34
|
| Rate for Payer: PHP Medicare Advantage |
$107.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$107.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.34
|
| Rate for Payer: UHC Medicare Advantage |
$107.34
|
| Rate for Payer: UHCCP DNSP |
$107.34
|
|
|
PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$160.79
|
| Rate for Payer: Aetna Medicare |
$119.99
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$119.99
|
| Rate for Payer: BCN Medicare Advantage |
$119.99
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$172.79
|
| Rate for Payer: Cofinity Commercial |
$160.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.99
|
| Rate for Payer: Healthscope Commercial |
$143.99
|
| Rate for Payer: Healthscope Whirlpool |
$143.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.99
|
| Rate for Payer: Nomi Health Commercial |
$143.99
|
| Rate for Payer: PACE SWMI |
$119.99
|
| Rate for Payer: PHP Medicare Advantage |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$119.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.99
|
| Rate for Payer: UHC Medicare Advantage |
$119.99
|
| Rate for Payer: UHCCP DNSP |
$119.99
|
|
