|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,285.08 |
| Rate for Payer: Aetna Commercial |
$875.17
|
| Rate for Payer: Aetna Medicare |
$653.11
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS MAPPO |
$653.11
|
| Rate for Payer: BCN Commercial |
$1,112.49
|
| Rate for Payer: BCN Medicare Advantage |
$653.11
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cofinity Commercial |
$940.48
|
| Rate for Payer: Cofinity Commercial |
$875.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.11
|
| Rate for Payer: Healthscope Commercial |
$783.73
|
| Rate for Payer: Healthscope Whirlpool |
$783.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.77
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$718.42
|
| Rate for Payer: Nomi Health Commercial |
$783.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.75
|
| Rate for Payer: PACE SWMI |
$653.11
|
| Rate for Payer: PHP Medicare Advantage |
$653.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,018.21
|
| Rate for Payer: Priority Health Medicare |
$653.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.21
|
| Rate for Payer: Railroad Medicare Medicare |
$653.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,285.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.11
|
| Rate for Payer: UHC Exchange |
$1,285.08
|
| Rate for Payer: UHC Medicaid |
$427.28
|
| Rate for Payer: UHCCP DNSP |
$653.11
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,976.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$407.90 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna Commercial |
$837.94
|
| Rate for Payer: Aetna Medicare |
$625.33
|
| Rate for Payer: BCBS Complete |
$428.30
|
| Rate for Payer: BCBS MAPPO |
$625.33
|
| Rate for Payer: BCN Commercial |
$1,089.09
|
| Rate for Payer: BCN Medicare Advantage |
$625.33
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cofinity Commercial |
$900.48
|
| Rate for Payer: Cofinity Commercial |
$837.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.33
|
| Rate for Payer: Healthscope Commercial |
$750.40
|
| Rate for Payer: Healthscope Whirlpool |
$750.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.60
|
| Rate for Payer: Meridian Medicaid |
$428.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.86
|
| Rate for Payer: Nomi Health Commercial |
$750.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,482.00
|
| Rate for Payer: PACE SWMI |
$625.33
|
| Rate for Payer: PHP Medicare Advantage |
$625.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$996.80
|
| Rate for Payer: Priority Health Medicare |
$625.33
|
| Rate for Payer: Priority Health Narrow Network |
$996.80
|
| Rate for Payer: Railroad Medicare Medicare |
$625.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,307.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.33
|
| Rate for Payer: UHC Exchange |
$1,307.75
|
| Rate for Payer: UHC Medicaid |
$407.90
|
| Rate for Payer: UHCCP DNSP |
$625.33
|
| Rate for Payer: UHCCP Medicaid |
$407.90
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,010.14 |
| Max. Negotiated Rate |
$2,569.82 |
| Rate for Payer: Aetna Commercial |
$1,296.90
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$1,397.77
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.10
|
| Rate for Payer: BCN Commercial |
$1,188.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$1,354.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,397.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,441.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$1,296.90
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.85
|
| Rate for Payer: Nomi Health Commercial |
$1,181.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,262.60
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,010.14
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 15240
|
| Hospital Charge Code |
15240
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$1,369.24 |
| Rate for Payer: Aetna Commercial |
$906.43
|
| Rate for Payer: Aetna Medicare |
$676.44
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$676.44
|
| Rate for Payer: BCN Commercial |
$1,199.63
|
| Rate for Payer: BCN Medicare Advantage |
$676.44
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$974.07
|
| Rate for Payer: Cofinity Commercial |
$906.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.44
|
| Rate for Payer: Healthscope Commercial |
$811.73
|
| Rate for Payer: Healthscope Whirlpool |
$811.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.26
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$744.08
|
| Rate for Payer: Nomi Health Commercial |
$811.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PACE SWMI |
$676.44
|
| Rate for Payer: PHP Medicare Advantage |
$676.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,097.98
|
| Rate for Payer: Priority Health Medicare |
$676.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,097.98
|
| Rate for Payer: Railroad Medicare Medicare |
$676.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$676.44
|
| Rate for Payer: UHC Exchange |
$1,369.24
|
| Rate for Payer: UHC Medicaid |
$445.17
|
| Rate for Payer: UHCCP DNSP |
$676.44
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,080.75 |
| Max. Negotiated Rate |
$1,441.00 |
| Rate for Payer: Aetna Commercial |
$1,296.90
|
| Rate for Payer: ASR ASR |
$1,397.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.35
|
| Rate for Payer: BCN Commercial |
$1,183.35
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$1,354.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.80
|
| Rate for Payer: Healthscope Commercial |
$1,397.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,441.00
|
| Rate for Payer: Mclaren Commercial |
$1,296.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.85
|
| Rate for Payer: Nomi Health Commercial |
$1,181.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$1,369.24 |
| Rate for Payer: Aetna Commercial |
$906.43
|
| Rate for Payer: Aetna Medicare |
$676.44
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$676.44
|
| Rate for Payer: BCN Commercial |
$1,199.63
|
| Rate for Payer: BCN Medicare Advantage |
$676.44
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$974.07
|
| Rate for Payer: Cofinity Commercial |
$906.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.44
|
| Rate for Payer: Healthscope Commercial |
$811.73
|
| Rate for Payer: Healthscope Whirlpool |
$811.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.26
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$744.08
|
| Rate for Payer: Nomi Health Commercial |
$811.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PACE SWMI |
$676.44
|
| Rate for Payer: PHP Medicare Advantage |
$676.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,097.98
|
| Rate for Payer: Priority Health Medicare |
$676.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,097.98
|
| Rate for Payer: Railroad Medicare Medicare |
$676.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$676.44
|
| Rate for Payer: UHC Exchange |
$1,369.24
|
| Rate for Payer: UHC Medicaid |
$445.17
|
| Rate for Payer: UHCCP DNSP |
$676.44
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Aetna Commercial |
$149.06
|
| Rate for Payer: Aetna Medicare |
$111.24
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCBS MAPPO |
$111.24
|
| Rate for Payer: BCN Commercial |
$200.69
|
| Rate for Payer: BCN Medicare Advantage |
$111.24
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$160.19
|
| Rate for Payer: Cofinity Commercial |
$149.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.24
|
| Rate for Payer: Healthscope Commercial |
$133.49
|
| Rate for Payer: Healthscope Whirlpool |
$133.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.80
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.36
|
| Rate for Payer: Nomi Health Commercial |
$133.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.25
|
| Rate for Payer: PACE SWMI |
$111.24
|
| Rate for Payer: PHP Medicare Advantage |
$111.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$183.69
|
| Rate for Payer: Priority Health Medicare |
$111.24
|
| Rate for Payer: Priority Health Narrow Network |
$183.69
|
| Rate for Payer: Railroad Medicare Medicare |
$111.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$111.24
|
| Rate for Payer: UHC Exchange |
$241.02
|
| Rate for Payer: UHC Medicaid |
$71.78
|
| Rate for Payer: UHCCP DNSP |
$111.24
|
| Rate for Payer: UHCCP Medicaid |
$71.78
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$463.91 |
| Max. Negotiated Rate |
$1,458.07 |
| Rate for Payer: Aetna Commercial |
$946.86
|
| Rate for Payer: Aetna Medicare |
$706.61
|
| Rate for Payer: BCBS Complete |
$487.11
|
| Rate for Payer: BCBS MAPPO |
$706.61
|
| Rate for Payer: BCN Commercial |
$1,273.83
|
| Rate for Payer: BCN Medicare Advantage |
$706.61
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$946.86
|
| Rate for Payer: Cofinity Commercial |
$1,017.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.61
|
| Rate for Payer: Healthscope Commercial |
$847.93
|
| Rate for Payer: Healthscope Whirlpool |
$847.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.94
|
| Rate for Payer: Meridian Medicaid |
$487.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$777.27
|
| Rate for Payer: Nomi Health Commercial |
$847.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,313.25
|
| Rate for Payer: PACE SWMI |
$706.61
|
| Rate for Payer: PHP Medicare Advantage |
$706.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,165.88
|
| Rate for Payer: Priority Health Medicare |
$706.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.88
|
| Rate for Payer: Railroad Medicare Medicare |
$706.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,458.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$706.61
|
| Rate for Payer: UHC Exchange |
$1,458.07
|
| Rate for Payer: UHC Medicaid |
$463.91
|
| Rate for Payer: UHCCP DNSP |
$706.61
|
| Rate for Payer: UHCCP Medicaid |
$463.91
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$342.93 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$699.45
|
| Rate for Payer: Aetna Medicare |
$521.98
|
| Rate for Payer: BCBS Complete |
$360.08
|
| Rate for Payer: BCBS MAPPO |
$521.98
|
| Rate for Payer: BCN Commercial |
$918.78
|
| Rate for Payer: BCN Medicare Advantage |
$521.98
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cofinity Commercial |
$751.65
|
| Rate for Payer: Cofinity Commercial |
$699.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.98
|
| Rate for Payer: Healthscope Commercial |
$626.38
|
| Rate for Payer: Healthscope Whirlpool |
$626.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.08
|
| Rate for Payer: Meridian Medicaid |
$360.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$574.18
|
| Rate for Payer: Nomi Health Commercial |
$626.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,305.00
|
| Rate for Payer: PACE SWMI |
$521.98
|
| Rate for Payer: PHP Medicare Advantage |
$521.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$840.91
|
| Rate for Payer: Priority Health Medicare |
$521.98
|
| Rate for Payer: Priority Health Narrow Network |
$840.91
|
| Rate for Payer: Railroad Medicare Medicare |
$521.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$521.98
|
| Rate for Payer: UHC Exchange |
$1,053.41
|
| Rate for Payer: UHC Medicaid |
$342.93
|
| Rate for Payer: UHCCP DNSP |
$521.98
|
| Rate for Payer: UHCCP Medicaid |
$342.93
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$385.96 |
| Max. Negotiated Rate |
$1,165.02 |
| Rate for Payer: Aetna Commercial |
$789.68
|
| Rate for Payer: Aetna Medicare |
$589.31
|
| Rate for Payer: BCBS Complete |
$405.26
|
| Rate for Payer: BCBS MAPPO |
$589.31
|
| Rate for Payer: BCN Commercial |
$1,014.89
|
| Rate for Payer: BCN Medicare Advantage |
$589.31
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$848.61
|
| Rate for Payer: Cofinity Commercial |
$789.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.31
|
| Rate for Payer: Healthscope Commercial |
$707.17
|
| Rate for Payer: Healthscope Whirlpool |
$707.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.78
|
| Rate for Payer: Meridian Medicaid |
$405.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$648.24
|
| Rate for Payer: Nomi Health Commercial |
$707.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.25
|
| Rate for Payer: PACE SWMI |
$589.31
|
| Rate for Payer: PHP Medicare Advantage |
$589.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$928.88
|
| Rate for Payer: Priority Health Medicare |
$589.31
|
| Rate for Payer: Priority Health Narrow Network |
$928.88
|
| Rate for Payer: Railroad Medicare Medicare |
$589.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,165.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$589.31
|
| Rate for Payer: UHC Exchange |
$1,165.02
|
| Rate for Payer: UHC Medicaid |
$385.96
|
| Rate for Payer: UHCCP DNSP |
$589.31
|
| Rate for Payer: UHCCP Medicaid |
$385.96
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$119.37
|
| Rate for Payer: Aetna Medicare |
$89.08
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS MAPPO |
$89.08
|
| Rate for Payer: BCN Commercial |
$158.86
|
| Rate for Payer: BCN Medicare Advantage |
$89.08
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$128.28
|
| Rate for Payer: Cofinity Commercial |
$119.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.08
|
| Rate for Payer: Healthscope Commercial |
$106.90
|
| Rate for Payer: Healthscope Whirlpool |
$106.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.53
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.99
|
| Rate for Payer: Nomi Health Commercial |
$106.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.50
|
| Rate for Payer: PACE SWMI |
$89.08
|
| Rate for Payer: PHP Medicare Advantage |
$89.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.40
|
| Rate for Payer: Priority Health Medicare |
$89.08
|
| Rate for Payer: Priority Health Narrow Network |
$145.40
|
| Rate for Payer: Railroad Medicare Medicare |
$89.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$89.08
|
| Rate for Payer: UHC Exchange |
$192.39
|
| Rate for Payer: UHC Medicaid |
$57.08
|
| Rate for Payer: UHCCP DNSP |
$89.08
|
| Rate for Payer: UHCCP Medicaid |
$57.08
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$219.75 |
| Rate for Payer: Aetna Commercial |
$77.14
|
| Rate for Payer: Aetna Medicare |
$57.57
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$57.57
|
| Rate for Payer: BCN Commercial |
$102.59
|
| Rate for Payer: BCN Medicare Advantage |
$57.57
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.57
|
| Rate for Payer: Healthscope Commercial |
$69.08
|
| Rate for Payer: Healthscope Whirlpool |
$69.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.45
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.33
|
| Rate for Payer: Nomi Health Commercial |
$69.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.75
|
| Rate for Payer: PACE SWMI |
$57.57
|
| Rate for Payer: PHP Medicare Advantage |
$57.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$93.89
|
| Rate for Payer: Priority Health Medicare |
$57.57
|
| Rate for Payer: Priority Health Narrow Network |
$93.89
|
| Rate for Payer: Railroad Medicare Medicare |
$57.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.57
|
| Rate for Payer: UHC Exchange |
$123.99
|
| Rate for Payer: UHC Medicaid |
$36.85
|
| Rate for Payer: UHCCP DNSP |
$57.57
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$555.93 |
| Rate for Payer: Aetna Commercial |
$517.32
|
| Rate for Payer: Aetna Medicare |
$386.06
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$386.06
|
| Rate for Payer: BCN Commercial |
$369.62
|
| Rate for Payer: BCN Medicare Advantage |
$386.06
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$555.93
|
| Rate for Payer: Cofinity Commercial |
$517.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.06
|
| Rate for Payer: Healthscope Commercial |
$463.27
|
| Rate for Payer: Healthscope Whirlpool |
$463.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$405.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$424.67
|
| Rate for Payer: Nomi Health Commercial |
$463.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PACE SWMI |
$386.06
|
| Rate for Payer: PHP Medicare Advantage |
$386.06
|
| Rate for Payer: Priority Health Medicare |
$386.06
|
| Rate for Payer: Railroad Medicare Medicare |
$386.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$386.06
|
| Rate for Payer: UHC Exchange |
$125.88
|
| Rate for Payer: UHCCP DNSP |
$386.06
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$344.61 |
| Max. Negotiated Rate |
$496.24 |
| Rate for Payer: Aetna Commercial |
$461.78
|
| Rate for Payer: Aetna Medicare |
$344.61
|
| Rate for Payer: BCBS MAPPO |
$344.61
|
| Rate for Payer: BCN Commercial |
$489.52
|
| Rate for Payer: BCN Medicare Advantage |
$344.61
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cofinity Commercial |
$461.78
|
| Rate for Payer: Cofinity Commercial |
$496.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.61
|
| Rate for Payer: Healthscope Commercial |
$413.53
|
| Rate for Payer: Healthscope Whirlpool |
$413.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.07
|
| Rate for Payer: Nomi Health Commercial |
$413.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.75
|
| Rate for Payer: PACE SWMI |
$344.61
|
| Rate for Payer: PHP Medicare Advantage |
$344.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$451.44
|
| Rate for Payer: Priority Health Medicare |
$344.61
|
| Rate for Payer: Priority Health Narrow Network |
$451.44
|
| Rate for Payer: Railroad Medicare Medicare |
$344.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$483.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$344.61
|
| Rate for Payer: UHC Exchange |
$483.31
|
| Rate for Payer: UHCCP DNSP |
$344.61
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$47.07
|
| Rate for Payer: Aetna Medicare |
$35.13
|
| Rate for Payer: BCBS MAPPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$54.78
|
| Rate for Payer: BCN Medicare Advantage |
$35.13
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$47.07
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.13
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Healthscope Whirlpool |
$42.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.64
|
| Rate for Payer: Nomi Health Commercial |
$42.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: PACE SWMI |
$35.13
|
| Rate for Payer: PHP Medicare Advantage |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.87
|
| Rate for Payer: Priority Health Medicare |
$35.13
|
| Rate for Payer: Priority Health Narrow Network |
$46.87
|
| Rate for Payer: Railroad Medicare Medicare |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.13
|
| Rate for Payer: UHC Exchange |
$54.71
|
| Rate for Payer: UHCCP DNSP |
$35.13
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Aetna Commercial |
$191.20
|
| Rate for Payer: Aetna Medicare |
$142.69
|
| Rate for Payer: BCBS MAPPO |
$142.69
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$142.69
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$191.20
|
| Rate for Payer: Cofinity Commercial |
$205.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.69
|
| Rate for Payer: Healthscope Commercial |
$171.23
|
| Rate for Payer: Healthscope Whirlpool |
$171.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.96
|
| Rate for Payer: Nomi Health Commercial |
$171.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.75
|
| Rate for Payer: PACE SWMI |
$142.69
|
| Rate for Payer: PHP Medicare Advantage |
$142.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$214.88
|
| Rate for Payer: Priority Health Medicare |
$142.69
|
| Rate for Payer: Priority Health Narrow Network |
$214.88
|
| Rate for Payer: Railroad Medicare Medicare |
$142.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.69
|
| Rate for Payer: UHC Exchange |
$244.25
|
| Rate for Payer: UHCCP DNSP |
$142.69
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: BCBS MAPPO |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$1.93
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.32
|
| Rate for Payer: Healthscope Whirlpool |
$2.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.12
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
| Rate for Payer: PACE SWMI |
$1.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.93
|
| Rate for Payer: Priority Health Medicare |
$1.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.93
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHCCP DNSP |
$1.93
|
|
|
PR GAS DIL/WSHOT DETER LNG VOL DSTRBJ VNTJ&CLSG VOL
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Aetna Commercial |
$62.06
|
| Rate for Payer: Aetna Medicare |
$46.31
|
| Rate for Payer: BCBS MAPPO |
$46.31
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: BCN Medicare Advantage |
$46.31
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.31
|
| Rate for Payer: Healthscope Commercial |
$55.57
|
| Rate for Payer: Healthscope Whirlpool |
$55.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.94
|
| Rate for Payer: Nomi Health Commercial |
$55.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: PACE SWMI |
$46.31
|
| Rate for Payer: PHP Medicare Advantage |
$46.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.00
|
| Rate for Payer: Priority Health Medicare |
$46.31
|
| Rate for Payer: Priority Health Narrow Network |
$62.00
|
| Rate for Payer: Railroad Medicare Medicare |
$46.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.31
|
| Rate for Payer: UHC Exchange |
$66.78
|
| Rate for Payer: UHCCP DNSP |
$46.31
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$40.23 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Aetna Medicare |
$20.46
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS MAPPO |
$20.46
|
| Rate for Payer: BCN Commercial |
$31.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.46
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$27.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.46
|
| Rate for Payer: Healthscope Commercial |
$24.55
|
| Rate for Payer: Healthscope Whirlpool |
$24.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.48
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$24.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE SWMI |
$20.46
|
| Rate for Payer: PHP Medicare Advantage |
$20.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.83
|
| Rate for Payer: Priority Health Medicare |
$20.46
|
| Rate for Payer: Priority Health Narrow Network |
$38.83
|
| Rate for Payer: Railroad Medicare Medicare |
$20.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.46
|
| Rate for Payer: UHC Exchange |
$40.23
|
| Rate for Payer: UHC Medicaid |
$12.99
|
| Rate for Payer: UHCCP DNSP |
$20.46
|
| Rate for Payer: UHCCP Medicaid |
$12.99
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Aetna Commercial |
$565.04
|
| Rate for Payer: Aetna Medicare |
$421.67
|
| Rate for Payer: BCBS Complete |
$290.75
|
| Rate for Payer: BCBS MAPPO |
$421.67
|
| Rate for Payer: BCN Commercial |
$693.69
|
| Rate for Payer: BCN Medicare Advantage |
$421.67
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$607.20
|
| Rate for Payer: Cofinity Commercial |
$565.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.67
|
| Rate for Payer: Healthscope Commercial |
$506.00
|
| Rate for Payer: Healthscope Whirlpool |
$506.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.75
|
| Rate for Payer: Meridian Medicaid |
$290.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$463.84
|
| Rate for Payer: Nomi Health Commercial |
$506.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.00
|
| Rate for Payer: PACE SWMI |
$421.67
|
| Rate for Payer: PHP Medicare Advantage |
$421.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$741.54
|
| Rate for Payer: Priority Health Medicare |
$421.67
|
| Rate for Payer: Priority Health Narrow Network |
$741.54
|
| Rate for Payer: Railroad Medicare Medicare |
$421.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$791.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$421.67
|
| Rate for Payer: UHC Exchange |
$791.20
|
| Rate for Payer: UHC Medicaid |
$276.90
|
| Rate for Payer: UHCCP DNSP |
$421.67
|
| Rate for Payer: UHCCP Medicaid |
$276.90
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,561.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$609.61 |
| Max. Negotiated Rate |
$1,920.75 |
| Rate for Payer: Aetna Commercial |
$1,276.14
|
| Rate for Payer: Aetna Medicare |
$952.34
|
| Rate for Payer: BCBS Complete |
$640.09
|
| Rate for Payer: BCBS MAPPO |
$952.34
|
| Rate for Payer: BCN Commercial |
$1,531.30
|
| Rate for Payer: BCN Medicare Advantage |
$952.34
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Cofinity Commercial |
$1,276.14
|
| Rate for Payer: Cofinity Commercial |
$1,371.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$952.34
|
| Rate for Payer: Healthscope Commercial |
$1,142.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,142.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$999.96
|
| Rate for Payer: Meridian Medicaid |
$640.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,047.57
|
| Rate for Payer: Nomi Health Commercial |
$1,142.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,920.75
|
| Rate for Payer: PACE SWMI |
$952.34
|
| Rate for Payer: PHP Medicare Advantage |
$952.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$609.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,865.77
|
| Rate for Payer: Priority Health Medicare |
$952.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,865.77
|
| Rate for Payer: Railroad Medicare Medicare |
$952.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,818.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$952.34
|
| Rate for Payer: UHC Exchange |
$1,818.28
|
| Rate for Payer: UHC Medicaid |
$609.61
|
| Rate for Payer: UHCCP DNSP |
$952.34
|
| Rate for Payer: UHCCP Medicaid |
$609.61
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$188.14 |
| Max. Negotiated Rate |
$292.76 |
| Rate for Payer: Aetna Commercial |
$252.11
|
| Rate for Payer: Aetna Commercial |
$252.11
|
| Rate for Payer: Aetna Medicare |
$188.14
|
| Rate for Payer: Aetna Medicare |
$188.14
|
| Rate for Payer: BCBS MAPPO |
$188.14
|
| Rate for Payer: BCBS MAPPO |
$188.14
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: BCN Medicare Advantage |
$188.14
|
| Rate for Payer: BCN Medicare Advantage |
$188.14
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$270.92
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$270.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.14
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$225.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.95
|
| Rate for Payer: Nomi Health Commercial |
$225.77
|
| Rate for Payer: Nomi Health Commercial |
$225.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: PACE SWMI |
$188.14
|
| Rate for Payer: PACE SWMI |
$188.14
|
| Rate for Payer: PHP Medicare Advantage |
$188.14
|
| Rate for Payer: PHP Medicare Advantage |
$188.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.18
|
| Rate for Payer: Priority Health Medicare |
$188.14
|
| Rate for Payer: Priority Health Medicare |
$188.14
|
| Rate for Payer: Priority Health Narrow Network |
$257.18
|
| Rate for Payer: Priority Health Narrow Network |
$257.18
|
| Rate for Payer: Railroad Medicare Medicare |
$188.14
|
| Rate for Payer: Railroad Medicare Medicare |
$188.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.14
|
| Rate for Payer: UHC Exchange |
$292.76
|
| Rate for Payer: UHC Exchange |
$292.76
|
| Rate for Payer: UHCCP DNSP |
$188.14
|
| Rate for Payer: UHCCP DNSP |
$188.14
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$255.49 |
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Medicare |
$174.34
|
| Rate for Payer: Aetna Medicare |
$174.34
|
| Rate for Payer: BCBS MAPPO |
$174.34
|
| Rate for Payer: BCBS MAPPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$246.50
|
| Rate for Payer: BCN Commercial |
$246.50
|
| Rate for Payer: BCN Medicare Advantage |
$174.34
|
| Rate for Payer: BCN Medicare Advantage |
$174.34
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$233.62
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Cofinity Commercial |
$233.62
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.34
|
| Rate for Payer: Healthscope Commercial |
$209.21
|
| Rate for Payer: Healthscope Commercial |
$209.21
|
| Rate for Payer: Healthscope Whirlpool |
$209.21
|
| Rate for Payer: Healthscope Whirlpool |
$209.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.77
|
| Rate for Payer: Nomi Health Commercial |
$209.21
|
| Rate for Payer: Nomi Health Commercial |
$209.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PACE SWMI |
$174.34
|
| Rate for Payer: PACE SWMI |
$174.34
|
| Rate for Payer: PHP Medicare Advantage |
$174.34
|
| Rate for Payer: PHP Medicare Advantage |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$227.33
|
| Rate for Payer: Priority Health Medicare |
$174.34
|
| Rate for Payer: Priority Health Medicare |
$174.34
|
| Rate for Payer: Priority Health Narrow Network |
$227.33
|
| Rate for Payer: Priority Health Narrow Network |
$227.33
|
| Rate for Payer: Railroad Medicare Medicare |
$174.34
|
| Rate for Payer: Railroad Medicare Medicare |
$174.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.34
|
| Rate for Payer: UHC Exchange |
$255.49
|
| Rate for Payer: UHC Exchange |
$255.49
|
| Rate for Payer: UHCCP DNSP |
$174.34
|
| Rate for Payer: UHCCP DNSP |
$174.34
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$737.33 |
| Rate for Payer: Aetna Commercial |
$622.07
|
| Rate for Payer: Aetna Commercial |
$622.07
|
| Rate for Payer: Aetna Medicare |
$464.23
|
| Rate for Payer: Aetna Medicare |
$464.23
|
| Rate for Payer: BCBS MAPPO |
$464.23
|
| Rate for Payer: BCBS MAPPO |
$464.23
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: BCN Medicare Advantage |
$464.23
|
| Rate for Payer: BCN Medicare Advantage |
$464.23
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$622.07
|
| Rate for Payer: Cofinity Commercial |
$668.49
|
| Rate for Payer: Cofinity Commercial |
$622.07
|
| Rate for Payer: Cofinity Commercial |
$668.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.23
|
| Rate for Payer: Healthscope Commercial |
$557.08
|
| Rate for Payer: Healthscope Commercial |
$557.08
|
| Rate for Payer: Healthscope Whirlpool |
$557.08
|
| Rate for Payer: Healthscope Whirlpool |
$557.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$510.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$510.65
|
| Rate for Payer: Nomi Health Commercial |
$557.08
|
| Rate for Payer: Nomi Health Commercial |
$557.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.50
|
| Rate for Payer: PACE SWMI |
$464.23
|
| Rate for Payer: PACE SWMI |
$464.23
|
| Rate for Payer: PHP Medicare Advantage |
$464.23
|
| Rate for Payer: PHP Medicare Advantage |
$464.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$602.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$602.07
|
| Rate for Payer: Priority Health Medicare |
$464.23
|
| Rate for Payer: Priority Health Medicare |
$464.23
|
| Rate for Payer: Priority Health Narrow Network |
$602.07
|
| Rate for Payer: Priority Health Narrow Network |
$602.07
|
| Rate for Payer: Railroad Medicare Medicare |
$464.23
|
| Rate for Payer: Railroad Medicare Medicare |
$464.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$737.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$464.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$464.23
|
| Rate for Payer: UHC Exchange |
$737.33
|
| Rate for Payer: UHC Exchange |
$737.33
|
| Rate for Payer: UHCCP DNSP |
$464.23
|
| Rate for Payer: UHCCP DNSP |
$464.23
|
|
