|
PR MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR
|
Professional
|
Both
|
$2,974.00
|
|
|
Service Code
|
HCPCS 58140
|
| Min. Negotiated Rate |
$591.71 |
| Max. Negotiated Rate |
$2,081.80 |
| Rate for Payer: Aetna Commercial |
$1,244.22
|
| Rate for Payer: Aetna Medicare |
$928.52
|
| Rate for Payer: BCBS Complete |
$621.30
|
| Rate for Payer: BCBS MAPPO |
$928.52
|
| Rate for Payer: BCBS Trust/PPO |
$737.51
|
| Rate for Payer: BCN Commercial |
$1,370.25
|
| Rate for Payer: BCN Medicare Advantage |
$928.52
|
| Rate for Payer: Cash Price |
$2,379.20
|
| Rate for Payer: Cash Price |
$2,379.20
|
| Rate for Payer: Cofinity Commercial |
$1,337.07
|
| Rate for Payer: Cofinity Commercial |
$1,244.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.52
|
| Rate for Payer: Healthscope Commercial |
$1,114.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.22
|
| Rate for Payer: Meridian Medicaid |
$621.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$974.95
|
| Rate for Payer: PACE SWMI |
$928.52
|
| Rate for Payer: PHP Medicare Advantage |
$928.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,081.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,327.49
|
| Rate for Payer: Priority Health Medicare |
$928.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,327.49
|
| Rate for Payer: UHC Medicare Advantage |
$956.38
|
|
|
PR MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA
|
Professional
|
Both
|
$2,172.00
|
|
|
Service Code
|
HCPCS 58146
|
| Min. Negotiated Rate |
$740.18 |
| Max. Negotiated Rate |
$2,587.61 |
| Rate for Payer: Aetna Commercial |
$1,540.34
|
| Rate for Payer: Aetna Medicare |
$1,149.51
|
| Rate for Payer: BCBS Complete |
$777.19
|
| Rate for Payer: BCBS MAPPO |
$1,149.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,587.61
|
| Rate for Payer: BCN Commercial |
$1,692.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.51
|
| Rate for Payer: Cash Price |
$1,737.60
|
| Rate for Payer: Cash Price |
$1,737.60
|
| Rate for Payer: Cofinity Commercial |
$1,655.29
|
| Rate for Payer: Cofinity Commercial |
$1,540.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.51
|
| Rate for Payer: Healthscope Commercial |
$1,379.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,379.41
|
| Rate for Payer: Meridian Medicaid |
$777.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,206.99
|
| Rate for Payer: PACE SWMI |
$1,149.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$740.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,520.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,639.94
|
| Rate for Payer: Priority Health Medicare |
$1,149.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,639.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,184.00
|
|
|
PR MYRINGOPLASTY
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 69620
|
| Min. Negotiated Rate |
$318.86 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$648.01
|
| Rate for Payer: Aetna Medicare |
$483.59
|
| Rate for Payer: BCBS Complete |
$334.80
|
| Rate for Payer: BCBS MAPPO |
$483.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.84
|
| Rate for Payer: BCN Commercial |
$1,099.04
|
| Rate for Payer: BCN Medicare Advantage |
$483.59
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cofinity Commercial |
$696.37
|
| Rate for Payer: Cofinity Commercial |
$648.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.59
|
| Rate for Payer: Healthscope Commercial |
$580.31
|
| Rate for Payer: Healthscope Whirlpool |
$580.31
|
| Rate for Payer: Meridian Medicaid |
$334.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$507.77
|
| Rate for Payer: PACE SWMI |
$483.59
|
| Rate for Payer: PHP Medicare Advantage |
$483.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$318.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.42
|
| Rate for Payer: Priority Health Medicare |
$483.59
|
| Rate for Payer: Priority Health Narrow Network |
$703.42
|
| Rate for Payer: UHC Medicare Advantage |
$498.10
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 69420
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$2,402.18 |
| Rate for Payer: Aetna Commercial |
$156.75
|
| Rate for Payer: Aetna Medicare |
$116.98
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$116.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.18
|
| Rate for Payer: BCN Commercial |
$282.46
|
| Rate for Payer: BCN Medicare Advantage |
$116.98
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$156.75
|
| Rate for Payer: Cofinity Commercial |
$168.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.98
|
| Rate for Payer: Healthscope Commercial |
$140.38
|
| Rate for Payer: Healthscope Whirlpool |
$140.38
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.83
|
| Rate for Payer: PACE SWMI |
$116.98
|
| Rate for Payer: PHP Medicare Advantage |
$116.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.67
|
| Rate for Payer: Priority Health Medicare |
$116.98
|
| Rate for Payer: Priority Health Narrow Network |
$170.67
|
| Rate for Payer: UHC Medicare Advantage |
$120.49
|
|
|
PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 69421
|
| Min. Negotiated Rate |
$97.77 |
| Max. Negotiated Rate |
$324.10 |
| Rate for Payer: Aetna Commercial |
$198.53
|
| Rate for Payer: Aetna Medicare |
$148.16
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: BCBS MAPPO |
$148.16
|
| Rate for Payer: BCBS Trust/PPO |
$178.04
|
| Rate for Payer: BCN Commercial |
$223.81
|
| Rate for Payer: BCN Medicare Advantage |
$148.16
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cofinity Commercial |
$213.35
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.16
|
| Rate for Payer: Healthscope Commercial |
$177.79
|
| Rate for Payer: Healthscope Whirlpool |
$177.79
|
| Rate for Payer: Meridian Medicaid |
$102.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$155.57
|
| Rate for Payer: PACE SWMI |
$148.16
|
| Rate for Payer: PHP Medicare Advantage |
$148.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.92
|
| Rate for Payer: Priority Health Medicare |
$148.16
|
| Rate for Payer: Priority Health Narrow Network |
$215.92
|
| Rate for Payer: UHC Medicare Advantage |
$152.60
|
|
|
PR NALTREXONE, DEPOT FORM
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J2315
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Aetna Commercial |
$5.28
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.03
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$5.28
|
| Rate for Payer: Cofinity Commercial |
$5.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.73
|
| Rate for Payer: Healthscope Whirlpool |
$4.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
|
|
PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 31231
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$698.94 |
| Rate for Payer: Aetna Commercial |
$85.56
|
| Rate for Payer: Aetna Medicare |
$63.85
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS MAPPO |
$63.85
|
| Rate for Payer: BCBS Trust/PPO |
$698.94
|
| Rate for Payer: BCN Commercial |
$223.82
|
| Rate for Payer: BCN Medicare Advantage |
$63.85
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$85.56
|
| Rate for Payer: Cofinity Commercial |
$91.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.85
|
| Rate for Payer: Healthscope Commercial |
$76.62
|
| Rate for Payer: Healthscope Whirlpool |
$76.62
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.04
|
| Rate for Payer: PACE SWMI |
$63.85
|
| Rate for Payer: PHP Medicare Advantage |
$63.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.12
|
| Rate for Payer: Priority Health Medicare |
$63.85
|
| Rate for Payer: Priority Health Narrow Network |
$86.12
|
| Rate for Payer: UHC Medicare Advantage |
$65.77
|
|
|
PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 31233
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$844.75 |
| Rate for Payer: Aetna Commercial |
$177.35
|
| Rate for Payer: Aetna Medicare |
$132.35
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$132.35
|
| Rate for Payer: BCBS Trust/PPO |
$844.75
|
| Rate for Payer: BCN Commercial |
$404.62
|
| Rate for Payer: BCN Medicare Advantage |
$132.35
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$177.35
|
| Rate for Payer: Cofinity Commercial |
$190.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.35
|
| Rate for Payer: Healthscope Commercial |
$158.82
|
| Rate for Payer: Healthscope Whirlpool |
$158.82
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.97
|
| Rate for Payer: PACE SWMI |
$132.35
|
| Rate for Payer: PHP Medicare Advantage |
$132.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.15
|
| Rate for Payer: Priority Health Medicare |
$132.35
|
| Rate for Payer: Priority Health Narrow Network |
$186.15
|
| Rate for Payer: UHC Medicare Advantage |
$136.32
|
|
|
PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 31235
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$1,103.09 |
| Rate for Payer: Aetna Commercial |
$208.88
|
| Rate for Payer: Aetna Medicare |
$155.88
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCBS MAPPO |
$155.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.09
|
| Rate for Payer: BCN Commercial |
$457.89
|
| Rate for Payer: BCN Medicare Advantage |
$155.88
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$224.47
|
| Rate for Payer: Cofinity Commercial |
$208.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.88
|
| Rate for Payer: Healthscope Commercial |
$187.06
|
| Rate for Payer: Healthscope Whirlpool |
$187.06
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$163.67
|
| Rate for Payer: PACE SWMI |
$155.88
|
| Rate for Payer: PHP Medicare Advantage |
$155.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.03
|
| Rate for Payer: Priority Health Medicare |
$155.88
|
| Rate for Payer: Priority Health Narrow Network |
$219.03
|
| Rate for Payer: UHC Medicare Advantage |
$160.56
|
|
|
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 31256
|
| Min. Negotiated Rate |
$114.38 |
| Max. Negotiated Rate |
$1,413.73 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Medicare |
$177.31
|
| Rate for Payer: BCBS Complete |
$120.10
|
| Rate for Payer: BCBS MAPPO |
$177.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.73
|
| Rate for Payer: BCN Commercial |
$261.93
|
| Rate for Payer: BCN Medicare Advantage |
$177.31
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cofinity Commercial |
$255.33
|
| Rate for Payer: Cofinity Commercial |
$237.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.31
|
| Rate for Payer: Healthscope Commercial |
$212.77
|
| Rate for Payer: Healthscope Whirlpool |
$212.77
|
| Rate for Payer: Meridian Medicaid |
$120.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.18
|
| Rate for Payer: PACE SWMI |
$177.31
|
| Rate for Payer: PHP Medicare Advantage |
$177.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.20
|
| Rate for Payer: Priority Health Medicare |
$177.31
|
| Rate for Payer: Priority Health Narrow Network |
$248.20
|
| Rate for Payer: UHC Medicare Advantage |
$182.63
|
|
|
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 31287
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$1,608.67 |
| Rate for Payer: Aetna Commercial |
$266.10
|
| Rate for Payer: Aetna Medicare |
$198.58
|
| Rate for Payer: BCBS Complete |
$134.19
|
| Rate for Payer: BCBS MAPPO |
$198.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,608.67
|
| Rate for Payer: BCN Commercial |
$293.21
|
| Rate for Payer: BCN Medicare Advantage |
$198.58
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$285.96
|
| Rate for Payer: Cofinity Commercial |
$266.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.58
|
| Rate for Payer: Healthscope Commercial |
$238.30
|
| Rate for Payer: Healthscope Whirlpool |
$238.30
|
| Rate for Payer: Meridian Medicaid |
$134.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$208.51
|
| Rate for Payer: PACE SWMI |
$198.58
|
| Rate for Payer: PHP Medicare Advantage |
$198.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.82
|
| Rate for Payer: Priority Health Medicare |
$198.58
|
| Rate for Payer: Priority Health Narrow Network |
$277.82
|
| Rate for Payer: UHC Medicare Advantage |
$204.54
|
|
|
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
|
Professional
|
Both
|
$2,069.00
|
|
|
Service Code
|
HCPCS 31290
|
| Min. Negotiated Rate |
$729.31 |
| Max. Negotiated Rate |
$1,674.21 |
| Rate for Payer: Aetna Commercial |
$1,513.21
|
| Rate for Payer: Aetna Medicare |
$1,129.26
|
| Rate for Payer: BCBS Complete |
$765.78
|
| Rate for Payer: BCBS MAPPO |
$1,129.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.13
|
| Rate for Payer: BCN Commercial |
$1,674.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,129.26
|
| Rate for Payer: Cash Price |
$1,655.20
|
| Rate for Payer: Cash Price |
$1,655.20
|
| Rate for Payer: Cofinity Commercial |
$1,626.13
|
| Rate for Payer: Cofinity Commercial |
$1,513.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,129.26
|
| Rate for Payer: Healthscope Commercial |
$1,355.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,355.11
|
| Rate for Payer: Meridian Medicaid |
$765.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,185.72
|
| Rate for Payer: PACE SWMI |
$1,129.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,129.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$729.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.40
|
| Rate for Payer: Priority Health Medicare |
$1,129.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.14
|
|
|
PR NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID
|
Professional
|
Both
|
$2,273.00
|
|
|
Service Code
|
HCPCS 31291
|
| Min. Negotiated Rate |
$782.35 |
| Max. Negotiated Rate |
$1,781.23 |
| Rate for Payer: Aetna Commercial |
$1,611.70
|
| Rate for Payer: Aetna Medicare |
$1,202.76
|
| Rate for Payer: BCBS Complete |
$821.47
|
| Rate for Payer: BCBS MAPPO |
$1,202.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,581.20
|
| Rate for Payer: BCN Commercial |
$1,781.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,202.76
|
| Rate for Payer: Cash Price |
$1,818.40
|
| Rate for Payer: Cash Price |
$1,818.40
|
| Rate for Payer: Cofinity Commercial |
$1,611.70
|
| Rate for Payer: Cofinity Commercial |
$1,731.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,202.76
|
| Rate for Payer: Healthscope Commercial |
$1,443.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.31
|
| Rate for Payer: Meridian Medicaid |
$821.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,262.90
|
| Rate for Payer: PACE SWMI |
$1,202.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,202.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,687.80
|
| Rate for Payer: Priority Health Medicare |
$1,202.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,687.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,238.84
|
|
|
PR NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL DCMPRN
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 31292
|
| Min. Negotiated Rate |
$631.97 |
| Max. Negotiated Rate |
$1,608.67 |
| Rate for Payer: Aetna Commercial |
$1,313.56
|
| Rate for Payer: Aetna Medicare |
$980.27
|
| Rate for Payer: BCBS Complete |
$663.57
|
| Rate for Payer: BCBS MAPPO |
$980.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,608.67
|
| Rate for Payer: BCN Commercial |
$1,455.28
|
| Rate for Payer: BCN Medicare Advantage |
$980.27
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cash Price |
$1,612.00
|
| Rate for Payer: Cofinity Commercial |
$1,313.56
|
| Rate for Payer: Cofinity Commercial |
$1,411.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.27
|
| Rate for Payer: Healthscope Commercial |
$1,176.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.32
|
| Rate for Payer: Meridian Medicaid |
$663.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,029.28
|
| Rate for Payer: PACE SWMI |
$980.27
|
| Rate for Payer: PHP Medicare Advantage |
$980.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,378.95
|
| Rate for Payer: Priority Health Medicare |
$980.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,378.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,009.68
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 31237
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$1,028.07 |
| Rate for Payer: Aetna Commercial |
$210.19
|
| Rate for Payer: Aetna Medicare |
$156.86
|
| Rate for Payer: BCBS Complete |
$107.13
|
| Rate for Payer: BCBS MAPPO |
$156.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.07
|
| Rate for Payer: BCN Commercial |
$303.13
|
| Rate for Payer: BCN Medicare Advantage |
$156.86
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cofinity Commercial |
$210.19
|
| Rate for Payer: Cofinity Commercial |
$225.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.86
|
| Rate for Payer: Healthscope Commercial |
$188.23
|
| Rate for Payer: Healthscope Whirlpool |
$188.23
|
| Rate for Payer: Meridian Medicaid |
$107.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$164.70
|
| Rate for Payer: PACE SWMI |
$156.86
|
| Rate for Payer: PHP Medicare Advantage |
$156.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.41
|
| Rate for Payer: Priority Health Medicare |
$156.86
|
| Rate for Payer: Priority Health Narrow Network |
$220.41
|
| Rate for Payer: UHC Medicare Advantage |
$161.57
|
|
|
PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 31240
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$1,226.18 |
| Rate for Payer: Aetna Commercial |
$208.99
|
| Rate for Payer: Aetna Medicare |
$155.96
|
| Rate for Payer: BCBS Complete |
$106.46
|
| Rate for Payer: BCBS MAPPO |
$155.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.18
|
| Rate for Payer: BCN Commercial |
$231.15
|
| Rate for Payer: BCN Medicare Advantage |
$155.96
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$224.58
|
| Rate for Payer: Cofinity Commercial |
$208.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.96
|
| Rate for Payer: Healthscope Commercial |
$187.15
|
| Rate for Payer: Healthscope Whirlpool |
$187.15
|
| Rate for Payer: Meridian Medicaid |
$106.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$163.76
|
| Rate for Payer: PACE SWMI |
$155.96
|
| Rate for Payer: PHP Medicare Advantage |
$155.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.03
|
| Rate for Payer: Priority Health Medicare |
$155.96
|
| Rate for Payer: Priority Health Narrow Network |
$219.03
|
| Rate for Payer: UHC Medicare Advantage |
$160.64
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 31238
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$993.73 |
| Rate for Payer: Aetna Commercial |
$219.52
|
| Rate for Payer: Aetna Medicare |
$163.82
|
| Rate for Payer: BCBS Complete |
$112.05
|
| Rate for Payer: BCBS MAPPO |
$163.82
|
| Rate for Payer: BCBS Trust/PPO |
$993.73
|
| Rate for Payer: BCN Commercial |
$367.97
|
| Rate for Payer: BCN Medicare Advantage |
$163.82
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$235.90
|
| Rate for Payer: Cofinity Commercial |
$219.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.82
|
| Rate for Payer: Healthscope Commercial |
$196.58
|
| Rate for Payer: Healthscope Whirlpool |
$196.58
|
| Rate for Payer: Meridian Medicaid |
$112.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.01
|
| Rate for Payer: PACE SWMI |
$163.82
|
| Rate for Payer: PHP Medicare Advantage |
$163.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.13
|
| Rate for Payer: Priority Health Medicare |
$163.82
|
| Rate for Payer: Priority Health Narrow Network |
$230.13
|
| Rate for Payer: UHC Medicare Advantage |
$168.73
|
|
|
PR NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 31239
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$1,144.83 |
| Rate for Payer: Aetna Commercial |
$791.65
|
| Rate for Payer: Aetna Medicare |
$590.78
|
| Rate for Payer: BCBS Complete |
$406.59
|
| Rate for Payer: BCBS MAPPO |
$590.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.83
|
| Rate for Payer: BCN Commercial |
$883.53
|
| Rate for Payer: BCN Medicare Advantage |
$590.78
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$850.72
|
| Rate for Payer: Cofinity Commercial |
$791.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.78
|
| Rate for Payer: Healthscope Commercial |
$708.94
|
| Rate for Payer: Healthscope Whirlpool |
$708.94
|
| Rate for Payer: Meridian Medicaid |
$406.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$620.32
|
| Rate for Payer: PACE SWMI |
$590.78
|
| Rate for Payer: PHP Medicare Advantage |
$590.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.18
|
| Rate for Payer: Priority Health Medicare |
$590.78
|
| Rate for Payer: Priority Health Narrow Network |
$837.18
|
| Rate for Payer: UHC Medicare Advantage |
$608.50
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$2,519.62 |
| Rate for Payer: Aetna Commercial |
$236.72
|
| Rate for Payer: Aetna Medicare |
$176.66
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$176.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.37
|
| Rate for Payer: BCN Commercial |
$2,519.62
|
| Rate for Payer: BCN Medicare Advantage |
$176.66
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.66
|
| Rate for Payer: Healthscope Commercial |
$211.99
|
| Rate for Payer: Healthscope Whirlpool |
$211.99
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.49
|
| Rate for Payer: PACE SWMI |
$176.66
|
| Rate for Payer: PHP Medicare Advantage |
$176.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.27
|
| Rate for Payer: Priority Health Medicare |
$176.66
|
| Rate for Payer: Priority Health Narrow Network |
$247.27
|
| Rate for Payer: UHC Medicare Advantage |
$181.96
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$3,915.00
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$2,740.50 |
| Rate for Payer: Aetna Commercial |
$207.70
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: BCBS Complete |
$105.34
|
| Rate for Payer: BCBS MAPPO |
$155.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,788.82
|
| Rate for Payer: BCN Commercial |
$2,482.00
|
| Rate for Payer: BCN Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$3,132.00
|
| Rate for Payer: Cash Price |
$3,132.00
|
| Rate for Payer: Cofinity Commercial |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$207.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.00
|
| Rate for Payer: Healthscope Commercial |
$186.00
|
| Rate for Payer: Healthscope Whirlpool |
$186.00
|
| Rate for Payer: Meridian Medicaid |
$105.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$162.75
|
| Rate for Payer: PACE SWMI |
$155.00
|
| Rate for Payer: PHP Medicare Advantage |
$155.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,740.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.17
|
| Rate for Payer: Priority Health Medicare |
$155.00
|
| Rate for Payer: Priority Health Narrow Network |
$217.17
|
| Rate for Payer: UHC Medicare Advantage |
$159.65
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$3,208.00
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$2,461.47 |
| Rate for Payer: Aetna Commercial |
$189.53
|
| Rate for Payer: Aetna Medicare |
$141.44
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$141.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: BCN Commercial |
$2,461.47
|
| Rate for Payer: BCN Medicare Advantage |
$141.44
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$189.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.44
|
| Rate for Payer: Healthscope Commercial |
$169.73
|
| Rate for Payer: Healthscope Whirlpool |
$169.73
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.51
|
| Rate for Payer: PACE SWMI |
$141.44
|
| Rate for Payer: PHP Medicare Advantage |
$141.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$141.44
|
| Rate for Payer: Priority Health Narrow Network |
$198.19
|
| Rate for Payer: UHC Medicare Advantage |
$145.68
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$282.86 |
| Max. Negotiated Rate |
$1,077.73 |
| Rate for Payer: Aetna Commercial |
$588.92
|
| Rate for Payer: Aetna Medicare |
$439.49
|
| Rate for Payer: BCBS Complete |
$297.00
|
| Rate for Payer: BCBS MAPPO |
$439.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.73
|
| Rate for Payer: BCN Commercial |
$647.50
|
| Rate for Payer: BCN Medicare Advantage |
$439.49
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$632.87
|
| Rate for Payer: Cofinity Commercial |
$588.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.49
|
| Rate for Payer: Healthscope Commercial |
$527.39
|
| Rate for Payer: Healthscope Whirlpool |
$527.39
|
| Rate for Payer: Meridian Medicaid |
$297.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$461.46
|
| Rate for Payer: PACE SWMI |
$439.49
|
| Rate for Payer: PHP Medicare Advantage |
$439.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.54
|
| Rate for Payer: Priority Health Medicare |
$439.49
|
| Rate for Payer: Priority Health Narrow Network |
$613.54
|
| Rate for Payer: UHC Medicare Advantage |
$452.67
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$316.94 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$661.10
|
| Rate for Payer: Aetna Medicare |
$493.36
|
| Rate for Payer: BCBS Complete |
$332.79
|
| Rate for Payer: BCBS MAPPO |
$493.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$726.66
|
| Rate for Payer: BCN Medicare Advantage |
$493.36
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cofinity Commercial |
$710.44
|
| Rate for Payer: Cofinity Commercial |
$661.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.36
|
| Rate for Payer: Healthscope Commercial |
$592.03
|
| Rate for Payer: Healthscope Whirlpool |
$592.03
|
| Rate for Payer: Meridian Medicaid |
$332.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$518.03
|
| Rate for Payer: PACE SWMI |
$493.36
|
| Rate for Payer: PHP Medicare Advantage |
$493.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$688.54
|
| Rate for Payer: Priority Health Medicare |
$493.36
|
| Rate for Payer: Priority Health Narrow Network |
$688.54
|
| Rate for Payer: UHC Medicare Advantage |
$508.16
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,218.26 |
| Rate for Payer: Aetna Commercial |
$623.23
|
| Rate for Payer: Aetna Medicare |
$465.10
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS MAPPO |
$465.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.26
|
| Rate for Payer: BCN Commercial |
$685.13
|
| Rate for Payer: BCN Medicare Advantage |
$465.10
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$669.74
|
| Rate for Payer: Cofinity Commercial |
$623.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.10
|
| Rate for Payer: Healthscope Commercial |
$558.12
|
| Rate for Payer: Healthscope Whirlpool |
$558.12
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$488.36
|
| Rate for Payer: PACE SWMI |
$465.10
|
| Rate for Payer: PHP Medicare Advantage |
$465.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.19
|
| Rate for Payer: Priority Health Medicare |
$465.10
|
| Rate for Payer: Priority Health Narrow Network |
$649.19
|
| Rate for Payer: UHC Medicare Advantage |
$479.05
|
|
|
PR NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 31241
|
| Min. Negotiated Rate |
$282.65 |
| Max. Negotiated Rate |
$1,456.52 |
| Rate for Payer: Aetna Commercial |
$587.27
|
| Rate for Payer: Aetna Medicare |
$438.26
|
| Rate for Payer: BCBS Complete |
$296.78
|
| Rate for Payer: BCBS MAPPO |
$438.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.52
|
| Rate for Payer: BCN Commercial |
$645.54
|
| Rate for Payer: BCN Medicare Advantage |
$438.26
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$587.27
|
| Rate for Payer: Cofinity Commercial |
$631.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.26
|
| Rate for Payer: Healthscope Commercial |
$525.91
|
| Rate for Payer: Healthscope Whirlpool |
$525.91
|
| Rate for Payer: Meridian Medicaid |
$296.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$460.17
|
| Rate for Payer: PACE SWMI |
$438.26
|
| Rate for Payer: PHP Medicare Advantage |
$438.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.68
|
| Rate for Payer: Priority Health Medicare |
$438.26
|
| Rate for Payer: Priority Health Narrow Network |
$611.68
|
| Rate for Payer: UHC Medicare Advantage |
$451.41
|
|
