|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$410.25 |
| Rate for Payer: Aetna Commercial |
$195.57
|
| Rate for Payer: Aetna Medicare |
$145.95
|
| Rate for Payer: BCBS Complete |
$99.08
|
| Rate for Payer: BCBS MAPPO |
$145.95
|
| Rate for Payer: BCN Commercial |
$254.97
|
| Rate for Payer: BCN Medicare Advantage |
$145.95
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$210.17
|
| Rate for Payer: Cofinity Commercial |
$195.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.95
|
| Rate for Payer: Healthscope Commercial |
$175.14
|
| Rate for Payer: Healthscope Whirlpool |
$175.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.25
|
| Rate for Payer: Meridian Medicaid |
$99.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.54
|
| Rate for Payer: Nomi Health Commercial |
$175.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.25
|
| Rate for Payer: PACE SWMI |
$145.95
|
| Rate for Payer: PHP Medicare Advantage |
$145.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$310.65
|
| Rate for Payer: Priority Health Medicare |
$145.95
|
| Rate for Payer: Priority Health Narrow Network |
$310.65
|
| Rate for Payer: Railroad Medicare Medicare |
$145.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$145.95
|
| Rate for Payer: UHC Exchange |
$295.63
|
| Rate for Payer: UHC Medicaid |
$94.36
|
| Rate for Payer: UHCCP DNSP |
$145.95
|
| Rate for Payer: UHCCP Medicaid |
$94.36
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Aetna Commercial |
$215.74
|
| Rate for Payer: Aetna Medicare |
$161.00
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$161.00
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$161.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$231.84
|
| Rate for Payer: Cofinity Commercial |
$215.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.00
|
| Rate for Payer: Healthscope Commercial |
$193.20
|
| Rate for Payer: Healthscope Whirlpool |
$193.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.05
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$177.10
|
| Rate for Payer: Nomi Health Commercial |
$193.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.25
|
| Rate for Payer: PACE SWMI |
$161.00
|
| Rate for Payer: PHP Medicare Advantage |
$161.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$350.70
|
| Rate for Payer: Priority Health Medicare |
$161.00
|
| Rate for Payer: Priority Health Narrow Network |
$350.70
|
| Rate for Payer: Railroad Medicare Medicare |
$161.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.00
|
| Rate for Payer: UHC Exchange |
$340.48
|
| Rate for Payer: UHC Medicaid |
$103.09
|
| Rate for Payer: UHCCP DNSP |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$443.25 |
| Rate for Payer: Aetna Commercial |
$225.44
|
| Rate for Payer: Aetna Medicare |
$168.24
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$168.24
|
| Rate for Payer: BCN Commercial |
$280.36
|
| Rate for Payer: BCN Medicare Advantage |
$168.24
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cofinity Commercial |
$242.27
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.24
|
| Rate for Payer: Healthscope Commercial |
$201.89
|
| Rate for Payer: Healthscope Whirlpool |
$201.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.65
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.06
|
| Rate for Payer: Nomi Health Commercial |
$201.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.25
|
| Rate for Payer: PACE SWMI |
$168.24
|
| Rate for Payer: PHP Medicare Advantage |
$168.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$341.60
|
| Rate for Payer: Priority Health Medicare |
$168.24
|
| Rate for Payer: Priority Health Narrow Network |
$341.60
|
| Rate for Payer: Railroad Medicare Medicare |
$168.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.24
|
| Rate for Payer: UHC Exchange |
$335.98
|
| Rate for Payer: UHC Medicaid |
$108.20
|
| Rate for Payer: UHCCP DNSP |
$168.24
|
| Rate for Payer: UHCCP Medicaid |
$108.20
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$1,021.50 |
| Rate for Payer: Aetna Commercial |
$632.91
|
| Rate for Payer: Aetna Medicare |
$472.32
|
| Rate for Payer: BCBS Complete |
$320.71
|
| Rate for Payer: BCBS MAPPO |
$472.32
|
| Rate for Payer: BCN Commercial |
$824.16
|
| Rate for Payer: BCN Medicare Advantage |
$472.32
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cofinity Commercial |
$680.14
|
| Rate for Payer: Cofinity Commercial |
$632.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.32
|
| Rate for Payer: Healthscope Commercial |
$566.78
|
| Rate for Payer: Healthscope Whirlpool |
$566.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.94
|
| Rate for Payer: Meridian Medicaid |
$320.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$519.55
|
| Rate for Payer: Nomi Health Commercial |
$566.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.50
|
| Rate for Payer: PACE SWMI |
$472.32
|
| Rate for Payer: PHP Medicare Advantage |
$472.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,004.17
|
| Rate for Payer: Priority Health Medicare |
$472.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,004.17
|
| Rate for Payer: Railroad Medicare Medicare |
$472.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$472.32
|
| Rate for Payer: UHC Exchange |
$955.80
|
| Rate for Payer: UHC Medicaid |
$305.44
|
| Rate for Payer: UHCCP DNSP |
$472.32
|
| Rate for Payer: UHCCP Medicaid |
$305.44
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$659.45 |
| Max. Negotiated Rate |
$1,937.99 |
| Rate for Payer: Aetna Commercial |
$1,374.88
|
| Rate for Payer: Aetna Medicare |
$1,026.03
|
| Rate for Payer: BCBS Complete |
$692.42
|
| Rate for Payer: BCBS MAPPO |
$1,026.03
|
| Rate for Payer: BCN Commercial |
$1,590.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.03
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cofinity Commercial |
$1,477.48
|
| Rate for Payer: Cofinity Commercial |
$1,374.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.03
|
| Rate for Payer: Healthscope Commercial |
$1,231.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,231.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.33
|
| Rate for Payer: Meridian Medicaid |
$692.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,128.63
|
| Rate for Payer: Nomi Health Commercial |
$1,231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,845.75
|
| Rate for Payer: PACE SWMI |
$1,026.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,937.99
|
| Rate for Payer: Priority Health Medicare |
$1,026.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,937.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,026.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,887.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,026.03
|
| Rate for Payer: UHC Exchange |
$1,887.29
|
| Rate for Payer: UHC Medicaid |
$659.45
|
| Rate for Payer: UHCCP DNSP |
$1,026.03
|
| Rate for Payer: UHCCP Medicaid |
$659.45
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,643.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$813.45 |
| Max. Negotiated Rate |
$2,732.25 |
| Rate for Payer: Aetna Commercial |
$1,696.59
|
| Rate for Payer: Aetna Medicare |
$1,266.11
|
| Rate for Payer: BCBS Complete |
$854.12
|
| Rate for Payer: BCBS MAPPO |
$1,266.11
|
| Rate for Payer: BCN Commercial |
$1,964.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.11
|
| Rate for Payer: Cash Price |
$2,914.40
|
| Rate for Payer: Cash Price |
$2,914.40
|
| Rate for Payer: Cofinity Commercial |
$1,823.20
|
| Rate for Payer: Cofinity Commercial |
$1,696.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.11
|
| Rate for Payer: Healthscope Commercial |
$1,519.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,519.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,329.42
|
| Rate for Payer: Meridian Medicaid |
$854.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,392.72
|
| Rate for Payer: Nomi Health Commercial |
$1,519.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,732.25
|
| Rate for Payer: PACE SWMI |
$1,266.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$813.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,393.06
|
| Rate for Payer: Priority Health Medicare |
$1,266.11
|
| Rate for Payer: Priority Health Narrow Network |
$2,393.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,266.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,331.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,266.11
|
| Rate for Payer: UHC Exchange |
$2,331.67
|
| Rate for Payer: UHC Medicaid |
$813.45
|
| Rate for Payer: UHCCP DNSP |
$1,266.11
|
| Rate for Payer: UHCCP Medicaid |
$813.45
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,374.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$802.58 |
| Max. Negotiated Rate |
$2,530.50 |
| Rate for Payer: Aetna Commercial |
$1,674.71
|
| Rate for Payer: Aetna Medicare |
$1,249.78
|
| Rate for Payer: BCBS Complete |
$842.71
|
| Rate for Payer: BCBS MAPPO |
$1,249.78
|
| Rate for Payer: BCN Commercial |
$1,940.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,249.78
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Cofinity Commercial |
$1,799.68
|
| Rate for Payer: Cofinity Commercial |
$1,674.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,249.78
|
| Rate for Payer: Healthscope Commercial |
$1,499.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,499.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,312.27
|
| Rate for Payer: Meridian Medicaid |
$842.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,374.76
|
| Rate for Payer: Nomi Health Commercial |
$1,499.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,530.50
|
| Rate for Payer: PACE SWMI |
$1,249.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,249.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$802.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,363.93
|
| Rate for Payer: Priority Health Medicare |
$1,249.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,363.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,249.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,305.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,249.78
|
| Rate for Payer: UHC Exchange |
$2,305.88
|
| Rate for Payer: UHC Medicaid |
$802.58
|
| Rate for Payer: UHCCP DNSP |
$1,249.78
|
| Rate for Payer: UHCCP Medicaid |
$802.58
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Aetna Commercial |
$140.18
|
| Rate for Payer: Aetna Medicare |
$104.61
|
| Rate for Payer: BCBS Complete |
$69.33
|
| Rate for Payer: BCBS MAPPO |
$104.61
|
| Rate for Payer: BCN Commercial |
$167.82
|
| Rate for Payer: BCN Medicare Advantage |
$104.61
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$150.64
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.61
|
| Rate for Payer: Healthscope Commercial |
$125.53
|
| Rate for Payer: Healthscope Whirlpool |
$125.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.84
|
| Rate for Payer: Meridian Medicaid |
$69.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.07
|
| Rate for Payer: Nomi Health Commercial |
$125.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PACE SWMI |
$104.61
|
| Rate for Payer: PHP Medicare Advantage |
$104.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$204.48
|
| Rate for Payer: Priority Health Medicare |
$104.61
|
| Rate for Payer: Priority Health Narrow Network |
$204.48
|
| Rate for Payer: Railroad Medicare Medicare |
$104.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.61
|
| Rate for Payer: UHC Exchange |
$208.12
|
| Rate for Payer: UHC Medicaid |
$66.03
|
| Rate for Payer: UHCCP DNSP |
$104.61
|
| Rate for Payer: UHCCP Medicaid |
$66.03
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$667.63 |
| Rate for Payer: Aetna Commercial |
$550.58
|
| Rate for Payer: Aetna Commercial |
$550.58
|
| Rate for Payer: Aetna Medicare |
$410.88
|
| Rate for Payer: Aetna Medicare |
$410.88
|
| Rate for Payer: BCBS MAPPO |
$410.88
|
| Rate for Payer: BCBS MAPPO |
$410.88
|
| Rate for Payer: BCN Commercial |
$577.16
|
| Rate for Payer: BCN Commercial |
$577.16
|
| Rate for Payer: BCN Medicare Advantage |
$410.88
|
| Rate for Payer: BCN Medicare Advantage |
$410.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$550.58
|
| Rate for Payer: Cofinity Commercial |
$591.67
|
| Rate for Payer: Cofinity Commercial |
$550.58
|
| Rate for Payer: Cofinity Commercial |
$591.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.88
|
| Rate for Payer: Healthscope Commercial |
$493.06
|
| Rate for Payer: Healthscope Commercial |
$493.06
|
| Rate for Payer: Healthscope Whirlpool |
$493.06
|
| Rate for Payer: Healthscope Whirlpool |
$493.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$451.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$451.97
|
| Rate for Payer: Nomi Health Commercial |
$493.06
|
| Rate for Payer: Nomi Health Commercial |
$493.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$633.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
| Rate for Payer: PACE SWMI |
$410.88
|
| Rate for Payer: PACE SWMI |
$410.88
|
| Rate for Payer: PHP Medicare Advantage |
$410.88
|
| Rate for Payer: PHP Medicare Advantage |
$410.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$532.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$532.27
|
| Rate for Payer: Priority Health Medicare |
$410.88
|
| Rate for Payer: Priority Health Medicare |
$410.88
|
| Rate for Payer: Priority Health Narrow Network |
$532.27
|
| Rate for Payer: Priority Health Narrow Network |
$532.27
|
| Rate for Payer: Railroad Medicare Medicare |
$410.88
|
| Rate for Payer: Railroad Medicare Medicare |
$410.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$410.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$410.88
|
| Rate for Payer: UHC Exchange |
$667.63
|
| Rate for Payer: UHC Exchange |
$667.63
|
| Rate for Payer: UHCCP DNSP |
$410.88
|
| Rate for Payer: UHCCP DNSP |
$410.88
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Aetna Commercial |
$156.93
|
| Rate for Payer: Aetna Medicare |
$117.11
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$117.11
|
| Rate for Payer: BCN Commercial |
$198.19
|
| Rate for Payer: BCN Medicare Advantage |
$117.11
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$168.64
|
| Rate for Payer: Cofinity Commercial |
$156.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.11
|
| Rate for Payer: Healthscope Commercial |
$140.53
|
| Rate for Payer: Healthscope Whirlpool |
$140.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.97
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.82
|
| Rate for Payer: Nomi Health Commercial |
$140.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.75
|
| Rate for Payer: PACE SWMI |
$117.11
|
| Rate for Payer: PHP Medicare Advantage |
$117.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$241.49
|
| Rate for Payer: Priority Health Medicare |
$117.11
|
| Rate for Payer: Priority Health Narrow Network |
$241.49
|
| Rate for Payer: Railroad Medicare Medicare |
$117.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.11
|
| Rate for Payer: UHC Exchange |
$235.49
|
| Rate for Payer: UHC Medicaid |
$76.04
|
| Rate for Payer: UHCCP DNSP |
$117.11
|
| Rate for Payer: UHCCP Medicaid |
$76.04
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$165.84
|
| Rate for Payer: Aetna Medicare |
$123.76
|
| Rate for Payer: BCBS Complete |
$84.31
|
| Rate for Payer: BCBS MAPPO |
$123.76
|
| Rate for Payer: BCN Commercial |
$207.65
|
| Rate for Payer: BCN Medicare Advantage |
$123.76
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$165.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.76
|
| Rate for Payer: Healthscope Commercial |
$148.51
|
| Rate for Payer: Healthscope Whirlpool |
$148.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.95
|
| Rate for Payer: Meridian Medicaid |
$84.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.14
|
| Rate for Payer: Nomi Health Commercial |
$148.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: PACE SWMI |
$123.76
|
| Rate for Payer: PHP Medicare Advantage |
$123.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.01
|
| Rate for Payer: Priority Health Medicare |
$123.76
|
| Rate for Payer: Priority Health Narrow Network |
$253.01
|
| Rate for Payer: Railroad Medicare Medicare |
$123.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$123.76
|
| Rate for Payer: UHC Exchange |
$248.30
|
| Rate for Payer: UHC Medicaid |
$80.30
|
| Rate for Payer: UHCCP DNSP |
$123.76
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,858.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$1,727.64 |
| Max. Negotiated Rate |
$5,304.87 |
| Rate for Payer: Aetna Commercial |
$3,620.76
|
| Rate for Payer: Aetna Medicare |
$2,702.06
|
| Rate for Payer: BCBS Complete |
$1,814.02
|
| Rate for Payer: BCBS MAPPO |
$2,702.06
|
| Rate for Payer: BCN Commercial |
$4,353.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,702.06
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cash Price |
$5,486.40
|
| Rate for Payer: Cofinity Commercial |
$3,890.97
|
| Rate for Payer: Cofinity Commercial |
$3,620.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,702.06
|
| Rate for Payer: Healthscope Commercial |
$3,242.47
|
| Rate for Payer: Healthscope Whirlpool |
$3,242.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,837.16
|
| Rate for Payer: Meridian Medicaid |
$1,814.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,972.27
|
| Rate for Payer: Nomi Health Commercial |
$3,242.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,143.50
|
| Rate for Payer: PACE SWMI |
$2,702.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,702.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,304.87
|
| Rate for Payer: Priority Health Medicare |
$2,702.06
|
| Rate for Payer: Priority Health Narrow Network |
$5,304.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2,702.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,864.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,702.06
|
| Rate for Payer: UHC Exchange |
$4,864.31
|
| Rate for Payer: UHC Medicaid |
$1,727.64
|
| Rate for Payer: UHCCP DNSP |
$2,702.06
|
| Rate for Payer: UHCCP Medicaid |
$1,727.64
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,794.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$1,831.16 |
| Max. Negotiated Rate |
$5,845.50 |
| Rate for Payer: Aetna Commercial |
$3,850.81
|
| Rate for Payer: Aetna Medicare |
$2,873.74
|
| Rate for Payer: BCBS Complete |
$1,922.72
|
| Rate for Payer: BCBS MAPPO |
$2,873.74
|
| Rate for Payer: BCN Commercial |
$4,653.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,873.74
|
| Rate for Payer: Cash Price |
$6,235.20
|
| Rate for Payer: Cash Price |
$6,235.20
|
| Rate for Payer: Cofinity Commercial |
$4,138.19
|
| Rate for Payer: Cofinity Commercial |
$3,850.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,873.74
|
| Rate for Payer: Healthscope Commercial |
$3,448.49
|
| Rate for Payer: Healthscope Whirlpool |
$3,448.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,017.43
|
| Rate for Payer: Meridian Medicaid |
$1,922.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,161.11
|
| Rate for Payer: Nomi Health Commercial |
$3,448.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,845.50
|
| Rate for Payer: PACE SWMI |
$2,873.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,873.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,831.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,669.55
|
| Rate for Payer: Priority Health Medicare |
$2,873.74
|
| Rate for Payer: Priority Health Narrow Network |
$5,669.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2,873.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,250.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,873.74
|
| Rate for Payer: UHC Exchange |
$5,250.42
|
| Rate for Payer: UHC Medicaid |
$1,831.16
|
| Rate for Payer: UHCCP DNSP |
$2,873.74
|
| Rate for Payer: UHCCP Medicaid |
$1,831.16
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,134.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$351.88 |
| Max. Negotiated Rate |
$1,600.50 |
| Rate for Payer: Aetna Commercial |
$723.25
|
| Rate for Payer: Aetna Medicare |
$539.74
|
| Rate for Payer: BCBS Complete |
$369.47
|
| Rate for Payer: BCBS MAPPO |
$539.74
|
| Rate for Payer: BCN Commercial |
$947.16
|
| Rate for Payer: BCN Medicare Advantage |
$539.74
|
| Rate for Payer: Cash Price |
$1,707.20
|
| Rate for Payer: Cash Price |
$1,707.20
|
| Rate for Payer: Cofinity Commercial |
$777.23
|
| Rate for Payer: Cofinity Commercial |
$723.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.74
|
| Rate for Payer: Healthscope Commercial |
$647.69
|
| Rate for Payer: Healthscope Whirlpool |
$647.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.73
|
| Rate for Payer: Meridian Medicaid |
$369.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$593.71
|
| Rate for Payer: Nomi Health Commercial |
$647.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,600.50
|
| Rate for Payer: PACE SWMI |
$539.74
|
| Rate for Payer: PHP Medicare Advantage |
$539.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,154.05
|
| Rate for Payer: Priority Health Medicare |
$539.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.05
|
| Rate for Payer: Railroad Medicare Medicare |
$539.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$539.74
|
| Rate for Payer: UHC Exchange |
$1,072.94
|
| Rate for Payer: UHC Medicaid |
$351.88
|
| Rate for Payer: UHCCP DNSP |
$539.74
|
| Rate for Payer: UHCCP Medicaid |
$351.88
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$601.73 |
| Max. Negotiated Rate |
$2,004.73 |
| Rate for Payer: Aetna Commercial |
$1,248.06
|
| Rate for Payer: Aetna Medicare |
$931.39
|
| Rate for Payer: BCBS Complete |
$631.82
|
| Rate for Payer: BCBS MAPPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$1,645.33
|
| Rate for Payer: BCN Medicare Advantage |
$931.39
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$1,341.20
|
| Rate for Payer: Cofinity Commercial |
$1,248.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.39
|
| Rate for Payer: Healthscope Commercial |
$1,117.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.96
|
| Rate for Payer: Meridian Medicaid |
$631.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,024.53
|
| Rate for Payer: Nomi Health Commercial |
$1,117.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: PACE SWMI |
$931.39
|
| Rate for Payer: PHP Medicare Advantage |
$931.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$601.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,004.73
|
| Rate for Payer: Priority Health Medicare |
$931.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,004.73
|
| Rate for Payer: Railroad Medicare Medicare |
$931.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,906.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$931.39
|
| Rate for Payer: UHC Exchange |
$1,906.94
|
| Rate for Payer: UHC Medicaid |
$601.73
|
| Rate for Payer: UHCCP DNSP |
$931.39
|
| Rate for Payer: UHCCP Medicaid |
$601.73
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$5,126.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$893.11 |
| Max. Negotiated Rate |
$3,844.50 |
| Rate for Payer: Aetna Commercial |
$1,875.34
|
| Rate for Payer: Aetna Medicare |
$1,399.51
|
| Rate for Payer: BCBS Complete |
$937.77
|
| Rate for Payer: BCBS MAPPO |
$1,399.51
|
| Rate for Payer: BCN Commercial |
$2,192.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,399.51
|
| Rate for Payer: Cash Price |
$4,100.80
|
| Rate for Payer: Cash Price |
$4,100.80
|
| Rate for Payer: Cofinity Commercial |
$2,015.29
|
| Rate for Payer: Cofinity Commercial |
$1,875.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,399.51
|
| Rate for Payer: Healthscope Commercial |
$1,679.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,469.49
|
| Rate for Payer: Meridian Medicaid |
$937.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,539.46
|
| Rate for Payer: Nomi Health Commercial |
$1,679.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,844.50
|
| Rate for Payer: PACE SWMI |
$1,399.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,399.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,671.56
|
| Rate for Payer: Priority Health Medicare |
$1,399.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,671.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,399.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,637.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,399.51
|
| Rate for Payer: UHC Exchange |
$2,637.77
|
| Rate for Payer: UHC Medicaid |
$893.11
|
| Rate for Payer: UHCCP DNSP |
$1,399.51
|
| Rate for Payer: UHCCP Medicaid |
$893.11
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,455.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$942.95 |
| Max. Negotiated Rate |
$2,848.73 |
| Rate for Payer: Aetna Commercial |
$1,989.69
|
| Rate for Payer: Aetna Medicare |
$1,484.84
|
| Rate for Payer: BCBS Complete |
$990.10
|
| Rate for Payer: BCBS MAPPO |
$1,484.84
|
| Rate for Payer: BCN Commercial |
$2,338.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,484.84
|
| Rate for Payer: Cash Price |
$2,764.00
|
| Rate for Payer: Cash Price |
$2,764.00
|
| Rate for Payer: Cofinity Commercial |
$2,138.17
|
| Rate for Payer: Cofinity Commercial |
$1,989.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,484.84
|
| Rate for Payer: Healthscope Commercial |
$1,781.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,781.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,559.08
|
| Rate for Payer: Meridian Medicaid |
$990.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,633.32
|
| Rate for Payer: Nomi Health Commercial |
$1,781.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,591.25
|
| Rate for Payer: PACE SWMI |
$1,484.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$942.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,848.73
|
| Rate for Payer: Priority Health Medicare |
$1,484.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,848.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,484.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,844.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,484.84
|
| Rate for Payer: UHC Exchange |
$2,844.26
|
| Rate for Payer: UHC Medicaid |
$942.95
|
| Rate for Payer: UHCCP DNSP |
$1,484.84
|
| Rate for Payer: UHCCP Medicaid |
$942.95
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCN Commercial |
$14.45
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Healthscope Commercial |
$11.69
|
| Rate for Payer: Healthscope Whirlpool |
$11.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.23
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.71
|
| Rate for Payer: Nomi Health Commercial |
$11.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Railroad Medicare Medicare |
$9.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.74
|
| Rate for Payer: UHC Exchange |
$12.96
|
| Rate for Payer: UHC Medicaid |
$6.39
|
| Rate for Payer: UHCCP DNSP |
$9.74
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$302.77 |
| Rate for Payer: Aetna Commercial |
$279.19
|
| Rate for Payer: Aetna Medicare |
$208.35
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$208.35
|
| Rate for Payer: BCN Commercial |
$302.77
|
| Rate for Payer: BCN Medicare Advantage |
$208.35
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$300.02
|
| Rate for Payer: Cofinity Commercial |
$279.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.35
|
| Rate for Payer: Healthscope Commercial |
$250.02
|
| Rate for Payer: Healthscope Whirlpool |
$250.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.77
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$229.19
|
| Rate for Payer: Nomi Health Commercial |
$250.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.50
|
| Rate for Payer: PACE SWMI |
$208.35
|
| Rate for Payer: PHP Medicare Advantage |
$208.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$279.23
|
| Rate for Payer: Priority Health Medicare |
$208.35
|
| Rate for Payer: Priority Health Narrow Network |
$279.23
|
| Rate for Payer: Railroad Medicare Medicare |
$208.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$208.35
|
| Rate for Payer: UHC Exchange |
$294.53
|
| Rate for Payer: UHC Medicaid |
$137.17
|
| Rate for Payer: UHCCP DNSP |
$208.35
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$438.23 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$302.24
|
| Rate for Payer: BCBS Complete |
$207.99
|
| Rate for Payer: BCBS MAPPO |
$302.24
|
| Rate for Payer: BCN Commercial |
$438.23
|
| Rate for Payer: BCN Medicare Advantage |
$302.24
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cofinity Commercial |
$435.23
|
| Rate for Payer: Cofinity Commercial |
$405.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.24
|
| Rate for Payer: Healthscope Commercial |
$362.69
|
| Rate for Payer: Healthscope Whirlpool |
$362.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.35
|
| Rate for Payer: Meridian Medicaid |
$207.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$332.46
|
| Rate for Payer: Nomi Health Commercial |
$362.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.50
|
| Rate for Payer: PACE SWMI |
$302.24
|
| Rate for Payer: PHP Medicare Advantage |
$302.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$404.14
|
| Rate for Payer: Priority Health Medicare |
$302.24
|
| Rate for Payer: Priority Health Narrow Network |
$404.14
|
| Rate for Payer: Railroad Medicare Medicare |
$302.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$302.24
|
| Rate for Payer: UHC Exchange |
$382.78
|
| Rate for Payer: UHC Medicaid |
$198.09
|
| Rate for Payer: UHCCP DNSP |
$302.24
|
| Rate for Payer: UHCCP Medicaid |
$198.09
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$237.71 |
| Max. Negotiated Rate |
$527.86 |
| Rate for Payer: Aetna Commercial |
$486.55
|
| Rate for Payer: Aetna Medicare |
$363.10
|
| Rate for Payer: BCBS Complete |
$249.60
|
| Rate for Payer: BCBS MAPPO |
$363.10
|
| Rate for Payer: BCN Commercial |
$527.86
|
| Rate for Payer: BCN Medicare Advantage |
$363.10
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$522.86
|
| Rate for Payer: Cofinity Commercial |
$486.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.10
|
| Rate for Payer: Healthscope Commercial |
$435.72
|
| Rate for Payer: Healthscope Whirlpool |
$435.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.25
|
| Rate for Payer: Meridian Medicaid |
$249.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$399.41
|
| Rate for Payer: Nomi Health Commercial |
$435.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.25
|
| Rate for Payer: PACE SWMI |
$363.10
|
| Rate for Payer: PHP Medicare Advantage |
$363.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$486.79
|
| Rate for Payer: Priority Health Medicare |
$363.10
|
| Rate for Payer: Priority Health Narrow Network |
$486.79
|
| Rate for Payer: Railroad Medicare Medicare |
$363.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$363.10
|
| Rate for Payer: UHC Exchange |
$456.15
|
| Rate for Payer: UHC Medicaid |
$237.71
|
| Rate for Payer: UHCCP DNSP |
$363.10
|
| Rate for Payer: UHCCP Medicaid |
$237.71
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$438.23 |
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna Medicare |
$301.94
|
| Rate for Payer: BCBS Complete |
$207.77
|
| Rate for Payer: BCBS MAPPO |
$301.94
|
| Rate for Payer: BCN Commercial |
$438.23
|
| Rate for Payer: BCN Medicare Advantage |
$301.94
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$404.60
|
| Rate for Payer: Cofinity Commercial |
$434.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.94
|
| Rate for Payer: Healthscope Commercial |
$362.33
|
| Rate for Payer: Healthscope Whirlpool |
$362.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.04
|
| Rate for Payer: Meridian Medicaid |
$207.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$332.13
|
| Rate for Payer: Nomi Health Commercial |
$362.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.50
|
| Rate for Payer: PACE SWMI |
$301.94
|
| Rate for Payer: PHP Medicare Advantage |
$301.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$404.14
|
| Rate for Payer: Priority Health Medicare |
$301.94
|
| Rate for Payer: Priority Health Narrow Network |
$404.14
|
| Rate for Payer: Railroad Medicare Medicare |
$301.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$301.94
|
| Rate for Payer: UHC Exchange |
$382.25
|
| Rate for Payer: UHC Medicaid |
$197.88
|
| Rate for Payer: UHCCP DNSP |
$301.94
|
| Rate for Payer: UHCCP Medicaid |
$197.88
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,735.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$391.44 |
| Max. Negotiated Rate |
$3,033.71 |
| Rate for Payer: Aetna Commercial |
$391.44
|
| Rate for Payer: BCBS Complete |
$1,094.00
|
| Rate for Payer: BCN Commercial |
$3,033.71
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,051.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$442.48
|
| Rate for Payer: UHC Exchange |
$442.48
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,627.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,970.25 |
| Rate for Payer: Aetna Commercial |
$738.37
|
| Rate for Payer: Aetna Medicare |
$551.02
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$551.02
|
| Rate for Payer: BCN Commercial |
$932.22
|
| Rate for Payer: BCN Medicare Advantage |
$551.02
|
| Rate for Payer: Cash Price |
$2,101.60
|
| Rate for Payer: Cash Price |
$2,101.60
|
| Rate for Payer: Cofinity Commercial |
$793.47
|
| Rate for Payer: Cofinity Commercial |
$738.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.02
|
| Rate for Payer: Healthscope Commercial |
$661.22
|
| Rate for Payer: Healthscope Whirlpool |
$661.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.57
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$606.12
|
| Rate for Payer: Nomi Health Commercial |
$661.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.25
|
| Rate for Payer: PACE SWMI |
$551.02
|
| Rate for Payer: PHP Medicare Advantage |
$551.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$877.88
|
| Rate for Payer: Priority Health Medicare |
$551.02
|
| Rate for Payer: Priority Health Narrow Network |
$877.88
|
| Rate for Payer: Railroad Medicare Medicare |
$551.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,009.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$551.02
|
| Rate for Payer: UHC Exchange |
$1,009.58
|
| Rate for Payer: UHC Medicaid |
$372.54
|
| Rate for Payer: UHCCP DNSP |
$551.02
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$452.41 |
| Max. Negotiated Rate |
$1,315.94 |
| Rate for Payer: Aetna Commercial |
$912.50
|
| Rate for Payer: Aetna Medicare |
$680.97
|
| Rate for Payer: BCBS Complete |
$475.03
|
| Rate for Payer: BCBS MAPPO |
$680.97
|
| Rate for Payer: BCN Commercial |
$1,164.78
|
| Rate for Payer: BCN Medicare Advantage |
$680.97
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cofinity Commercial |
$980.60
|
| Rate for Payer: Cofinity Commercial |
$912.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.97
|
| Rate for Payer: Healthscope Commercial |
$817.16
|
| Rate for Payer: Healthscope Whirlpool |
$817.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.02
|
| Rate for Payer: Meridian Medicaid |
$475.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$749.07
|
| Rate for Payer: Nomi Health Commercial |
$817.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,185.00
|
| Rate for Payer: PACE SWMI |
$680.97
|
| Rate for Payer: PHP Medicare Advantage |
$680.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$452.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,096.87
|
| Rate for Payer: Priority Health Medicare |
$680.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.87
|
| Rate for Payer: Railroad Medicare Medicare |
$680.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,315.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$680.97
|
| Rate for Payer: UHC Exchange |
$1,315.94
|
| Rate for Payer: UHC Medicaid |
$452.41
|
| Rate for Payer: UHCCP DNSP |
$680.97
|
| Rate for Payer: UHCCP Medicaid |
$452.41
|
|
