|
PR LESION FL FACE/NECK
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00075
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR LESION REMOVAL COLONOSCOPY
|
Professional
|
Both
|
$1,553.00
|
|
|
Service Code
|
HCPCS G6024
|
| Min. Negotiated Rate |
$621.20 |
| Max. Negotiated Rate |
$1,087.10 |
| Rate for Payer: BCBS Complete |
$621.20
|
| Rate for Payer: Cash Price |
$1,242.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.10
|
|
|
PR LESION SINGLE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 00073
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
HCPCS J1950
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$2,222.66 |
| Rate for Payer: Aetna Commercial |
$2,068.31
|
| Rate for Payer: Aetna Medicare |
$1,543.52
|
| Rate for Payer: BCBS Complete |
$432.40
|
| Rate for Payer: BCBS MAPPO |
$1,543.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.82
|
| Rate for Payer: BCN Commercial |
$1,126.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,543.52
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cofinity Commercial |
$2,068.31
|
| Rate for Payer: Cofinity Commercial |
$2,222.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,543.52
|
| Rate for Payer: Healthscope Commercial |
$1,852.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,852.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,620.69
|
| Rate for Payer: PACE SWMI |
$1,543.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,543.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.70
|
| Rate for Payer: Priority Health Medicare |
$1,543.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,589.82
|
|
|
PR LEUPROLIDE ACETATE INJECITON
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS J9218
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Aetna Medicare |
$10.06
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$10.06
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$14.48
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.06
|
| Rate for Payer: Healthscope Commercial |
$12.07
|
| Rate for Payer: Healthscope Whirlpool |
$12.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.56
|
| Rate for Payer: PACE SWMI |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Medicare |
$10.06
|
| Rate for Payer: UHC Medicare Advantage |
$10.36
|
|
|
PR LEUPROLIDE ACETATE SUSPNSION
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Min. Negotiated Rate |
$165.86 |
| Max. Negotiated Rate |
$316.40 |
| Rate for Payer: Aetna Commercial |
$222.26
|
| Rate for Payer: Aetna Medicare |
$165.86
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$165.86
|
| Rate for Payer: BCBS Trust/PPO |
$191.56
|
| Rate for Payer: BCN Commercial |
$182.32
|
| Rate for Payer: BCN Medicare Advantage |
$165.86
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Cofinity Commercial |
$238.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.86
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Healthscope Whirlpool |
$199.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.16
|
| Rate for Payer: PACE SWMI |
$165.86
|
| Rate for Payer: PHP Medicare Advantage |
$165.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health Medicare |
$165.86
|
| Rate for Payer: UHC Medicare Advantage |
$170.84
|
|
|
PR LEVALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J7614
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Aetna Medicare |
$0.04
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.05
|
| Rate for Payer: Cofinity Commercial |
$0.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.04
|
| Rate for Payer: Healthscope Whirlpool |
$0.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.04
|
| Rate for Payer: PHP Medicare Advantage |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: UHC Medicare Advantage |
$0.04
|
|
|
PR LEVONORGESTREL IMPLANT SYS
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS J7306
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$2,147.54 |
| Rate for Payer: Aetna Commercial |
$406.00
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.54
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.00
|
|
|
PR LEVONORGESTREL IU CONTRACEPT
|
Professional
|
Both
|
$823.00
|
|
|
Service Code
|
HCPCS J7302
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$576.10 |
| Rate for Payer: BCBS Complete |
$329.20
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.10
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$1,383.09 |
| Rate for Payer: Aetna Commercial |
$1,141.40
|
| Rate for Payer: Aetna Medicare |
$851.79
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$851.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.09
|
| Rate for Payer: BCN Commercial |
$1,319.43
|
| Rate for Payer: BCN Medicare Advantage |
$851.79
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$1,141.40
|
| Rate for Payer: Cofinity Commercial |
$1,226.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$851.79
|
| Rate for Payer: Healthscope Commercial |
$1,022.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,022.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$894.38
|
| Rate for Payer: PACE SWMI |
$851.79
|
| Rate for Payer: PHP Medicare Advantage |
$851.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,276.74
|
| Rate for Payer: Priority Health Medicare |
$851.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,276.74
|
| Rate for Payer: UHC Medicare Advantage |
$877.34
|
|
|
PR LIDOCAINE INJECTION
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2001
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Healthscope Commercial |
$0.04
|
| Rate for Payer: Healthscope Whirlpool |
$0.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR
|
Professional
|
Both
|
$2,440.00
|
|
|
Service Code
|
HCPCS 27427
|
| Min. Negotiated Rate |
$459.02 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$939.26
|
| Rate for Payer: Aetna Medicare |
$700.94
|
| Rate for Payer: BCBS Complete |
$481.97
|
| Rate for Payer: BCBS MAPPO |
$700.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.49
|
| Rate for Payer: BCN Commercial |
$1,046.26
|
| Rate for Payer: BCN Medicare Advantage |
$700.94
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cofinity Commercial |
$1,009.35
|
| Rate for Payer: Cofinity Commercial |
$939.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.94
|
| Rate for Payer: Healthscope Commercial |
$841.13
|
| Rate for Payer: Healthscope Whirlpool |
$841.13
|
| Rate for Payer: Meridian Medicaid |
$481.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.99
|
| Rate for Payer: PACE SWMI |
$700.94
|
| Rate for Payer: PHP Medicare Advantage |
$700.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,093.29
|
| Rate for Payer: Priority Health Medicare |
$700.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,093.29
|
| Rate for Payer: UHC Medicare Advantage |
$721.97
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR
|
Professional
|
Both
|
$3,183.00
|
|
|
Service Code
|
HCPCS 27428
|
| Min. Negotiated Rate |
$720.79 |
| Max. Negotiated Rate |
$2,228.10 |
| Rate for Payer: Aetna Commercial |
$1,473.88
|
| Rate for Payer: Aetna Medicare |
$1,099.91
|
| Rate for Payer: BCBS Complete |
$756.83
|
| Rate for Payer: BCBS MAPPO |
$1,099.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.07
|
| Rate for Payer: BCN Commercial |
$1,639.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.91
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cofinity Commercial |
$1,583.87
|
| Rate for Payer: Cofinity Commercial |
$1,473.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.91
|
| Rate for Payer: Healthscope Commercial |
$1,319.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,319.89
|
| Rate for Payer: Meridian Medicaid |
$756.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,154.91
|
| Rate for Payer: PACE SWMI |
$1,099.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,228.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,712.73
|
| Rate for Payer: Priority Health Medicare |
$1,099.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,712.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,132.91
|
|
|
PR LIGATION ARTERIES ETHMOIDAL
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 30915
|
| Min. Negotiated Rate |
$388.94 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$793.79
|
| Rate for Payer: Aetna Medicare |
$592.38
|
| Rate for Payer: BCBS Complete |
$408.39
|
| Rate for Payer: BCBS MAPPO |
$592.38
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$892.81
|
| Rate for Payer: BCN Medicare Advantage |
$592.38
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$853.03
|
| Rate for Payer: Cofinity Commercial |
$793.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.38
|
| Rate for Payer: Healthscope Commercial |
$710.86
|
| Rate for Payer: Healthscope Whirlpool |
$710.86
|
| Rate for Payer: Meridian Medicaid |
$408.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$622.00
|
| Rate for Payer: PACE SWMI |
$592.38
|
| Rate for Payer: PHP Medicare Advantage |
$592.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.98
|
| Rate for Payer: Priority Health Medicare |
$592.38
|
| Rate for Payer: Priority Health Narrow Network |
$845.98
|
| Rate for Payer: UHC Medicare Advantage |
$610.15
|
|
|
PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 30920
|
| Min. Negotiated Rate |
$561.04 |
| Max. Negotiated Rate |
$2,317.12 |
| Rate for Payer: Aetna Commercial |
$1,149.87
|
| Rate for Payer: Aetna Medicare |
$858.11
|
| Rate for Payer: BCBS Complete |
$589.09
|
| Rate for Payer: BCBS MAPPO |
$858.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.12
|
| Rate for Payer: BCN Commercial |
$1,291.09
|
| Rate for Payer: BCN Medicare Advantage |
$858.11
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cofinity Commercial |
$1,235.68
|
| Rate for Payer: Cofinity Commercial |
$1,149.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.11
|
| Rate for Payer: Healthscope Commercial |
$1,029.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,029.73
|
| Rate for Payer: Meridian Medicaid |
$589.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$901.02
|
| Rate for Payer: PACE SWMI |
$858.11
|
| Rate for Payer: PHP Medicare Advantage |
$858.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.37
|
| Rate for Payer: Priority Health Medicare |
$858.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,223.37
|
| Rate for Payer: UHC Medicare Advantage |
$883.85
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$793.80
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$855.54
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$683.81
|
| Rate for Payer: BCN Commercial |
$683.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$829.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$882.00
|
| Rate for Payer: Healthscope Whirlpool |
$855.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$793.80
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.70
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$802.62
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$626.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$776.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
37609
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$911.85 |
| Rate for Payer: Aetna Commercial |
$269.54
|
| Rate for Payer: Aetna Medicare |
$201.15
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$201.15
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: BCN Medicare Advantage |
$201.15
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$289.66
|
| Rate for Payer: Cofinity Commercial |
$269.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.15
|
| Rate for Payer: Healthscope Commercial |
$241.38
|
| Rate for Payer: Healthscope Whirlpool |
$241.38
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$211.21
|
| Rate for Payer: PACE SWMI |
$201.15
|
| Rate for Payer: PHP Medicare Advantage |
$201.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.49
|
| Rate for Payer: Priority Health Medicare |
$201.15
|
| Rate for Payer: Priority Health Narrow Network |
$324.49
|
| Rate for Payer: UHC Medicare Advantage |
$207.18
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 37609
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$911.85 |
| Rate for Payer: Aetna Commercial |
$269.54
|
| Rate for Payer: Aetna Medicare |
$201.15
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$201.15
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: BCN Medicare Advantage |
$201.15
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$269.54
|
| Rate for Payer: Cofinity Commercial |
$289.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.15
|
| Rate for Payer: Healthscope Commercial |
$241.38
|
| Rate for Payer: Healthscope Whirlpool |
$241.38
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$211.21
|
| Rate for Payer: PACE SWMI |
$201.15
|
| Rate for Payer: PHP Medicare Advantage |
$201.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.49
|
| Rate for Payer: Priority Health Medicare |
$201.15
|
| Rate for Payer: Priority Health Narrow Network |
$324.49
|
| Rate for Payer: UHC Medicare Advantage |
$207.18
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Aetna Commercial |
$793.80
|
| Rate for Payer: ASR ASR |
$855.54
|
| Rate for Payer: BCBS Trust/PPO |
$683.81
|
| Rate for Payer: BCN Commercial |
$683.81
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$829.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$882.00
|
| Rate for Payer: Healthscope Whirlpool |
$855.54
|
| Rate for Payer: Mclaren Commercial |
$793.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$776.16
|
|
|
PR LIGATION DIRECT ESOPHAGEAL VARICES
|
Professional
|
Both
|
$3,073.00
|
|
|
Service Code
|
HCPCS 43400
|
| Min. Negotiated Rate |
$972.56 |
| Max. Negotiated Rate |
$2,672.92 |
| Rate for Payer: Aetna Commercial |
$2,032.27
|
| Rate for Payer: Aetna Medicare |
$1,516.62
|
| Rate for Payer: BCBS Complete |
$1,021.19
|
| Rate for Payer: BCBS MAPPO |
$1,516.62
|
| Rate for Payer: BCBS Trust/PPO |
$986.56
|
| Rate for Payer: BCN Commercial |
$2,221.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,516.62
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cofinity Commercial |
$2,183.93
|
| Rate for Payer: Cofinity Commercial |
$2,032.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,516.62
|
| Rate for Payer: Healthscope Commercial |
$1,819.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,819.94
|
| Rate for Payer: Meridian Medicaid |
$1,021.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,592.45
|
| Rate for Payer: PACE SWMI |
$1,516.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,516.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$972.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,672.92
|
| Rate for Payer: Priority Health Medicare |
$1,516.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,672.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,562.12
|
|
|
PR LIGATION HEMORRHOID BUNDLE W/US
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 0249T
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: BCBS Complete |
$820.00
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.00
|
|
|
PR LIGATION INTERNAL/COMMON CAROTID ARTERY
|
Professional
|
Both
|
$1,957.00
|
|
|
Service Code
|
HCPCS 37605
|
| Min. Negotiated Rate |
$462.42 |
| Max. Negotiated Rate |
$1,369.90 |
| Rate for Payer: Aetna Commercial |
$976.83
|
| Rate for Payer: Aetna Medicare |
$728.98
|
| Rate for Payer: BCBS Complete |
$485.54
|
| Rate for Payer: BCBS MAPPO |
$728.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.94
|
| Rate for Payer: BCN Commercial |
$1,055.06
|
| Rate for Payer: BCN Medicare Advantage |
$728.98
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cofinity Commercial |
$976.83
|
| Rate for Payer: Cofinity Commercial |
$1,049.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.98
|
| Rate for Payer: Healthscope Commercial |
$874.78
|
| Rate for Payer: Healthscope Whirlpool |
$874.78
|
| Rate for Payer: Meridian Medicaid |
$485.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$765.43
|
| Rate for Payer: PACE SWMI |
$728.98
|
| Rate for Payer: PHP Medicare Advantage |
$728.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.49
|
| Rate for Payer: Priority Health Medicare |
$728.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.49
|
| Rate for Payer: UHC Medicare Advantage |
$750.85
|
|
|
PR LIGATION MAJOR ARTERY ABDOMEN
|
Professional
|
Both
|
$3,207.00
|
|
|
Service Code
|
HCPCS 37617
|
| Min. Negotiated Rate |
$837.30 |
| Max. Negotiated Rate |
$2,244.90 |
| Rate for Payer: Aetna Commercial |
$1,747.31
|
| Rate for Payer: Aetna Medicare |
$1,303.96
|
| Rate for Payer: BCBS Complete |
$879.16
|
| Rate for Payer: BCBS MAPPO |
$1,303.96
|
| Rate for Payer: BCBS Trust/PPO |
$999.54
|
| Rate for Payer: BCN Commercial |
$1,902.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.96
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cofinity Commercial |
$1,747.31
|
| Rate for Payer: Cofinity Commercial |
$1,877.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.96
|
| Rate for Payer: Healthscope Commercial |
$1,564.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,564.75
|
| Rate for Payer: Meridian Medicaid |
$879.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,369.16
|
| Rate for Payer: PACE SWMI |
$1,303.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,244.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,071.45
|
| Rate for Payer: Priority Health Medicare |
$1,303.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,071.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,343.08
|
|
|
PR LIGATION MAJOR ARTERY CHEST
|
Professional
|
Both
|
$3,321.00
|
|
|
Service Code
|
HCPCS 37616
|
| Min. Negotiated Rate |
$713.55 |
| Max. Negotiated Rate |
$2,324.70 |
| Rate for Payer: Aetna Commercial |
$1,463.21
|
| Rate for Payer: Aetna Medicare |
$1,091.95
|
| Rate for Payer: BCBS Complete |
$749.23
|
| Rate for Payer: BCBS MAPPO |
$1,091.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$1,598.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.95
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cash Price |
$2,656.80
|
| Rate for Payer: Cofinity Commercial |
$1,572.41
|
| Rate for Payer: Cofinity Commercial |
$1,463.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.95
|
| Rate for Payer: Healthscope Commercial |
$1,310.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,310.34
|
| Rate for Payer: Meridian Medicaid |
$749.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,146.55
|
| Rate for Payer: PACE SWMI |
$1,091.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,324.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,740.03
|
| Rate for Payer: Priority Health Medicare |
$1,091.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,740.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,124.71
|
|
|
PR LIGATION MAJOR ARTERY EXTREMITY
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
HCPCS 37618
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$848.45 |
| Rate for Payer: Aetna Commercial |
$513.33
|
| Rate for Payer: Aetna Medicare |
$383.08
|
| Rate for Payer: BCBS Complete |
$262.34
|
| Rate for Payer: BCBS MAPPO |
$383.08
|
| Rate for Payer: BCBS Trust/PPO |
$848.45
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: BCN Medicare Advantage |
$383.08
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cofinity Commercial |
$513.33
|
| Rate for Payer: Cofinity Commercial |
$551.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.08
|
| Rate for Payer: Healthscope Commercial |
$459.70
|
| Rate for Payer: Healthscope Whirlpool |
$459.70
|
| Rate for Payer: Meridian Medicaid |
$262.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.23
|
| Rate for Payer: PACE SWMI |
$383.08
|
| Rate for Payer: PHP Medicare Advantage |
$383.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.47
|
| Rate for Payer: Priority Health Medicare |
$383.08
|
| Rate for Payer: Priority Health Narrow Network |
$615.47
|
| Rate for Payer: UHC Medicare Advantage |
$394.57
|
|
