|
PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$211.25 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: Aetna Medicare |
$112.60
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$112.60
|
| Rate for Payer: BCN Medicare Advantage |
$112.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$162.14
|
| Rate for Payer: Cofinity Commercial |
$150.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.60
|
| Rate for Payer: Healthscope Commercial |
$135.12
|
| Rate for Payer: Healthscope Whirlpool |
$135.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.23
|
| Rate for Payer: Nomi Health Commercial |
$135.12
|
| Rate for Payer: PACE SWMI |
$112.60
|
| Rate for Payer: PHP Medicare Advantage |
$112.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$112.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.60
|
| Rate for Payer: UHC Medicare Advantage |
$112.60
|
| Rate for Payer: UHCCP DNSP |
$112.60
|
|
|
PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 96415
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: Aetna Medicare |
$23.91
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$23.91
|
| Rate for Payer: BCN Medicare Advantage |
$23.91
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$34.43
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.91
|
| Rate for Payer: Healthscope Commercial |
$28.69
|
| Rate for Payer: Healthscope Whirlpool |
$28.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.11
|
| Rate for Payer: Nomi Health Commercial |
$28.69
|
| Rate for Payer: PACE SWMI |
$23.91
|
| Rate for Payer: PHP Medicare Advantage |
$23.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$23.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.91
|
| Rate for Payer: UHC Medicare Advantage |
$23.91
|
| Rate for Payer: UHCCP DNSP |
$23.91
|
|
|
PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 96450
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$476.45 |
| Rate for Payer: Aetna Commercial |
$98.03
|
| Rate for Payer: Aetna Medicare |
$73.16
|
| Rate for Payer: BCBS Complete |
$293.20
|
| Rate for Payer: BCBS MAPPO |
$73.16
|
| Rate for Payer: BCN Medicare Advantage |
$73.16
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cofinity Commercial |
$98.03
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.16
|
| Rate for Payer: Healthscope Commercial |
$87.79
|
| Rate for Payer: Healthscope Whirlpool |
$87.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.82
|
| Rate for Payer: Nomi Health Commercial |
$87.79
|
| Rate for Payer: PACE SWMI |
$73.16
|
| Rate for Payer: PHP Medicare Advantage |
$73.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.45
|
| Rate for Payer: Priority Health Medicare |
$73.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.16
|
| Rate for Payer: UHC Medicare Advantage |
$73.16
|
| Rate for Payer: UHCCP DNSP |
$73.16
|
|
|
PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 96417
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Commercial |
$73.02
|
| Rate for Payer: Aetna Medicare |
$54.49
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$54.49
|
| Rate for Payer: BCN Medicare Advantage |
$54.49
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$73.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.49
|
| Rate for Payer: Healthscope Commercial |
$65.39
|
| Rate for Payer: Healthscope Whirlpool |
$65.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.21
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: PACE SWMI |
$54.49
|
| Rate for Payer: PHP Medicare Advantage |
$54.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$54.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.49
|
| Rate for Payer: UHC Medicare Advantage |
$54.49
|
| Rate for Payer: UHCCP DNSP |
$54.49
|
|
|
PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 96413
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$161.20 |
| Rate for Payer: Aetna Commercial |
$147.47
|
| Rate for Payer: Aetna Medicare |
$110.05
|
| Rate for Payer: BCBS Complete |
$99.20
|
| Rate for Payer: BCBS MAPPO |
$110.05
|
| Rate for Payer: BCN Medicare Advantage |
$110.05
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$158.47
|
| Rate for Payer: Cofinity Commercial |
$147.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.05
|
| Rate for Payer: Healthscope Commercial |
$132.06
|
| Rate for Payer: Healthscope Whirlpool |
$132.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.55
|
| Rate for Payer: Nomi Health Commercial |
$132.06
|
| Rate for Payer: PACE SWMI |
$110.05
|
| Rate for Payer: PHP Medicare Advantage |
$110.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.20
|
| Rate for Payer: Priority Health Medicare |
$110.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.05
|
| Rate for Payer: UHC Medicare Advantage |
$110.05
|
| Rate for Payer: UHCCP DNSP |
$110.05
|
|
|
PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 96409
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$114.42
|
| Rate for Payer: Aetna Medicare |
$85.39
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$85.39
|
| Rate for Payer: BCN Medicare Advantage |
$85.39
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$122.96
|
| Rate for Payer: Cofinity Commercial |
$114.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.39
|
| Rate for Payer: Healthscope Commercial |
$102.47
|
| Rate for Payer: Healthscope Whirlpool |
$102.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.66
|
| Rate for Payer: Nomi Health Commercial |
$102.47
|
| Rate for Payer: PACE SWMI |
$85.39
|
| Rate for Payer: PHP Medicare Advantage |
$85.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$85.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.39
|
| Rate for Payer: UHC Medicare Advantage |
$85.39
|
| Rate for Payer: UHCCP DNSP |
$85.39
|
|
|
PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 96411
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: Aetna Medicare |
$47.09
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$47.09
|
| Rate for Payer: BCN Medicare Advantage |
$47.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$67.81
|
| Rate for Payer: Cofinity Commercial |
$63.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.09
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$56.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: Nomi Health Commercial |
$56.51
|
| Rate for Payer: PACE SWMI |
$47.09
|
| Rate for Payer: PHP Medicare Advantage |
$47.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$47.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.09
|
| Rate for Payer: UHC Medicare Advantage |
$47.09
|
| Rate for Payer: UHCCP DNSP |
$47.09
|
|
|
PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 96402
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$43.60
|
| Rate for Payer: Aetna Medicare |
$32.54
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$32.54
|
| Rate for Payer: BCN Medicare Advantage |
$32.54
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$46.86
|
| Rate for Payer: Cofinity Commercial |
$43.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.54
|
| Rate for Payer: Healthscope Commercial |
$39.05
|
| Rate for Payer: Healthscope Whirlpool |
$39.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.17
|
| Rate for Payer: Nomi Health Commercial |
$39.05
|
| Rate for Payer: PACE SWMI |
$32.54
|
| Rate for Payer: PHP Medicare Advantage |
$32.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$32.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.54
|
| Rate for Payer: UHC Medicare Advantage |
$32.54
|
| Rate for Payer: UHCCP DNSP |
$32.54
|
|
|
PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 96401
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$88.34 |
| Rate for Payer: Aetna Commercial |
$82.21
|
| Rate for Payer: Aetna Medicare |
$61.35
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$61.35
|
| Rate for Payer: BCN Medicare Advantage |
$61.35
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Cofinity Commercial |
$82.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.35
|
| Rate for Payer: Healthscope Commercial |
$73.62
|
| Rate for Payer: Healthscope Whirlpool |
$73.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.42
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: PACE SWMI |
$61.35
|
| Rate for Payer: PHP Medicare Advantage |
$61.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health Medicare |
$61.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.35
|
| Rate for Payer: UHC Medicare Advantage |
$61.35
|
| Rate for Payer: UHCCP DNSP |
$61.35
|
|
|
PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 96542
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Commercial |
$52.03
|
| Rate for Payer: Aetna Medicare |
$38.83
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS MAPPO |
$38.83
|
| Rate for Payer: BCN Medicare Advantage |
$38.83
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$55.92
|
| Rate for Payer: Cofinity Commercial |
$52.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$46.60
|
| Rate for Payer: Healthscope Whirlpool |
$46.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.77
|
| Rate for Payer: Nomi Health Commercial |
$46.60
|
| Rate for Payer: PACE SWMI |
$38.83
|
| Rate for Payer: PHP Medicare Advantage |
$38.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Medicare |
$38.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.83
|
| Rate for Payer: UHC Medicare Advantage |
$38.83
|
| Rate for Payer: UHCCP DNSP |
$38.83
|
|
|
PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 98941
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Aetna Commercial |
$42.73
|
| Rate for Payer: Aetna Medicare |
$31.89
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$31.89
|
| Rate for Payer: BCN Medicare Advantage |
$31.89
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$42.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.89
|
| Rate for Payer: Healthscope Commercial |
$38.27
|
| Rate for Payer: Healthscope Whirlpool |
$38.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.48
|
| Rate for Payer: Nomi Health Commercial |
$38.27
|
| Rate for Payer: PACE SWMI |
$31.89
|
| Rate for Payer: PHP Medicare Advantage |
$31.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$31.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.89
|
| Rate for Payer: UHC Medicare Advantage |
$31.89
|
| Rate for Payer: UHCCP DNSP |
$31.89
|
|
|
PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 50688
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$106.29 |
| Rate for Payer: Aetna Commercial |
$98.91
|
| Rate for Payer: Aetna Medicare |
$73.81
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$73.81
|
| Rate for Payer: BCN Medicare Advantage |
$73.81
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$98.91
|
| Rate for Payer: Cofinity Commercial |
$106.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.81
|
| Rate for Payer: Healthscope Commercial |
$88.57
|
| Rate for Payer: Healthscope Whirlpool |
$88.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.50
|
| Rate for Payer: Nomi Health Commercial |
$88.57
|
| Rate for Payer: PACE SWMI |
$73.81
|
| Rate for Payer: PHP Medicare Advantage |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health Medicare |
$73.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.81
|
| Rate for Payer: UHC Medicare Advantage |
$73.81
|
| Rate for Payer: UHCCP DNSP |
$73.81
|
|
|
PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 47620
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$1,924.56 |
| Rate for Payer: Aetna Commercial |
$1,790.91
|
| Rate for Payer: Aetna Medicare |
$1,336.50
|
| Rate for Payer: BCBS Complete |
$848.00
|
| Rate for Payer: BCBS MAPPO |
$1,336.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cofinity Commercial |
$1,924.56
|
| Rate for Payer: Cofinity Commercial |
$1,790.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,336.50
|
| Rate for Payer: Healthscope Commercial |
$1,603.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,603.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,403.33
|
| Rate for Payer: Nomi Health Commercial |
$1,603.80
|
| Rate for Payer: PACE SWMI |
$1,336.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,336.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.00
|
| Rate for Payer: Priority Health Medicare |
$1,336.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,336.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,336.50
|
| Rate for Payer: UHCCP DNSP |
$1,336.50
|
|
|
PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM
|
Professional
|
Both
|
$2,644.00
|
|
|
Service Code
|
HCPCS 47741
|
| Min. Negotiated Rate |
$1,057.60 |
| Max. Negotiated Rate |
$2,063.10 |
| Rate for Payer: Aetna Commercial |
$1,919.83
|
| Rate for Payer: Aetna Medicare |
$1,432.71
|
| Rate for Payer: BCBS Complete |
$1,057.60
|
| Rate for Payer: BCBS MAPPO |
$1,432.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,432.71
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cash Price |
$2,115.20
|
| Rate for Payer: Cofinity Commercial |
$2,063.10
|
| Rate for Payer: Cofinity Commercial |
$1,919.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,432.71
|
| Rate for Payer: Healthscope Commercial |
$1,719.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,719.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,504.35
|
| Rate for Payer: Nomi Health Commercial |
$1,719.25
|
| Rate for Payer: PACE SWMI |
$1,432.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,432.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,718.60
|
| Rate for Payer: Priority Health Medicare |
$1,432.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,432.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.71
|
| Rate for Payer: UHCCP DNSP |
$1,432.71
|
|
|
PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX
|
Professional
|
Both
|
$2,623.00
|
|
|
Service Code
|
HCPCS 47480
|
| Min. Negotiated Rate |
$849.48 |
| Max. Negotiated Rate |
$1,704.95 |
| Rate for Payer: Aetna Commercial |
$1,138.30
|
| Rate for Payer: Aetna Medicare |
$849.48
|
| Rate for Payer: BCBS Complete |
$1,049.20
|
| Rate for Payer: BCBS MAPPO |
$849.48
|
| Rate for Payer: BCN Medicare Advantage |
$849.48
|
| Rate for Payer: Cash Price |
$2,098.40
|
| Rate for Payer: Cash Price |
$2,098.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.25
|
| Rate for Payer: Cofinity Commercial |
$1,138.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$849.48
|
| Rate for Payer: Healthscope Commercial |
$1,019.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,019.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$891.95
|
| Rate for Payer: Nomi Health Commercial |
$1,019.38
|
| Rate for Payer: PACE SWMI |
$849.48
|
| Rate for Payer: PHP Medicare Advantage |
$849.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.95
|
| Rate for Payer: Priority Health Medicare |
$849.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$849.48
|
| Rate for Payer: UHC Medicare Advantage |
$849.48
|
| Rate for Payer: UHCCP DNSP |
$849.48
|
|
|
PR CHOLECYSTECTOMY
|
Facility
|
IP
|
$2,617.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$1,701.05 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna Commercial |
$2,355.30
|
| Rate for Payer: ASR ASR |
$2,538.49
|
| Rate for Payer: ASR Commercial |
$2,538.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,132.59
|
| Rate for Payer: BCN Commercial |
$2,028.96
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$2,459.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,093.60
|
| Rate for Payer: Healthscope Commercial |
$2,617.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,538.49
|
| Rate for Payer: Mclaren Commercial |
$2,355.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,224.45
|
| Rate for Payer: Nomi Health Commercial |
$2,145.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,302.96
|
|
|
PR CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$1,701.05 |
| Rate for Payer: Aetna Commercial |
$1,395.74
|
| Rate for Payer: Aetna Medicare |
$1,041.60
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: BCBS MAPPO |
$1,041.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,499.90
|
| Rate for Payer: Cofinity Commercial |
$1,395.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.60
|
| Rate for Payer: Healthscope Commercial |
$1,249.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,093.68
|
| Rate for Payer: Nomi Health Commercial |
$1,249.92
|
| Rate for Payer: PACE SWMI |
$1,041.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health Medicare |
$1,041.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,041.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.60
|
| Rate for Payer: UHCCP DNSP |
$1,041.60
|
|
|
PR CHOLECYSTECTOMY
|
Facility
|
OP
|
$2,617.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$1,046.80 |
| Max. Negotiated Rate |
$2,617.00 |
| Rate for Payer: Aetna Commercial |
$2,355.30
|
| Rate for Payer: Aetna Medicare |
$1,308.50
|
| Rate for Payer: ASR ASR |
$2,538.49
|
| Rate for Payer: ASR Commercial |
$2,538.49
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,143.06
|
| Rate for Payer: BCN Commercial |
$2,028.96
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$2,459.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,093.60
|
| Rate for Payer: Healthscope Commercial |
$2,617.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,538.49
|
| Rate for Payer: Mclaren Commercial |
$2,355.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,224.45
|
| Rate for Payer: Nomi Health Commercial |
$2,145.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,293.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,834.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,302.96
|
|
|
PR CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,617.00
|
|
|
Service Code
|
HCPCS 47600
|
| Min. Negotiated Rate |
$1,041.60 |
| Max. Negotiated Rate |
$1,701.05 |
| Rate for Payer: Aetna Commercial |
$1,395.74
|
| Rate for Payer: Aetna Medicare |
$1,041.60
|
| Rate for Payer: BCBS Complete |
$1,046.80
|
| Rate for Payer: BCBS MAPPO |
$1,041.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cash Price |
$2,093.60
|
| Rate for Payer: Cofinity Commercial |
$1,499.90
|
| Rate for Payer: Cofinity Commercial |
$1,395.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.60
|
| Rate for Payer: Healthscope Commercial |
$1,249.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,093.68
|
| Rate for Payer: Nomi Health Commercial |
$1,249.92
|
| Rate for Payer: PACE SWMI |
$1,041.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.05
|
| Rate for Payer: Priority Health Medicare |
$1,041.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,041.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.60
|
| Rate for Payer: UHCCP DNSP |
$1,041.60
|
|
|
PR CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 47612
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$3,061.50 |
| Rate for Payer: Aetna Commercial |
$1,658.25
|
| Rate for Payer: Aetna Medicare |
$1,237.50
|
| Rate for Payer: BCBS Complete |
$1,884.00
|
| Rate for Payer: BCBS MAPPO |
$1,237.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.50
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cofinity Commercial |
$1,782.00
|
| Rate for Payer: Cofinity Commercial |
$1,658.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.50
|
| Rate for Payer: Healthscope Commercial |
$1,485.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,299.38
|
| Rate for Payer: Nomi Health Commercial |
$1,485.00
|
| Rate for Payer: PACE SWMI |
$1,237.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.50
|
| Rate for Payer: Priority Health Medicare |
$1,237.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,237.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,237.50
|
| Rate for Payer: UHCCP DNSP |
$1,237.50
|
|
|
PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$3,009.00
|
|
|
Service Code
|
HCPCS 47605
|
| Min. Negotiated Rate |
$1,096.15 |
| Max. Negotiated Rate |
$1,955.85 |
| Rate for Payer: Aetna Commercial |
$1,468.84
|
| Rate for Payer: Aetna Medicare |
$1,096.15
|
| Rate for Payer: BCBS Complete |
$1,203.60
|
| Rate for Payer: BCBS MAPPO |
$1,096.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.15
|
| Rate for Payer: Cash Price |
$2,407.20
|
| Rate for Payer: Cash Price |
$2,407.20
|
| Rate for Payer: Cofinity Commercial |
$1,578.46
|
| Rate for Payer: Cofinity Commercial |
$1,468.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.15
|
| Rate for Payer: Healthscope Commercial |
$1,315.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,315.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,150.96
|
| Rate for Payer: Nomi Health Commercial |
$1,315.38
|
| Rate for Payer: PACE SWMI |
$1,096.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,955.85
|
| Rate for Payer: Priority Health Medicare |
$1,096.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.15
|
| Rate for Payer: UHCCP DNSP |
$1,096.15
|
|
|
PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT
|
Professional
|
Both
|
$3,310.00
|
|
|
Service Code
|
HCPCS 47610
|
| Min. Negotiated Rate |
$1,220.11 |
| Max. Negotiated Rate |
$2,151.50 |
| Rate for Payer: Aetna Commercial |
$1,634.95
|
| Rate for Payer: Aetna Medicare |
$1,220.11
|
| Rate for Payer: BCBS Complete |
$1,324.00
|
| Rate for Payer: BCBS MAPPO |
$1,220.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,220.11
|
| Rate for Payer: Cash Price |
$2,648.00
|
| Rate for Payer: Cash Price |
$2,648.00
|
| Rate for Payer: Cofinity Commercial |
$1,756.96
|
| Rate for Payer: Cofinity Commercial |
$1,634.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,220.11
|
| Rate for Payer: Healthscope Commercial |
$1,464.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,464.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,281.12
|
| Rate for Payer: Nomi Health Commercial |
$1,464.13
|
| Rate for Payer: PACE SWMI |
$1,220.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,220.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.50
|
| Rate for Payer: Priority Health Medicare |
$1,220.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,220.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,220.11
|
| Rate for Payer: UHCCP DNSP |
$1,220.11
|
|
|
PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 47490
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$444.53 |
| Rate for Payer: Aetna Commercial |
$413.66
|
| Rate for Payer: Aetna Medicare |
$308.70
|
| Rate for Payer: BCBS Complete |
$270.80
|
| Rate for Payer: BCBS MAPPO |
$308.70
|
| Rate for Payer: BCN Medicare Advantage |
$308.70
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$444.53
|
| Rate for Payer: Cofinity Commercial |
$413.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.70
|
| Rate for Payer: Healthscope Commercial |
$370.44
|
| Rate for Payer: Healthscope Whirlpool |
$370.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.13
|
| Rate for Payer: Nomi Health Commercial |
$370.44
|
| Rate for Payer: PACE SWMI |
$308.70
|
| Rate for Payer: PHP Medicare Advantage |
$308.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.05
|
| Rate for Payer: Priority Health Medicare |
$308.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.70
|
| Rate for Payer: UHC Medicare Advantage |
$308.70
|
| Rate for Payer: UHCCP DNSP |
$308.70
|
|
|
PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$2,405.00
|
|
|
Service Code
|
HCPCS 47420
|
| Min. Negotiated Rate |
$962.00 |
| Max. Negotiated Rate |
$1,864.02 |
| Rate for Payer: Aetna Commercial |
$1,734.58
|
| Rate for Payer: Aetna Medicare |
$1,294.46
|
| Rate for Payer: BCBS Complete |
$962.00
|
| Rate for Payer: BCBS MAPPO |
$1,294.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,294.46
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cofinity Commercial |
$1,864.02
|
| Rate for Payer: Cofinity Commercial |
$1,734.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,294.46
|
| Rate for Payer: Healthscope Commercial |
$1,553.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,553.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,359.18
|
| Rate for Payer: Nomi Health Commercial |
$1,553.35
|
| Rate for Payer: PACE SWMI |
$1,294.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,294.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.25
|
| Rate for Payer: Priority Health Medicare |
$1,294.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,294.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,294.46
|
| Rate for Payer: UHCCP DNSP |
$1,294.46
|
|
|
PR CHOLERA IMMUNIZATION,INJECTABLE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 90725
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
|
