|
PR EPIDRM AGRFT T/A/L 1ST 100 SQCM/</1% INFT/CHLD
|
Professional
|
Both
|
$1,608.00
|
|
|
Service Code
|
HCPCS 15110
|
| Min. Negotiated Rate |
$643.20 |
| Max. Negotiated Rate |
$1,045.20 |
| Rate for Payer: Aetna Commercial |
$918.62
|
| Rate for Payer: Aetna Medicare |
$685.54
|
| Rate for Payer: BCBS Complete |
$643.20
|
| Rate for Payer: BCBS MAPPO |
$685.54
|
| Rate for Payer: BCN Medicare Advantage |
$685.54
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cash Price |
$1,286.40
|
| Rate for Payer: Cofinity Commercial |
$987.18
|
| Rate for Payer: Cofinity Commercial |
$918.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.54
|
| Rate for Payer: Healthscope Commercial |
$822.65
|
| Rate for Payer: Healthscope Whirlpool |
$822.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.82
|
| Rate for Payer: Nomi Health Commercial |
$822.65
|
| Rate for Payer: PACE SWMI |
$685.54
|
| Rate for Payer: PHP Medicare Advantage |
$685.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,045.20
|
| Rate for Payer: Priority Health Medicare |
$685.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.54
|
| Rate for Payer: UHC Medicare Advantage |
$685.54
|
| Rate for Payer: UHCCP DNSP |
$685.54
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$862.76 |
| Rate for Payer: Aetna Commercial |
$802.85
|
| Rate for Payer: Aetna Medicare |
$599.14
|
| Rate for Payer: BCBS Complete |
$504.00
|
| Rate for Payer: BCBS MAPPO |
$599.14
|
| Rate for Payer: BCN Medicare Advantage |
$599.14
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cofinity Commercial |
$862.76
|
| Rate for Payer: Cofinity Commercial |
$802.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.14
|
| Rate for Payer: Healthscope Commercial |
$718.97
|
| Rate for Payer: Healthscope Whirlpool |
$718.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.10
|
| Rate for Payer: Nomi Health Commercial |
$718.97
|
| Rate for Payer: PACE SWMI |
$599.14
|
| Rate for Payer: PHP Medicare Advantage |
$599.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Medicare |
$599.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.14
|
| Rate for Payer: UHC Medicare Advantage |
$599.14
|
| Rate for Payer: UHCCP DNSP |
$599.14
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 27185
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$1,001.07 |
| Rate for Payer: Aetna Commercial |
$931.55
|
| Rate for Payer: Aetna Medicare |
$695.19
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: BCBS MAPPO |
$695.19
|
| Rate for Payer: BCN Medicare Advantage |
$695.19
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$931.55
|
| Rate for Payer: Cofinity Commercial |
$1,001.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.19
|
| Rate for Payer: Healthscope Commercial |
$834.23
|
| Rate for Payer: Healthscope Whirlpool |
$834.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.95
|
| Rate for Payer: Nomi Health Commercial |
$834.23
|
| Rate for Payer: PACE SWMI |
$695.19
|
| Rate for Payer: PHP Medicare Advantage |
$695.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health Medicare |
$695.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.19
|
| Rate for Payer: UHC Medicare Advantage |
$695.19
|
| Rate for Payer: UHCCP DNSP |
$695.19
|
|
|
PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 59300
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$247.65 |
| Rate for Payer: Aetna Commercial |
$192.80
|
| Rate for Payer: Aetna Medicare |
$143.88
|
| Rate for Payer: BCBS Complete |
$152.40
|
| Rate for Payer: BCBS MAPPO |
$143.88
|
| Rate for Payer: BCN Medicare Advantage |
$143.88
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.88
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Healthscope Whirlpool |
$172.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.07
|
| Rate for Payer: Nomi Health Commercial |
$172.66
|
| Rate for Payer: PACE SWMI |
$143.88
|
| Rate for Payer: PHP Medicare Advantage |
$143.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health Medicare |
$143.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.88
|
| Rate for Payer: UHC Medicare Advantage |
$143.88
|
| Rate for Payer: UHCCP DNSP |
$143.88
|
|
|
PR EPOETIN ALFA, NON-ESRD
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS J0885
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$11.44
|
| Rate for Payer: Aetna Medicare |
$8.54
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$10.25
|
| Rate for Payer: Healthscope Whirlpool |
$10.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Nomi Health Commercial |
$10.25
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$8.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP DNSP |
$8.54
|
|
|
PR ERCP,ABLATION TUMOR
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 43272
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Medicare |
$827.50
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
|
|
PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 43277
|
| Min. Negotiated Rate |
$355.29 |
| Max. Negotiated Rate |
$770.25 |
| Rate for Payer: Aetna Commercial |
$476.09
|
| Rate for Payer: Aetna Medicare |
$355.29
|
| Rate for Payer: BCBS Complete |
$474.00
|
| Rate for Payer: BCBS MAPPO |
$355.29
|
| Rate for Payer: BCN Medicare Advantage |
$355.29
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$476.09
|
| Rate for Payer: Cofinity Commercial |
$511.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.29
|
| Rate for Payer: Healthscope Commercial |
$426.35
|
| Rate for Payer: Healthscope Whirlpool |
$426.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.05
|
| Rate for Payer: Nomi Health Commercial |
$426.35
|
| Rate for Payer: PACE SWMI |
$355.29
|
| Rate for Payer: PHP Medicare Advantage |
$355.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health Medicare |
$355.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.29
|
| Rate for Payer: UHC Medicare Advantage |
$355.29
|
| Rate for Payer: UHCCP DNSP |
$355.29
|
|
|
PR ERCP,BALLOON DIL DUCTS
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
HCPCS 43271
|
| Min. Negotiated Rate |
$668.80 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna Medicare |
$836.00
|
| Rate for Payer: BCBS Complete |
$668.80
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.80
|
|
|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$451.73 |
| Max. Negotiated Rate |
$966.55 |
| Rate for Payer: Aetna Commercial |
$605.32
|
| Rate for Payer: Aetna Medicare |
$451.73
|
| Rate for Payer: BCBS Complete |
$594.80
|
| Rate for Payer: BCBS MAPPO |
$451.73
|
| Rate for Payer: BCN Medicare Advantage |
$451.73
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cofinity Commercial |
$650.49
|
| Rate for Payer: Cofinity Commercial |
$605.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.73
|
| Rate for Payer: Healthscope Commercial |
$542.08
|
| Rate for Payer: Healthscope Whirlpool |
$542.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.32
|
| Rate for Payer: Nomi Health Commercial |
$542.08
|
| Rate for Payer: PACE SWMI |
$451.73
|
| Rate for Payer: PHP Medicare Advantage |
$451.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.55
|
| Rate for Payer: Priority Health Medicare |
$451.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.73
|
| Rate for Payer: UHC Medicare Advantage |
$451.73
|
| Rate for Payer: UHCCP DNSP |
$451.73
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$405.66 |
| Max. Negotiated Rate |
$1,238.25 |
| Rate for Payer: Aetna Commercial |
$543.58
|
| Rate for Payer: Aetna Medicare |
$405.66
|
| Rate for Payer: BCBS Complete |
$762.00
|
| Rate for Payer: BCBS MAPPO |
$405.66
|
| Rate for Payer: BCN Medicare Advantage |
$405.66
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cofinity Commercial |
$584.15
|
| Rate for Payer: Cofinity Commercial |
$543.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.66
|
| Rate for Payer: Healthscope Commercial |
$486.79
|
| Rate for Payer: Healthscope Whirlpool |
$486.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.94
|
| Rate for Payer: Nomi Health Commercial |
$486.79
|
| Rate for Payer: PACE SWMI |
$405.66
|
| Rate for Payer: PHP Medicare Advantage |
$405.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health Medicare |
$405.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.66
|
| Rate for Payer: UHC Medicare Advantage |
$405.66
|
| Rate for Payer: UHCCP DNSP |
$405.66
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$302.93 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Healthscope Whirlpool |
$363.52
|
| Rate for Payer: Aetna Commercial |
$405.93
|
| Rate for Payer: Aetna Medicare |
$302.93
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$302.93
|
| Rate for Payer: BCN Medicare Advantage |
$302.93
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$436.22
|
| Rate for Payer: Cofinity Commercial |
$405.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.93
|
| Rate for Payer: Healthscope Commercial |
$363.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.08
|
| Rate for Payer: Nomi Health Commercial |
$363.52
|
| Rate for Payer: PACE SWMI |
$302.93
|
| Rate for Payer: PHP Medicare Advantage |
$302.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$302.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.93
|
| Rate for Payer: UHC Medicare Advantage |
$302.93
|
| Rate for Payer: UHCCP DNSP |
$302.93
|
|
|
PR ERCP,INSERT STENT,BILIARY/PANC
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 43268
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$1,108.25 |
| Rate for Payer: Aetna Medicare |
$852.50
|
| Rate for Payer: BCBS Complete |
$682.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,108.25
|
|
|
PR ERCP,NASOBILIARY DRAIN TUBE
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
HCPCS 43267
|
| Min. Negotiated Rate |
$659.60 |
| Max. Negotiated Rate |
$1,071.85 |
| Rate for Payer: Aetna Medicare |
$824.50
|
| Rate for Payer: BCBS Complete |
$659.60
|
| Rate for Payer: Cash Price |
$1,319.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.85
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$342.26 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$458.63
|
| Rate for Payer: Aetna Medicare |
$342.26
|
| Rate for Payer: BCBS Complete |
$735.60
|
| Rate for Payer: BCBS MAPPO |
$342.26
|
| Rate for Payer: BCN Medicare Advantage |
$342.26
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cofinity Commercial |
$492.85
|
| Rate for Payer: Cofinity Commercial |
$458.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.26
|
| Rate for Payer: Healthscope Commercial |
$410.71
|
| Rate for Payer: Healthscope Whirlpool |
$410.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.37
|
| Rate for Payer: Nomi Health Commercial |
$410.71
|
| Rate for Payer: PACE SWMI |
$342.26
|
| Rate for Payer: PHP Medicare Advantage |
$342.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health Medicare |
$342.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.26
|
| Rate for Payer: UHC Medicare Advantage |
$342.26
|
| Rate for Payer: UHCCP DNSP |
$342.26
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$531.70 |
| Rate for Payer: Aetna Commercial |
$473.57
|
| Rate for Payer: Aetna Medicare |
$353.41
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$353.41
|
| Rate for Payer: BCN Medicare Advantage |
$353.41
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$508.91
|
| Rate for Payer: Cofinity Commercial |
$473.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.41
|
| Rate for Payer: Healthscope Commercial |
$424.09
|
| Rate for Payer: Healthscope Whirlpool |
$424.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.08
|
| Rate for Payer: Nomi Health Commercial |
$424.09
|
| Rate for Payer: PACE SWMI |
$353.41
|
| Rate for Payer: PHP Medicare Advantage |
$353.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$353.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.41
|
| Rate for Payer: UHC Medicare Advantage |
$353.41
|
| Rate for Payer: UHCCP DNSP |
$353.41
|
|
|
PR ERCP,RMV F.B./CHANGE STENT
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 43269
|
| Min. Negotiated Rate |
$677.20 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Medicare |
$846.50
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$434.24 |
| Max. Negotiated Rate |
$928.85 |
| Rate for Payer: Aetna Commercial |
$581.88
|
| Rate for Payer: Aetna Medicare |
$434.24
|
| Rate for Payer: BCBS Complete |
$571.60
|
| Rate for Payer: BCBS MAPPO |
$434.24
|
| Rate for Payer: BCN Medicare Advantage |
$434.24
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cofinity Commercial |
$625.31
|
| Rate for Payer: Cofinity Commercial |
$581.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.24
|
| Rate for Payer: Healthscope Commercial |
$521.09
|
| Rate for Payer: Healthscope Whirlpool |
$521.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.95
|
| Rate for Payer: Nomi Health Commercial |
$521.09
|
| Rate for Payer: PACE SWMI |
$434.24
|
| Rate for Payer: PHP Medicare Advantage |
$434.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.85
|
| Rate for Payer: Priority Health Medicare |
$434.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.24
|
| Rate for Payer: UHC Medicare Advantage |
$434.24
|
| Rate for Payer: UHCCP DNSP |
$434.24
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$406.48 |
| Max. Negotiated Rate |
$876.20 |
| Rate for Payer: Aetna Commercial |
$544.68
|
| Rate for Payer: Aetna Medicare |
$406.48
|
| Rate for Payer: BCBS Complete |
$539.20
|
| Rate for Payer: BCBS MAPPO |
$406.48
|
| Rate for Payer: BCN Medicare Advantage |
$406.48
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$585.33
|
| Rate for Payer: Cofinity Commercial |
$544.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.48
|
| Rate for Payer: Healthscope Commercial |
$487.78
|
| Rate for Payer: Healthscope Whirlpool |
$487.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$426.80
|
| Rate for Payer: Nomi Health Commercial |
$487.78
|
| Rate for Payer: PACE SWMI |
$406.48
|
| Rate for Payer: PHP Medicare Advantage |
$406.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health Medicare |
$406.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.48
|
| Rate for Payer: UHC Medicare Advantage |
$406.48
|
| Rate for Payer: UHCCP DNSP |
$406.48
|
|
|
PR ERCP W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43261
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$425.58
|
| Rate for Payer: Aetna Medicare |
$317.60
|
| Rate for Payer: BCBS Complete |
$468.00
|
| Rate for Payer: BCBS MAPPO |
$317.60
|
| Rate for Payer: BCN Medicare Advantage |
$317.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$457.34
|
| Rate for Payer: Cofinity Commercial |
$425.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.60
|
| Rate for Payer: Healthscope Commercial |
$381.12
|
| Rate for Payer: Healthscope Whirlpool |
$381.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.48
|
| Rate for Payer: Nomi Health Commercial |
$381.12
|
| Rate for Payer: PACE SWMI |
$317.60
|
| Rate for Payer: PHP Medicare Advantage |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health Medicare |
$317.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.60
|
| Rate for Payer: UHC Medicare Advantage |
$317.60
|
| Rate for Payer: UHCCP DNSP |
$317.60
|
|
|
PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 43263
|
| Min. Negotiated Rate |
$335.83 |
| Max. Negotiated Rate |
$1,054.30 |
| Rate for Payer: Aetna Commercial |
$450.01
|
| Rate for Payer: Aetna Medicare |
$335.83
|
| Rate for Payer: BCBS Complete |
$648.80
|
| Rate for Payer: BCBS MAPPO |
$335.83
|
| Rate for Payer: BCN Medicare Advantage |
$335.83
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cofinity Commercial |
$483.60
|
| Rate for Payer: Cofinity Commercial |
$450.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.83
|
| Rate for Payer: Healthscope Commercial |
$403.00
|
| Rate for Payer: Healthscope Whirlpool |
$403.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.62
|
| Rate for Payer: Nomi Health Commercial |
$403.00
|
| Rate for Payer: PACE SWMI |
$335.83
|
| Rate for Payer: PHP Medicare Advantage |
$335.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.30
|
| Rate for Payer: Priority Health Medicare |
$335.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.83
|
| Rate for Payer: UHC Medicare Advantage |
$335.83
|
| Rate for Payer: UHCCP DNSP |
$335.83
|
|
|
PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 43262
|
| Min. Negotiated Rate |
$335.15 |
| Max. Negotiated Rate |
$1,097.20 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Medicare |
$335.15
|
| Rate for Payer: BCBS Complete |
$675.20
|
| Rate for Payer: BCBS MAPPO |
$335.15
|
| Rate for Payer: BCN Medicare Advantage |
$335.15
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$482.62
|
| Rate for Payer: Cofinity Commercial |
$449.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.15
|
| Rate for Payer: Healthscope Commercial |
$402.18
|
| Rate for Payer: Healthscope Whirlpool |
$402.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$351.91
|
| Rate for Payer: Nomi Health Commercial |
$402.18
|
| Rate for Payer: PACE SWMI |
$335.15
|
| Rate for Payer: PHP Medicare Advantage |
$335.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health Medicare |
$335.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.15
|
| Rate for Payer: UHC Medicare Advantage |
$335.15
|
| Rate for Payer: UHCCP DNSP |
$335.15
|
|
|
PR ESCHAROTOMY EACH ADDITIONAL INCISION
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 16036
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$282.10 |
| Rate for Payer: Aetna Commercial |
$107.17
|
| Rate for Payer: Aetna Medicare |
$79.98
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: BCBS MAPPO |
$79.98
|
| Rate for Payer: BCN Medicare Advantage |
$79.98
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.98
|
| Rate for Payer: Healthscope Commercial |
$95.98
|
| Rate for Payer: Healthscope Whirlpool |
$95.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.98
|
| Rate for Payer: Nomi Health Commercial |
$95.98
|
| Rate for Payer: PACE SWMI |
$79.98
|
| Rate for Payer: PHP Medicare Advantage |
$79.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: Priority Health Medicare |
$79.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.98
|
| Rate for Payer: UHC Medicare Advantage |
$79.98
|
| Rate for Payer: UHCCP DNSP |
$79.98
|
|
|
PR ESCHAROTOMY FIRST INCISION
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna Commercial |
$252.01
|
| Rate for Payer: Aetna Medicare |
$188.07
|
| Rate for Payer: BCBS Complete |
$344.00
|
| Rate for Payer: BCBS MAPPO |
$188.07
|
| Rate for Payer: BCN Medicare Advantage |
$188.07
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cofinity Commercial |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$252.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.07
|
| Rate for Payer: Healthscope Commercial |
$225.68
|
| Rate for Payer: Healthscope Whirlpool |
$225.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.47
|
| Rate for Payer: Nomi Health Commercial |
$225.68
|
| Rate for Payer: PACE SWMI |
$188.07
|
| Rate for Payer: PHP Medicare Advantage |
$188.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.00
|
| Rate for Payer: Priority Health Medicare |
$188.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.07
|
| Rate for Payer: UHC Medicare Advantage |
$188.07
|
| Rate for Payer: UHCCP DNSP |
$188.07
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
|
Professional
|
Both
|
$3,466.00
|
|
|
Service Code
|
HCPCS 43325
|
| Min. Negotiated Rate |
$1,321.97 |
| Max. Negotiated Rate |
$2,252.90 |
| Rate for Payer: Aetna Commercial |
$1,771.44
|
| Rate for Payer: Aetna Medicare |
$1,321.97
|
| Rate for Payer: BCBS Complete |
$1,386.40
|
| Rate for Payer: BCBS MAPPO |
$1,321.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,321.97
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cofinity Commercial |
$1,903.64
|
| Rate for Payer: Cofinity Commercial |
$1,771.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,321.97
|
| Rate for Payer: Healthscope Commercial |
$1,586.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,586.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,388.07
|
| Rate for Payer: Nomi Health Commercial |
$1,586.36
|
| Rate for Payer: PACE SWMI |
$1,321.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,321.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.90
|
| Rate for Payer: Priority Health Medicare |
$1,321.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,321.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,321.97
|
| Rate for Payer: UHCCP DNSP |
$1,321.97
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY
|
Professional
|
Both
|
$2,096.00
|
|
|
Service Code
|
HCPCS 43327
|
| Min. Negotiated Rate |
$810.51 |
| Max. Negotiated Rate |
$1,362.40 |
| Rate for Payer: Aetna Commercial |
$1,086.08
|
| Rate for Payer: Aetna Medicare |
$810.51
|
| Rate for Payer: BCBS Complete |
$838.40
|
| Rate for Payer: BCBS MAPPO |
$810.51
|
| Rate for Payer: BCN Medicare Advantage |
$810.51
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cofinity Commercial |
$1,167.13
|
| Rate for Payer: Cofinity Commercial |
$1,086.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.51
|
| Rate for Payer: Healthscope Commercial |
$972.61
|
| Rate for Payer: Healthscope Whirlpool |
$972.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.04
|
| Rate for Payer: Nomi Health Commercial |
$972.61
|
| Rate for Payer: PACE SWMI |
$810.51
|
| Rate for Payer: PHP Medicare Advantage |
$810.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.40
|
| Rate for Payer: Priority Health Medicare |
$810.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.51
|
| Rate for Payer: UHC Medicare Advantage |
$810.51
|
| Rate for Payer: UHCCP DNSP |
$810.51
|
|
