|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$763.75 |
| Rate for Payer: Aetna Commercial |
$453.09
|
| Rate for Payer: Aetna Medicare |
$338.13
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: BCBS MAPPO |
$338.13
|
| Rate for Payer: BCN Medicare Advantage |
$338.13
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$486.91
|
| Rate for Payer: Cofinity Commercial |
$453.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$405.76
|
| Rate for Payer: Healthscope Whirlpool |
$405.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.04
|
| Rate for Payer: Nomi Health Commercial |
$405.76
|
| Rate for Payer: PACE SWMI |
$338.13
|
| Rate for Payer: PHP Medicare Advantage |
$338.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health Medicare |
$338.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.13
|
| Rate for Payer: UHC Medicare Advantage |
$338.13
|
| Rate for Payer: UHCCP DNSP |
$338.13
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare |
$28.05
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$40.39
|
| Rate for Payer: Cofinity Commercial |
$37.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: Nomi Health Commercial |
$33.66
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health Medicare |
$28.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
| Rate for Payer: UHCCP DNSP |
$28.05
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$575.82 |
| Max. Negotiated Rate |
$1,127.10 |
| Rate for Payer: Aetna Commercial |
$771.60
|
| Rate for Payer: Aetna Medicare |
$575.82
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$575.82
|
| Rate for Payer: BCN Medicare Advantage |
$575.82
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$829.18
|
| Rate for Payer: Cofinity Commercial |
$771.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.82
|
| Rate for Payer: Healthscope Commercial |
$690.98
|
| Rate for Payer: Healthscope Whirlpool |
$690.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.61
|
| Rate for Payer: Nomi Health Commercial |
$690.98
|
| Rate for Payer: PACE SWMI |
$575.82
|
| Rate for Payer: PHP Medicare Advantage |
$575.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health Medicare |
$575.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.82
|
| Rate for Payer: UHC Medicare Advantage |
$575.82
|
| Rate for Payer: UHCCP DNSP |
$575.82
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$102.38
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$122.86
|
| Rate for Payer: Healthscope Whirlpool |
$122.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
| Rate for Payer: UHCCP DNSP |
$102.38
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$174.74 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$234.15
|
| Rate for Payer: Aetna Medicare |
$174.74
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$174.74
|
| Rate for Payer: BCN Medicare Advantage |
$174.74
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$251.63
|
| Rate for Payer: Cofinity Commercial |
$234.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.74
|
| Rate for Payer: Healthscope Commercial |
$209.69
|
| Rate for Payer: Healthscope Whirlpool |
$209.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.48
|
| Rate for Payer: Nomi Health Commercial |
$209.69
|
| Rate for Payer: PACE SWMI |
$174.74
|
| Rate for Payer: PHP Medicare Advantage |
$174.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$174.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.74
|
| Rate for Payer: UHC Medicare Advantage |
$174.74
|
| Rate for Payer: UHCCP DNSP |
$174.74
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Aetna Medicare |
$99.08
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$99.08
|
| Rate for Payer: BCN Medicare Advantage |
$99.08
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Cofinity Commercial |
$132.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.08
|
| Rate for Payer: Healthscope Commercial |
$118.90
|
| Rate for Payer: Healthscope Whirlpool |
$118.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.03
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PACE SWMI |
$99.08
|
| Rate for Payer: PHP Medicare Advantage |
$99.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$99.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.08
|
| Rate for Payer: UHC Medicare Advantage |
$99.08
|
| Rate for Payer: UHCCP DNSP |
$99.08
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$243.47
|
| Rate for Payer: ASR Commercial |
$243.47
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$205.54
|
| Rate for Payer: BCN Commercial |
$194.60
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$235.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$251.00
|
| Rate for Payer: Healthscope Whirlpool |
$243.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$225.90
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.35
|
| Rate for Payer: Nomi Health Commercial |
$205.82
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.93
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$175.95
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: ASR ASR |
$243.47
|
| Rate for Payer: ASR Commercial |
$243.47
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$194.60
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$235.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.80
|
| Rate for Payer: Healthscope Commercial |
$251.00
|
| Rate for Payer: Healthscope Whirlpool |
$243.47
|
| Rate for Payer: Mclaren Commercial |
$225.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.35
|
| Rate for Payer: Nomi Health Commercial |
$205.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.88
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Aetna Medicare |
$99.08
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$99.08
|
| Rate for Payer: BCN Medicare Advantage |
$99.08
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Cofinity Commercial |
$132.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.08
|
| Rate for Payer: Healthscope Commercial |
$118.90
|
| Rate for Payer: Healthscope Whirlpool |
$118.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.03
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PACE SWMI |
$99.08
|
| Rate for Payer: PHP Medicare Advantage |
$99.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$99.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.08
|
| Rate for Payer: UHC Medicare Advantage |
$99.08
|
| Rate for Payer: UHCCP DNSP |
$99.08
|
|
|
PR INCISION&SUBCUTANEOUS PLMT CRANIAL BONE GRAFT
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$1,035.45 |
| Rate for Payer: Aetna Commercial |
$116.59
|
| Rate for Payer: Aetna Medicare |
$87.01
|
| Rate for Payer: BCBS Complete |
$637.20
|
| Rate for Payer: BCBS MAPPO |
$87.01
|
| Rate for Payer: BCN Medicare Advantage |
$87.01
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Cofinity Commercial |
$116.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.01
|
| Rate for Payer: Healthscope Commercial |
$104.41
|
| Rate for Payer: Healthscope Whirlpool |
$104.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.36
|
| Rate for Payer: Nomi Health Commercial |
$104.41
|
| Rate for Payer: PACE SWMI |
$87.01
|
| Rate for Payer: PHP Medicare Advantage |
$87.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,035.45
|
| Rate for Payer: Priority Health Medicare |
$87.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.01
|
| Rate for Payer: UHC Medicare Advantage |
$87.01
|
| Rate for Payer: UHCCP DNSP |
$87.01
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$105.56 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Aetna Commercial |
$141.45
|
| Rate for Payer: Aetna Medicare |
$105.56
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: BCBS MAPPO |
$105.56
|
| Rate for Payer: BCN Medicare Advantage |
$105.56
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$152.01
|
| Rate for Payer: Cofinity Commercial |
$141.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.56
|
| Rate for Payer: Healthscope Commercial |
$126.67
|
| Rate for Payer: Healthscope Whirlpool |
$126.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.84
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: PACE SWMI |
$105.56
|
| Rate for Payer: PHP Medicare Advantage |
$105.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health Medicare |
$105.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.56
|
| Rate for Payer: UHC Medicare Advantage |
$105.56
|
| Rate for Payer: UHCCP DNSP |
$105.56
|
|
|
PR INCOBOTULINUMTOXIN A
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0588
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$6.68
|
| Rate for Payer: Healthscope Whirlpool |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Nomi Health Commercial |
$6.68
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP DNSP |
$5.57
|
|
|
PR INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 99340
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
|
|
PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 59856
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$700.56 |
| Rate for Payer: Aetna Commercial |
$651.91
|
| Rate for Payer: Aetna Medicare |
$486.50
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$486.50
|
| Rate for Payer: BCN Medicare Advantage |
$486.50
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$700.56
|
| Rate for Payer: Cofinity Commercial |
$651.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.50
|
| Rate for Payer: Healthscope Commercial |
$583.80
|
| Rate for Payer: Healthscope Whirlpool |
$583.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.82
|
| Rate for Payer: Nomi Health Commercial |
$583.80
|
| Rate for Payer: PACE SWMI |
$486.50
|
| Rate for Payer: PHP Medicare Advantage |
$486.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$486.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.50
|
| Rate for Payer: UHC Medicare Advantage |
$486.50
|
| Rate for Payer: UHCCP DNSP |
$486.50
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$567.92 |
| Max. Negotiated Rate |
$1,188.85 |
| Rate for Payer: Aetna Commercial |
$761.01
|
| Rate for Payer: Aetna Medicare |
$567.92
|
| Rate for Payer: BCBS Complete |
$731.60
|
| Rate for Payer: BCBS MAPPO |
$567.92
|
| Rate for Payer: BCN Medicare Advantage |
$567.92
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cofinity Commercial |
$817.80
|
| Rate for Payer: Cofinity Commercial |
$761.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.92
|
| Rate for Payer: Healthscope Commercial |
$681.50
|
| Rate for Payer: Healthscope Whirlpool |
$681.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.32
|
| Rate for Payer: Nomi Health Commercial |
$681.50
|
| Rate for Payer: PACE SWMI |
$567.92
|
| Rate for Payer: PHP Medicare Advantage |
$567.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,188.85
|
| Rate for Payer: Priority Health Medicare |
$567.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.92
|
| Rate for Payer: UHC Medicare Advantage |
$567.92
|
| Rate for Payer: UHCCP DNSP |
$567.92
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$600.60 |
| Rate for Payer: Aetna Commercial |
$555.15
|
| Rate for Payer: Aetna Medicare |
$414.29
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$414.29
|
| Rate for Payer: BCN Medicare Advantage |
$414.29
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$596.58
|
| Rate for Payer: Cofinity Commercial |
$555.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.29
|
| Rate for Payer: Healthscope Commercial |
$497.15
|
| Rate for Payer: Healthscope Whirlpool |
$497.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.00
|
| Rate for Payer: Nomi Health Commercial |
$497.15
|
| Rate for Payer: PACE SWMI |
$414.29
|
| Rate for Payer: PHP Medicare Advantage |
$414.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$414.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.29
|
| Rate for Payer: UHC Medicare Advantage |
$414.29
|
| Rate for Payer: UHCCP DNSP |
$414.29
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$213.73 |
| Max. Negotiated Rate |
$523.90 |
| Rate for Payer: Aetna Commercial |
$286.40
|
| Rate for Payer: Aetna Medicare |
$213.73
|
| Rate for Payer: BCBS Complete |
$322.40
|
| Rate for Payer: BCBS MAPPO |
$213.73
|
| Rate for Payer: BCN Medicare Advantage |
$213.73
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$307.77
|
| Rate for Payer: Cofinity Commercial |
$286.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.73
|
| Rate for Payer: Healthscope Commercial |
$256.48
|
| Rate for Payer: Healthscope Whirlpool |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.42
|
| Rate for Payer: Nomi Health Commercial |
$256.48
|
| Rate for Payer: PACE SWMI |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health Medicare |
$213.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.73
|
| Rate for Payer: UHC Medicare Advantage |
$213.73
|
| Rate for Payer: UHCCP DNSP |
$213.73
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$338.80 |
| Max. Negotiated Rate |
$550.55 |
| Rate for Payer: Aetna Commercial |
$487.53
|
| Rate for Payer: Aetna Medicare |
$363.83
|
| Rate for Payer: BCBS Complete |
$338.80
|
| Rate for Payer: BCBS MAPPO |
$363.83
|
| Rate for Payer: BCN Medicare Advantage |
$363.83
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$523.92
|
| Rate for Payer: Cofinity Commercial |
$487.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.83
|
| Rate for Payer: Healthscope Commercial |
$436.60
|
| Rate for Payer: Healthscope Whirlpool |
$436.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.02
|
| Rate for Payer: Nomi Health Commercial |
$436.60
|
| Rate for Payer: PACE SWMI |
$363.83
|
| Rate for Payer: PHP Medicare Advantage |
$363.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.55
|
| Rate for Payer: Priority Health Medicare |
$363.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.83
|
| Rate for Payer: UHC Medicare Advantage |
$363.83
|
| Rate for Payer: UHCCP DNSP |
$363.83
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Aetna Commercial |
$50.53
|
| Rate for Payer: Aetna Medicare |
$37.71
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$37.71
|
| Rate for Payer: BCN Medicare Advantage |
$37.71
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$54.30
|
| Rate for Payer: Cofinity Commercial |
$50.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.71
|
| Rate for Payer: Healthscope Commercial |
$45.25
|
| Rate for Payer: Healthscope Whirlpool |
$45.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.60
|
| Rate for Payer: Nomi Health Commercial |
$45.25
|
| Rate for Payer: PACE SWMI |
$37.71
|
| Rate for Payer: PHP Medicare Advantage |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$37.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.71
|
| Rate for Payer: UHC Medicare Advantage |
$37.71
|
| Rate for Payer: UHCCP DNSP |
$37.71
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$10,965.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$2,958.07 |
| Max. Negotiated Rate |
$7,127.25 |
| Rate for Payer: Aetna Commercial |
$3,963.81
|
| Rate for Payer: Aetna Medicare |
$2,958.07
|
| Rate for Payer: BCBS Complete |
$4,386.00
|
| Rate for Payer: BCBS MAPPO |
$2,958.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,958.07
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cofinity Commercial |
$4,259.62
|
| Rate for Payer: Cofinity Commercial |
$3,963.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,958.07
|
| Rate for Payer: Healthscope Commercial |
$3,549.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,549.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,105.97
|
| Rate for Payer: Nomi Health Commercial |
$3,549.68
|
| Rate for Payer: PACE SWMI |
$2,958.07
|
| Rate for Payer: PHP Medicare Advantage |
$2,958.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,127.25
|
| Rate for Payer: Priority Health Medicare |
$2,958.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,958.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,958.07
|
| Rate for Payer: UHCCP DNSP |
$2,958.07
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,572.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$2,628.80 |
| Max. Negotiated Rate |
$4,271.80 |
| Rate for Payer: Aetna Commercial |
$3,853.99
|
| Rate for Payer: Aetna Medicare |
$2,876.11
|
| Rate for Payer: BCBS Complete |
$2,628.80
|
| Rate for Payer: BCBS MAPPO |
$2,876.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,876.11
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cofinity Commercial |
$4,141.60
|
| Rate for Payer: Cofinity Commercial |
$3,853.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,876.11
|
| Rate for Payer: Healthscope Commercial |
$3,451.33
|
| Rate for Payer: Healthscope Whirlpool |
$3,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,019.92
|
| Rate for Payer: Nomi Health Commercial |
$3,451.33
|
| Rate for Payer: PACE SWMI |
$2,876.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,876.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,271.80
|
| Rate for Payer: Priority Health Medicare |
$2,876.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,876.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,876.11
|
| Rate for Payer: UHCCP DNSP |
$2,876.11
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: Aetna Medicare |
$63.92
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$63.92
|
| Rate for Payer: BCN Medicare Advantage |
$63.92
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Cofinity Commercial |
$85.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$76.70
|
| Rate for Payer: Healthscope Whirlpool |
$76.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$76.70
|
| Rate for Payer: PACE SWMI |
$63.92
|
| Rate for Payer: PHP Medicare Advantage |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$63.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.92
|
| Rate for Payer: UHC Medicare Advantage |
$63.92
|
| Rate for Payer: UHCCP DNSP |
$63.92
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$92.84
|
| Rate for Payer: Aetna Medicare |
$69.28
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$69.28
|
| Rate for Payer: BCN Medicare Advantage |
$69.28
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Cofinity Commercial |
$92.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.28
|
| Rate for Payer: Healthscope Commercial |
$83.14
|
| Rate for Payer: Healthscope Whirlpool |
$83.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.74
|
| Rate for Payer: Nomi Health Commercial |
$83.14
|
| Rate for Payer: PACE SWMI |
$69.28
|
| Rate for Payer: PHP Medicare Advantage |
$69.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$69.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.28
|
| Rate for Payer: UHC Medicare Advantage |
$69.28
|
| Rate for Payer: UHCCP DNSP |
$69.28
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$2,629.00
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$809.27 |
| Max. Negotiated Rate |
$1,708.85 |
| Rate for Payer: Aetna Commercial |
$1,084.42
|
| Rate for Payer: Aetna Medicare |
$809.27
|
| Rate for Payer: BCBS Complete |
$1,051.60
|
| Rate for Payer: BCBS MAPPO |
$809.27
|
| Rate for Payer: BCN Medicare Advantage |
$809.27
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cofinity Commercial |
$1,165.35
|
| Rate for Payer: Cofinity Commercial |
$1,084.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$809.27
|
| Rate for Payer: Healthscope Commercial |
$971.12
|
| Rate for Payer: Healthscope Whirlpool |
$971.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.73
|
| Rate for Payer: Nomi Health Commercial |
$971.12
|
| Rate for Payer: PACE SWMI |
$809.27
|
| Rate for Payer: PHP Medicare Advantage |
$809.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.85
|
| Rate for Payer: Priority Health Medicare |
$809.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$809.27
|
| Rate for Payer: UHC Medicare Advantage |
$809.27
|
| Rate for Payer: UHCCP DNSP |
$809.27
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$1,082.80 |
| Max. Negotiated Rate |
$1,825.57 |
| Rate for Payer: Aetna Commercial |
$1,698.80
|
| Rate for Payer: Aetna Medicare |
$1,267.76
|
| Rate for Payer: BCBS Complete |
$1,082.80
|
| Rate for Payer: BCBS MAPPO |
$1,267.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,267.76
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cofinity Commercial |
$1,825.57
|
| Rate for Payer: Cofinity Commercial |
$1,698.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,267.76
|
| Rate for Payer: Healthscope Commercial |
$1,521.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.15
|
| Rate for Payer: Nomi Health Commercial |
$1,521.31
|
| Rate for Payer: PACE SWMI |
$1,267.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,267.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.55
|
| Rate for Payer: Priority Health Medicare |
$1,267.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,267.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,267.76
|
| Rate for Payer: UHCCP DNSP |
$1,267.76
|
|
