|
PR INTERTHORACOSCAPULAR AMPUTATION
|
Professional
|
Both
|
$5,989.00
|
|
|
Service Code
|
HCPCS 23900
|
| Min. Negotiated Rate |
$1,333.90 |
| Max. Negotiated Rate |
$3,892.85 |
| Rate for Payer: Aetna Commercial |
$1,787.43
|
| Rate for Payer: Aetna Medicare |
$1,333.90
|
| Rate for Payer: BCBS Complete |
$2,395.60
|
| Rate for Payer: BCBS MAPPO |
$1,333.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.90
|
| Rate for Payer: Cash Price |
$4,791.20
|
| Rate for Payer: Cash Price |
$4,791.20
|
| Rate for Payer: Cofinity Commercial |
$1,920.82
|
| Rate for Payer: Cofinity Commercial |
$1,787.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.90
|
| Rate for Payer: Healthscope Commercial |
$1,600.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,600.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,400.60
|
| Rate for Payer: Nomi Health Commercial |
$1,600.68
|
| Rate for Payer: PACE SWMI |
$1,333.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,892.85
|
| Rate for Payer: Priority Health Medicare |
$1,333.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.90
|
| Rate for Payer: UHCCP DNSP |
$1,333.90
|
|
|
PR INTESTINAL PLICATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,967.00
|
|
|
Service Code
|
HCPCS 44680
|
| Min. Negotiated Rate |
$1,048.51 |
| Max. Negotiated Rate |
$1,928.55 |
| Rate for Payer: Aetna Commercial |
$1,405.00
|
| Rate for Payer: Aetna Medicare |
$1,048.51
|
| Rate for Payer: BCBS Complete |
$1,186.80
|
| Rate for Payer: BCBS MAPPO |
$1,048.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.51
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cofinity Commercial |
$1,509.85
|
| Rate for Payer: Cofinity Commercial |
$1,405.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.51
|
| Rate for Payer: Healthscope Commercial |
$1,258.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.94
|
| Rate for Payer: Nomi Health Commercial |
$1,258.21
|
| Rate for Payer: PACE SWMI |
$1,048.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,928.55
|
| Rate for Payer: Priority Health Medicare |
$1,048.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.51
|
| Rate for Payer: UHCCP DNSP |
$1,048.51
|
|
|
PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 46946
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$518.27 |
| Rate for Payer: Aetna Commercial |
$482.28
|
| Rate for Payer: Aetna Medicare |
$359.91
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: BCBS MAPPO |
$359.91
|
| Rate for Payer: BCN Medicare Advantage |
$359.91
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$518.27
|
| Rate for Payer: Cofinity Commercial |
$482.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.91
|
| Rate for Payer: Healthscope Commercial |
$431.89
|
| Rate for Payer: Healthscope Whirlpool |
$431.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.91
|
| Rate for Payer: Nomi Health Commercial |
$431.89
|
| Rate for Payer: PACE SWMI |
$359.91
|
| Rate for Payer: PHP Medicare Advantage |
$359.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health Medicare |
$359.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.91
|
| Rate for Payer: UHC Medicare Advantage |
$359.91
|
| Rate for Payer: UHCCP DNSP |
$359.91
|
|
|
PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 46945
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$464.30 |
| Rate for Payer: Aetna Commercial |
$432.06
|
| Rate for Payer: Aetna Medicare |
$322.43
|
| Rate for Payer: BCBS Complete |
$184.40
|
| Rate for Payer: BCBS MAPPO |
$322.43
|
| Rate for Payer: BCN Medicare Advantage |
$322.43
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$464.30
|
| Rate for Payer: Cofinity Commercial |
$432.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.43
|
| Rate for Payer: Healthscope Commercial |
$386.92
|
| Rate for Payer: Healthscope Whirlpool |
$386.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.55
|
| Rate for Payer: Nomi Health Commercial |
$386.92
|
| Rate for Payer: PACE SWMI |
$322.43
|
| Rate for Payer: PHP Medicare Advantage |
$322.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health Medicare |
$322.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.43
|
| Rate for Payer: UHC Medicare Advantage |
$322.43
|
| Rate for Payer: UHCCP DNSP |
$322.43
|
|
|
PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 93662
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$363.35 |
| Rate for Payer: Aetna Medicare |
$279.50
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS Complete |
$223.60
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.45
|
|
|
PR INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
HCPCS 93613
|
| Min. Negotiated Rate |
$275.74 |
| Max. Negotiated Rate |
$780.65 |
| Rate for Payer: Aetna Commercial |
$369.49
|
| Rate for Payer: Aetna Medicare |
$275.74
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS MAPPO |
$275.74
|
| Rate for Payer: BCN Medicare Advantage |
$275.74
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cofinity Commercial |
$397.07
|
| Rate for Payer: Cofinity Commercial |
$369.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.74
|
| Rate for Payer: Healthscope Commercial |
$330.89
|
| Rate for Payer: Healthscope Whirlpool |
$330.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.53
|
| Rate for Payer: Nomi Health Commercial |
$330.89
|
| Rate for Payer: PACE SWMI |
$275.74
|
| Rate for Payer: PHP Medicare Advantage |
$275.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.65
|
| Rate for Payer: Priority Health Medicare |
$275.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.74
|
| Rate for Payer: UHC Medicare Advantage |
$275.74
|
| Rate for Payer: UHCCP DNSP |
$275.74
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL CMPL
|
Professional
|
Both
|
$9,212.00
|
|
|
Service Code
|
HCPCS 61692
|
| Min. Negotiated Rate |
$3,616.18 |
| Max. Negotiated Rate |
$5,987.80 |
| Rate for Payer: Aetna Commercial |
$4,845.68
|
| Rate for Payer: Aetna Medicare |
$3,616.18
|
| Rate for Payer: BCBS Complete |
$3,684.80
|
| Rate for Payer: BCBS MAPPO |
$3,616.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,616.18
|
| Rate for Payer: Cash Price |
$7,369.60
|
| Rate for Payer: Cash Price |
$7,369.60
|
| Rate for Payer: Cofinity Commercial |
$5,207.30
|
| Rate for Payer: Cofinity Commercial |
$4,845.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,616.18
|
| Rate for Payer: Healthscope Commercial |
$4,339.42
|
| Rate for Payer: Healthscope Whirlpool |
$4,339.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,796.99
|
| Rate for Payer: Nomi Health Commercial |
$4,339.42
|
| Rate for Payer: PACE SWMI |
$3,616.18
|
| Rate for Payer: PHP Medicare Advantage |
$3,616.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,987.80
|
| Rate for Payer: Priority Health Medicare |
$3,616.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,616.18
|
| Rate for Payer: UHC Medicare Advantage |
$3,616.18
|
| Rate for Payer: UHCCP DNSP |
$3,616.18
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL SMPL
|
Professional
|
Both
|
$7,820.00
|
|
|
Service Code
|
HCPCS 61690
|
| Min. Negotiated Rate |
$2,166.30 |
| Max. Negotiated Rate |
$5,083.00 |
| Rate for Payer: Aetna Commercial |
$2,902.84
|
| Rate for Payer: Aetna Medicare |
$2,166.30
|
| Rate for Payer: BCBS Complete |
$3,128.00
|
| Rate for Payer: BCBS MAPPO |
$2,166.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,166.30
|
| Rate for Payer: Cash Price |
$6,256.00
|
| Rate for Payer: Cash Price |
$6,256.00
|
| Rate for Payer: Cofinity Commercial |
$3,119.47
|
| Rate for Payer: Cofinity Commercial |
$2,902.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,166.30
|
| Rate for Payer: Healthscope Commercial |
$2,599.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,599.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,274.61
|
| Rate for Payer: Nomi Health Commercial |
$2,599.56
|
| Rate for Payer: PACE SWMI |
$2,166.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,166.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,083.00
|
| Rate for Payer: Priority Health Medicare |
$2,166.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,166.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,166.30
|
| Rate for Payer: UHCCP DNSP |
$2,166.30
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL
|
Professional
|
Both
|
$12,123.00
|
|
|
Service Code
|
HCPCS 61686
|
| Min. Negotiated Rate |
$4,449.06 |
| Max. Negotiated Rate |
$7,879.95 |
| Rate for Payer: Aetna Commercial |
$5,961.74
|
| Rate for Payer: Aetna Medicare |
$4,449.06
|
| Rate for Payer: BCBS Complete |
$4,849.20
|
| Rate for Payer: BCBS MAPPO |
$4,449.06
|
| Rate for Payer: BCN Medicare Advantage |
$4,449.06
|
| Rate for Payer: Cash Price |
$9,698.40
|
| Rate for Payer: Cash Price |
$9,698.40
|
| Rate for Payer: Cofinity Commercial |
$6,406.65
|
| Rate for Payer: Cofinity Commercial |
$5,961.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,449.06
|
| Rate for Payer: Healthscope Commercial |
$5,338.87
|
| Rate for Payer: Healthscope Whirlpool |
$5,338.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,671.51
|
| Rate for Payer: Nomi Health Commercial |
$5,338.87
|
| Rate for Payer: PACE SWMI |
$4,449.06
|
| Rate for Payer: PHP Medicare Advantage |
$4,449.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,879.95
|
| Rate for Payer: Priority Health Medicare |
$4,449.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,449.06
|
| Rate for Payer: UHC Medicare Advantage |
$4,449.06
|
| Rate for Payer: UHCCP DNSP |
$4,449.06
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL
|
Professional
|
Both
|
$5,987.00
|
|
|
Service Code
|
HCPCS 61684
|
| Min. Negotiated Rate |
$2,394.80 |
| Max. Negotiated Rate |
$4,059.37 |
| Rate for Payer: Aetna Commercial |
$3,777.47
|
| Rate for Payer: Aetna Medicare |
$2,819.01
|
| Rate for Payer: BCBS Complete |
$2,394.80
|
| Rate for Payer: BCBS MAPPO |
$2,819.01
|
| Rate for Payer: BCN Medicare Advantage |
$2,819.01
|
| Rate for Payer: Cash Price |
$4,789.60
|
| Rate for Payer: Cash Price |
$4,789.60
|
| Rate for Payer: Cofinity Commercial |
$4,059.37
|
| Rate for Payer: Cofinity Commercial |
$3,777.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,819.01
|
| Rate for Payer: Healthscope Commercial |
$3,382.81
|
| Rate for Payer: Healthscope Whirlpool |
$3,382.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,959.96
|
| Rate for Payer: Nomi Health Commercial |
$3,382.81
|
| Rate for Payer: PACE SWMI |
$2,819.01
|
| Rate for Payer: PHP Medicare Advantage |
$2,819.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,891.55
|
| Rate for Payer: Priority Health Medicare |
$2,819.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,819.01
|
| Rate for Payer: UHC Medicare Advantage |
$2,819.01
|
| Rate for Payer: UHCCP DNSP |
$2,819.01
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL
|
Professional
|
Both
|
$8,916.00
|
|
|
Service Code
|
HCPCS 61682
|
| Min. Negotiated Rate |
$3,566.40 |
| Max. Negotiated Rate |
$5,909.77 |
| Rate for Payer: Aetna Commercial |
$5,499.37
|
| Rate for Payer: Aetna Medicare |
$4,104.01
|
| Rate for Payer: BCBS Complete |
$3,566.40
|
| Rate for Payer: BCBS MAPPO |
$4,104.01
|
| Rate for Payer: BCN Medicare Advantage |
$4,104.01
|
| Rate for Payer: Cash Price |
$7,132.80
|
| Rate for Payer: Cash Price |
$7,132.80
|
| Rate for Payer: Cofinity Commercial |
$5,909.77
|
| Rate for Payer: Cofinity Commercial |
$5,499.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,104.01
|
| Rate for Payer: Healthscope Commercial |
$4,924.81
|
| Rate for Payer: Healthscope Whirlpool |
$4,924.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,309.21
|
| Rate for Payer: Nomi Health Commercial |
$4,924.81
|
| Rate for Payer: PACE SWMI |
$4,104.01
|
| Rate for Payer: PHP Medicare Advantage |
$4,104.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,795.40
|
| Rate for Payer: Priority Health Medicare |
$4,104.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,104.01
|
| Rate for Payer: UHC Medicare Advantage |
$4,104.01
|
| Rate for Payer: UHCCP DNSP |
$4,104.01
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL
|
Professional
|
Both
|
$4,754.00
|
|
|
Service Code
|
HCPCS 61680
|
| Min. Negotiated Rate |
$1,901.60 |
| Max. Negotiated Rate |
$3,219.87 |
| Rate for Payer: Aetna Commercial |
$2,996.27
|
| Rate for Payer: Aetna Medicare |
$2,236.02
|
| Rate for Payer: BCBS Complete |
$1,901.60
|
| Rate for Payer: BCBS MAPPO |
$2,236.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,236.02
|
| Rate for Payer: Cash Price |
$3,803.20
|
| Rate for Payer: Cash Price |
$3,803.20
|
| Rate for Payer: Cofinity Commercial |
$3,219.87
|
| Rate for Payer: Cofinity Commercial |
$2,996.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,236.02
|
| Rate for Payer: Healthscope Commercial |
$2,683.22
|
| Rate for Payer: Healthscope Whirlpool |
$2,683.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,347.82
|
| Rate for Payer: Nomi Health Commercial |
$2,683.22
|
| Rate for Payer: PACE SWMI |
$2,236.02
|
| Rate for Payer: PHP Medicare Advantage |
$2,236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.10
|
| Rate for Payer: Priority Health Medicare |
$2,236.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,236.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,236.02
|
| Rate for Payer: UHCCP DNSP |
$2,236.02
|
|
|
PR INTRAFRACTION TRACK MOTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS G6017
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
|
|
PR INTRAOPERATIVE COLONIC LAVAGE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44701
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$267.80 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna Medicare |
$165.11
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$165.11
|
| Rate for Payer: BCN Medicare Advantage |
$165.11
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$237.76
|
| Rate for Payer: Cofinity Commercial |
$221.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.11
|
| Rate for Payer: Healthscope Commercial |
$198.13
|
| Rate for Payer: Healthscope Whirlpool |
$198.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.37
|
| Rate for Payer: Nomi Health Commercial |
$198.13
|
| Rate for Payer: PACE SWMI |
$165.11
|
| Rate for Payer: PHP Medicare Advantage |
$165.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$165.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.11
|
| Rate for Payer: UHC Medicare Advantage |
$165.11
|
| Rate for Payer: UHCCP DNSP |
$165.11
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Aetna Medicare |
$133.31
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$133.31
|
| Rate for Payer: BCN Medicare Advantage |
$133.31
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$191.97
|
| Rate for Payer: Cofinity Commercial |
$178.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.31
|
| Rate for Payer: Healthscope Commercial |
$159.97
|
| Rate for Payer: Healthscope Whirlpool |
$159.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.98
|
| Rate for Payer: Nomi Health Commercial |
$159.97
|
| Rate for Payer: PACE SWMI |
$133.31
|
| Rate for Payer: PHP Medicare Advantage |
$133.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$133.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.31
|
| Rate for Payer: UHC Medicare Advantage |
$133.31
|
| Rate for Payer: UHCCP DNSP |
$133.31
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$295.85
|
| Rate for Payer: ASR Commercial |
$295.85
|
| Rate for Payer: BCBS Trust/PPO |
$248.54
|
| Rate for Payer: BCN Commercial |
$236.47
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$286.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$305.00
|
| Rate for Payer: Healthscope Whirlpool |
$295.85
|
| Rate for Payer: Mclaren Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: Nomi Health Commercial |
$250.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.40
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: ASR ASR |
$295.85
|
| Rate for Payer: ASR Commercial |
$295.85
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS Trust/PPO |
$249.76
|
| Rate for Payer: BCN Commercial |
$236.47
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$286.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$305.00
|
| Rate for Payer: Healthscope Whirlpool |
$295.85
|
| Rate for Payer: Mclaren Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: Nomi Health Commercial |
$250.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.24
|
| Rate for Payer: Priority Health Narrow Network |
$213.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.40
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Aetna Medicare |
$133.31
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$133.31
|
| Rate for Payer: BCN Medicare Advantage |
$133.31
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$191.97
|
| Rate for Payer: Cofinity Commercial |
$178.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.31
|
| Rate for Payer: Healthscope Commercial |
$159.97
|
| Rate for Payer: Healthscope Whirlpool |
$159.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.98
|
| Rate for Payer: Nomi Health Commercial |
$159.97
|
| Rate for Payer: PACE SWMI |
$133.31
|
| Rate for Payer: PHP Medicare Advantage |
$133.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$133.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.31
|
| Rate for Payer: UHC Medicare Advantage |
$133.31
|
| Rate for Payer: UHCCP DNSP |
$133.31
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$443.95 |
| Rate for Payer: Aetna Commercial |
$364.02
|
| Rate for Payer: Aetna Medicare |
$271.66
|
| Rate for Payer: BCBS Complete |
$273.20
|
| Rate for Payer: BCBS MAPPO |
$271.66
|
| Rate for Payer: BCN Medicare Advantage |
$271.66
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cofinity Commercial |
$391.19
|
| Rate for Payer: Cofinity Commercial |
$364.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.66
|
| Rate for Payer: Healthscope Commercial |
$325.99
|
| Rate for Payer: Healthscope Whirlpool |
$325.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.24
|
| Rate for Payer: Nomi Health Commercial |
$325.99
|
| Rate for Payer: PACE SWMI |
$271.66
|
| Rate for Payer: PHP Medicare Advantage |
$271.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.95
|
| Rate for Payer: Priority Health Medicare |
$271.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.66
|
| Rate for Payer: UHC Medicare Advantage |
$271.66
|
| Rate for Payer: UHCCP DNSP |
$271.66
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$222.01 |
| Max. Negotiated Rate |
$390.65 |
| Rate for Payer: Aetna Commercial |
$297.49
|
| Rate for Payer: Aetna Medicare |
$222.01
|
| Rate for Payer: BCBS Complete |
$240.40
|
| Rate for Payer: BCBS MAPPO |
$222.01
|
| Rate for Payer: BCN Medicare Advantage |
$222.01
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cofinity Commercial |
$319.69
|
| Rate for Payer: Cofinity Commercial |
$297.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.01
|
| Rate for Payer: Healthscope Commercial |
$266.41
|
| Rate for Payer: Healthscope Whirlpool |
$266.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.11
|
| Rate for Payer: Nomi Health Commercial |
$266.41
|
| Rate for Payer: PACE SWMI |
$222.01
|
| Rate for Payer: PHP Medicare Advantage |
$222.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.65
|
| Rate for Payer: Priority Health Medicare |
$222.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.01
|
| Rate for Payer: UHC Medicare Advantage |
$222.01
|
| Rate for Payer: UHCCP DNSP |
$222.01
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$148.12
|
| Rate for Payer: Aetna Medicare |
$110.54
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$110.54
|
| Rate for Payer: BCN Medicare Advantage |
$110.54
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$159.18
|
| Rate for Payer: Cofinity Commercial |
$148.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$132.65
|
| Rate for Payer: Healthscope Whirlpool |
$132.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.07
|
| Rate for Payer: Nomi Health Commercial |
$132.65
|
| Rate for Payer: PACE SWMI |
$110.54
|
| Rate for Payer: PHP Medicare Advantage |
$110.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$110.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.54
|
| Rate for Payer: UHC Medicare Advantage |
$110.54
|
| Rate for Payer: UHCCP DNSP |
$110.54
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$249.48 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna Medicare |
$249.48
|
| Rate for Payer: BCBS Complete |
$282.80
|
| Rate for Payer: BCBS MAPPO |
$249.48
|
| Rate for Payer: BCN Medicare Advantage |
$249.48
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$359.25
|
| Rate for Payer: Cofinity Commercial |
$334.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$299.38
|
| Rate for Payer: Healthscope Whirlpool |
$299.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.95
|
| Rate for Payer: Nomi Health Commercial |
$299.38
|
| Rate for Payer: PACE SWMI |
$249.48
|
| Rate for Payer: PHP Medicare Advantage |
$249.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.55
|
| Rate for Payer: Priority Health Medicare |
$249.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.48
|
| Rate for Payer: UHC Medicare Advantage |
$249.48
|
| Rate for Payer: UHCCP DNSP |
$249.48
|
|
|
PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94610
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$75.67 |
| Rate for Payer: Aetna Commercial |
$70.42
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$52.55
|
| Rate for Payer: BCN Medicare Advantage |
$52.55
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.55
|
| Rate for Payer: Healthscope Commercial |
$63.06
|
| Rate for Payer: Healthscope Whirlpool |
$63.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.18
|
| Rate for Payer: Nomi Health Commercial |
$63.06
|
| Rate for Payer: PACE SWMI |
$52.55
|
| Rate for Payer: PHP Medicare Advantage |
$52.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$52.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.55
|
| Rate for Payer: UHC Medicare Advantage |
$52.55
|
| Rate for Payer: UHCCP DNSP |
$52.55
|
|
|
PR INTRAUT COPPER CONTRACEPTIVE
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS J7300
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$879.45 |
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$67.81 |
| Max. Negotiated Rate |
$275.60 |
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Aetna Medicare |
$67.81
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS MAPPO |
$67.81
|
| Rate for Payer: BCN Medicare Advantage |
$67.81
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$90.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.81
|
| Rate for Payer: Healthscope Commercial |
$81.37
|
| Rate for Payer: Healthscope Whirlpool |
$81.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.20
|
| Rate for Payer: Nomi Health Commercial |
$81.37
|
| Rate for Payer: PACE SWMI |
$67.81
|
| Rate for Payer: PHP Medicare Advantage |
$67.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Medicare |
$67.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.81
|
| Rate for Payer: UHC Medicare Advantage |
$67.81
|
| Rate for Payer: UHCCP DNSP |
$67.81
|
|
