|
PR LESION <15
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
PR LESION FL FACE/NECK
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR LESION REMOVAL COLONOSCOPY
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS G6024
|
| Min. Negotiated Rate |
$652.80 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: BCBS Complete |
$652.80
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,224.00
|
|
|
PR LESION SINGLE
|
Professional
|
Both
|
$37.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
|
|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS J1950
|
| Min. Negotiated Rate |
$852.00 |
| Max. Negotiated Rate |
$2,542.42 |
| Rate for Payer: Aetna Commercial |
$2,365.86
|
| Rate for Payer: Aetna Medicare |
$1,765.57
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.42
|
| Rate for Payer: BCN Commercial |
$1,186.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cofinity Commercial |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,365.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$2,118.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,118.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Nomi Health Commercial |
$2,118.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.00
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,763.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$1,763.87
|
| Rate for Payer: UHCCP DNSP |
$1,765.57
|
|
|
PR LEUPROLIDE ACETATE INJECITON
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS J9218
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$14.16
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$6.23
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.40
|
| Rate for Payer: UHC Exchange |
$50.40
|
|
|
PR LEUPROLIDE ACETATE SUSPNSION
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS J9217
|
| Min. Negotiated Rate |
$170.78 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna Commercial |
$236.11
|
| Rate for Payer: Aetna Medicare |
$176.20
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$180.44
|
| Rate for Payer: BCN Commercial |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$253.73
|
| Rate for Payer: Cofinity Commercial |
$236.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$211.44
|
| Rate for Payer: Healthscope Whirlpool |
$211.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Nomi Health Commercial |
$211.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.25
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$170.78
|
| Rate for Payer: UHCCP DNSP |
$176.20
|
|
|
PR LEVALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J7614
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$0.11
|
| Rate for Payer: Healthscope Whirlpool |
$0.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.10
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
|
|
PR LEVONORGESTREL IMPLANT SYS
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS J7306
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$507.50 |
| Rate for Payer: Aetna Commercial |
$406.00
|
| Rate for Payer: BCBS Complete |
$231.20
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.50
|
| Rate for Payer: UHC Exchange |
$507.50
|
|
|
PR LEVONORGESTREL IU CONTRACEPT
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS J7302
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.00
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,403.84 |
| Rate for Payer: Aetna Commercial |
$1,097.63
|
| Rate for Payer: Aetna Medicare |
$819.13
|
| Rate for Payer: BCBS MAPPO |
$819.13
|
| Rate for Payer: BCN Commercial |
$1,277.82
|
| Rate for Payer: BCN Medicare Advantage |
$819.13
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$1,097.63
|
| Rate for Payer: Cofinity Commercial |
$1,179.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.13
|
| Rate for Payer: Healthscope Commercial |
$982.96
|
| Rate for Payer: Healthscope Whirlpool |
$982.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$860.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$901.04
|
| Rate for Payer: Nomi Health Commercial |
$982.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.50
|
| Rate for Payer: PACE SWMI |
$819.13
|
| Rate for Payer: PHP Medicare Advantage |
$819.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,214.50
|
| Rate for Payer: Priority Health Medicare |
$819.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.50
|
| Rate for Payer: Railroad Medicare Medicare |
$819.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,403.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$819.13
|
| Rate for Payer: UHC Exchange |
$1,403.84
|
| Rate for Payer: UHCCP DNSP |
$819.13
|
|
|
PR LIDOCAINE INJECTION
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2001
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR
|
Professional
|
Both
|
$2,564.00
|
|
|
Service Code
|
HCPCS 27427
|
| Min. Negotiated Rate |
$422.59 |
| Max. Negotiated Rate |
$1,923.00 |
| Rate for Payer: Aetna Commercial |
$865.99
|
| Rate for Payer: Aetna Medicare |
$646.26
|
| Rate for Payer: BCBS Complete |
$443.72
|
| Rate for Payer: BCBS MAPPO |
$646.26
|
| Rate for Payer: BCN Commercial |
$1,081.11
|
| Rate for Payer: BCN Medicare Advantage |
$646.26
|
| Rate for Payer: Cash Price |
$2,051.20
|
| Rate for Payer: Cash Price |
$2,051.20
|
| Rate for Payer: Cofinity Commercial |
$930.61
|
| Rate for Payer: Cofinity Commercial |
$865.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.26
|
| Rate for Payer: Healthscope Commercial |
$775.51
|
| Rate for Payer: Healthscope Whirlpool |
$775.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$678.57
|
| Rate for Payer: Meridian Medicaid |
$443.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$710.89
|
| Rate for Payer: Nomi Health Commercial |
$775.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,923.00
|
| Rate for Payer: PACE SWMI |
$646.26
|
| Rate for Payer: PHP Medicare Advantage |
$646.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,155.68
|
| Rate for Payer: Priority Health Medicare |
$646.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,155.68
|
| Rate for Payer: Railroad Medicare Medicare |
$646.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,241.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$646.26
|
| Rate for Payer: UHC Exchange |
$1,241.68
|
| Rate for Payer: UHC Medicaid |
$422.59
|
| Rate for Payer: UHCCP DNSP |
$646.26
|
| Rate for Payer: UHCCP Medicaid |
$422.59
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR
|
Professional
|
Both
|
$3,344.00
|
|
|
Service Code
|
HCPCS 27428
|
| Min. Negotiated Rate |
$663.50 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$1,363.26
|
| Rate for Payer: Aetna Medicare |
$1,017.36
|
| Rate for Payer: BCBS Complete |
$696.67
|
| Rate for Payer: BCBS MAPPO |
$1,017.36
|
| Rate for Payer: BCN Commercial |
$1,700.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.36
|
| Rate for Payer: Cash Price |
$2,675.20
|
| Rate for Payer: Cash Price |
$2,675.20
|
| Rate for Payer: Cofinity Commercial |
$1,465.00
|
| Rate for Payer: Cofinity Commercial |
$1,363.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.36
|
| Rate for Payer: Healthscope Commercial |
$1,220.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,220.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.23
|
| Rate for Payer: Meridian Medicaid |
$696.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,119.10
|
| Rate for Payer: Nomi Health Commercial |
$1,220.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,508.00
|
| Rate for Payer: PACE SWMI |
$1,017.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,817.37
|
| Rate for Payer: Priority Health Medicare |
$1,017.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,817.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,017.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,949.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,017.36
|
| Rate for Payer: UHC Exchange |
$1,949.62
|
| Rate for Payer: UHC Medicaid |
$663.50
|
| Rate for Payer: UHCCP DNSP |
$1,017.36
|
| Rate for Payer: UHCCP Medicaid |
$663.50
|
|
|
PR LIGATION ARTERIES ETHMOIDAL
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
HCPCS 30915
|
| Min. Negotiated Rate |
$344.85 |
| Max. Negotiated Rate |
$1,008.66 |
| Rate for Payer: Aetna Commercial |
$700.15
|
| Rate for Payer: Aetna Medicare |
$522.50
|
| Rate for Payer: BCBS Complete |
$362.09
|
| Rate for Payer: BCBS MAPPO |
$522.50
|
| Rate for Payer: BCN Commercial |
$901.84
|
| Rate for Payer: BCN Medicare Advantage |
$522.50
|
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Cofinity Commercial |
$752.40
|
| Rate for Payer: Cofinity Commercial |
$700.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.50
|
| Rate for Payer: Healthscope Commercial |
$627.00
|
| Rate for Payer: Healthscope Whirlpool |
$627.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.62
|
| Rate for Payer: Meridian Medicaid |
$362.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$574.75
|
| Rate for Payer: Nomi Health Commercial |
$627.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$801.75
|
| Rate for Payer: PACE SWMI |
$522.50
|
| Rate for Payer: PHP Medicare Advantage |
$522.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$849.28
|
| Rate for Payer: Priority Health Medicare |
$522.50
|
| Rate for Payer: Priority Health Narrow Network |
$849.28
|
| Rate for Payer: Railroad Medicare Medicare |
$522.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,008.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$522.50
|
| Rate for Payer: UHC Exchange |
$1,008.66
|
| Rate for Payer: UHC Medicaid |
$344.85
|
| Rate for Payer: UHCCP DNSP |
$522.50
|
| Rate for Payer: UHCCP Medicaid |
$344.85
|
|
|
PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 30920
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$1,464.87 |
| Rate for Payer: Aetna Commercial |
$1,006.82
|
| Rate for Payer: Aetna Medicare |
$751.36
|
| Rate for Payer: BCBS Complete |
$519.54
|
| Rate for Payer: BCBS MAPPO |
$751.36
|
| Rate for Payer: BCN Commercial |
$1,301.73
|
| Rate for Payer: BCN Medicare Advantage |
$751.36
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$1,081.96
|
| Rate for Payer: Cofinity Commercial |
$1,006.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.36
|
| Rate for Payer: Healthscope Commercial |
$901.63
|
| Rate for Payer: Healthscope Whirlpool |
$901.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.93
|
| Rate for Payer: Meridian Medicaid |
$519.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$826.50
|
| Rate for Payer: Nomi Health Commercial |
$901.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,159.50
|
| Rate for Payer: PACE SWMI |
$751.36
|
| Rate for Payer: PHP Medicare Advantage |
$751.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,225.84
|
| Rate for Payer: Priority Health Medicare |
$751.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,225.84
|
| Rate for Payer: Railroad Medicare Medicare |
$751.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,464.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.36
|
| Rate for Payer: UHC Exchange |
$1,464.87
|
| Rate for Payer: UHC Medicaid |
$494.80
|
| Rate for Payer: UHCCP DNSP |
$751.36
|
| Rate for Payer: UHCCP Medicaid |
$494.80
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$695.25 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna Commercial |
$834.30
|
| Rate for Payer: ASR ASR |
$899.19
|
| Rate for Payer: BCBS Trust/PPO |
$761.25
|
| Rate for Payer: BCN Commercial |
$761.25
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cofinity Commercial |
$871.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.60
|
| Rate for Payer: Healthscope Commercial |
$899.19
|
| Rate for Payer: Healthscope Whirlpool |
$927.00
|
| Rate for Payer: Mclaren Commercial |
$834.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.95
|
| Rate for Payer: Nomi Health Commercial |
$760.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 37609
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$247.91
|
| Rate for Payer: Aetna Medicare |
$185.01
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS MAPPO |
$185.01
|
| Rate for Payer: BCN Commercial |
$303.77
|
| Rate for Payer: BCN Medicare Advantage |
$185.01
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cofinity Commercial |
$266.41
|
| Rate for Payer: Cofinity Commercial |
$247.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.01
|
| Rate for Payer: Healthscope Commercial |
$222.01
|
| Rate for Payer: Healthscope Whirlpool |
$222.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.26
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.51
|
| Rate for Payer: Nomi Health Commercial |
$222.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
| Rate for Payer: PACE SWMI |
$185.01
|
| Rate for Payer: PHP Medicare Advantage |
$185.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$326.66
|
| Rate for Payer: Priority Health Medicare |
$185.01
|
| Rate for Payer: Priority Health Narrow Network |
$326.66
|
| Rate for Payer: Railroad Medicare Medicare |
$185.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.01
|
| Rate for Payer: UHC Exchange |
$360.86
|
| Rate for Payer: UHC Medicaid |
$119.92
|
| Rate for Payer: UHCCP DNSP |
$185.01
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$649.83 |
| Max. Negotiated Rate |
$2,057.07 |
| Rate for Payer: Aetna Commercial |
$834.30
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$899.19
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$764.31
|
| Rate for Payer: BCN Commercial |
$764.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cofinity Commercial |
$871.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$899.19
|
| Rate for Payer: Healthscope Whirlpool |
$927.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$834.30
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.95
|
| Rate for Payer: Nomi Health Commercial |
$760.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$812.24
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$649.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
37609
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$247.91
|
| Rate for Payer: Aetna Medicare |
$185.01
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS MAPPO |
$185.01
|
| Rate for Payer: BCN Commercial |
$303.77
|
| Rate for Payer: BCN Medicare Advantage |
$185.01
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cofinity Commercial |
$266.41
|
| Rate for Payer: Cofinity Commercial |
$247.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.01
|
| Rate for Payer: Healthscope Commercial |
$222.01
|
| Rate for Payer: Healthscope Whirlpool |
$222.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.26
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.51
|
| Rate for Payer: Nomi Health Commercial |
$222.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.25
|
| Rate for Payer: PACE SWMI |
$185.01
|
| Rate for Payer: PHP Medicare Advantage |
$185.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$326.66
|
| Rate for Payer: Priority Health Medicare |
$185.01
|
| Rate for Payer: Priority Health Narrow Network |
$326.66
|
| Rate for Payer: Railroad Medicare Medicare |
$185.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.01
|
| Rate for Payer: UHC Exchange |
$360.86
|
| Rate for Payer: UHC Medicaid |
$119.92
|
| Rate for Payer: UHCCP DNSP |
$185.01
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR LIGATION DIRECT ESOPHAGEAL VARICES
|
Professional
|
Both
|
$3,228.00
|
|
|
Service Code
|
HCPCS 43400
|
| Min. Negotiated Rate |
$905.68 |
| Max. Negotiated Rate |
$2,784.41 |
| Rate for Payer: Aetna Commercial |
$1,899.18
|
| Rate for Payer: Aetna Medicare |
$1,417.30
|
| Rate for Payer: BCBS Complete |
$950.96
|
| Rate for Payer: BCBS MAPPO |
$1,417.30
|
| Rate for Payer: BCN Commercial |
$2,285.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,417.30
|
| Rate for Payer: Cash Price |
$2,582.40
|
| Rate for Payer: Cash Price |
$2,582.40
|
| Rate for Payer: Cofinity Commercial |
$2,040.91
|
| Rate for Payer: Cofinity Commercial |
$1,899.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,417.30
|
| Rate for Payer: Healthscope Commercial |
$1,700.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,700.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,488.16
|
| Rate for Payer: Meridian Medicaid |
$950.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,559.03
|
| Rate for Payer: Nomi Health Commercial |
$1,700.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,421.00
|
| Rate for Payer: PACE SWMI |
$1,417.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,417.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,784.41
|
| Rate for Payer: Priority Health Medicare |
$1,417.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,784.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,417.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,721.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,417.30
|
| Rate for Payer: UHC Exchange |
$2,721.12
|
| Rate for Payer: UHC Medicaid |
$905.68
|
| Rate for Payer: UHCCP DNSP |
$1,417.30
|
| Rate for Payer: UHCCP Medicaid |
$905.68
|
|
|
PR LIGATION HEMORRHOID BUNDLE W/US
|
Professional
|
Both
|
$2,154.00
|
|
|
Service Code
|
HCPCS 0249T
|
| Min. Negotiated Rate |
$861.60 |
| Max. Negotiated Rate |
$1,615.50 |
| Rate for Payer: BCBS Complete |
$861.60
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,615.50
|
|
|
PR LIGATION INTERNAL/COMMON CAROTID ARTERY
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
HCPCS 37605
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$1,542.00 |
| Rate for Payer: Aetna Commercial |
$914.87
|
| Rate for Payer: Aetna Medicare |
$682.74
|
| Rate for Payer: BCBS Complete |
$452.22
|
| Rate for Payer: BCBS MAPPO |
$682.74
|
| Rate for Payer: BCN Commercial |
$1,083.61
|
| Rate for Payer: BCN Medicare Advantage |
$682.74
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$914.87
|
| Rate for Payer: Cofinity Commercial |
$983.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$682.74
|
| Rate for Payer: Healthscope Commercial |
$819.29
|
| Rate for Payer: Healthscope Whirlpool |
$819.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.88
|
| Rate for Payer: Meridian Medicaid |
$452.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$751.01
|
| Rate for Payer: Nomi Health Commercial |
$819.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,542.00
|
| Rate for Payer: PACE SWMI |
$682.74
|
| Rate for Payer: PHP Medicare Advantage |
$682.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,165.28
|
| Rate for Payer: Priority Health Medicare |
$682.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.28
|
| Rate for Payer: Railroad Medicare Medicare |
$682.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$682.74
|
| Rate for Payer: UHC Exchange |
$1,325.64
|
| Rate for Payer: UHC Medicaid |
$430.69
|
| Rate for Payer: UHCCP DNSP |
$682.74
|
| Rate for Payer: UHCCP Medicaid |
$430.69
|
|
|
PR LIGATION INTERNAL JUGULAR VEIN
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 37565
|
| Min. Negotiated Rate |
$415.35 |
| Max. Negotiated Rate |
$1,279.42 |
| Rate for Payer: Aetna Commercial |
$866.56
|
| Rate for Payer: Aetna Medicare |
$646.69
|
| Rate for Payer: BCBS Complete |
$436.12
|
| Rate for Payer: BCBS MAPPO |
$646.69
|
| Rate for Payer: BCN Commercial |
$1,083.11
|
| Rate for Payer: BCN Medicare Advantage |
$646.69
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$931.23
|
| Rate for Payer: Cofinity Commercial |
$866.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.69
|
| Rate for Payer: Healthscope Commercial |
$776.03
|
| Rate for Payer: Healthscope Whirlpool |
$776.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.02
|
| Rate for Payer: Meridian Medicaid |
$436.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$711.36
|
| Rate for Payer: Nomi Health Commercial |
$776.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,170.75
|
| Rate for Payer: PACE SWMI |
$646.69
|
| Rate for Payer: PHP Medicare Advantage |
$646.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$415.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,164.75
|
| Rate for Payer: Priority Health Medicare |
$646.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.75
|
| Rate for Payer: Railroad Medicare Medicare |
$646.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,279.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$646.69
|
| Rate for Payer: UHC Exchange |
$1,279.42
|
| Rate for Payer: UHC Medicaid |
$415.35
|
| Rate for Payer: UHCCP DNSP |
$646.69
|
| Rate for Payer: UHCCP Medicaid |
$415.35
|
|
|
PR LIGATION MAJOR ARTERY ABDOMEN
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
HCPCS 37617
|
| Min. Negotiated Rate |
$768.08 |
| Max. Negotiated Rate |
$2,526.75 |
| Rate for Payer: Aetna Commercial |
$1,616.94
|
| Rate for Payer: Aetna Medicare |
$1,206.67
|
| Rate for Payer: BCBS Complete |
$806.48
|
| Rate for Payer: BCBS MAPPO |
$1,206.67
|
| Rate for Payer: BCN Commercial |
$1,961.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,206.67
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,737.60
|
| Rate for Payer: Cofinity Commercial |
$1,616.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,206.67
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,448.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,267.00
|
| Rate for Payer: Meridian Medicaid |
$806.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,327.34
|
| Rate for Payer: Nomi Health Commercial |
$1,448.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.75
|
| Rate for Payer: PACE SWMI |
$1,206.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,206.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$768.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,109.40
|
| Rate for Payer: Priority Health Medicare |
$1,206.67
|
| Rate for Payer: Priority Health Narrow Network |
$2,109.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,206.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,373.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,206.67
|
| Rate for Payer: UHC Exchange |
$2,373.24
|
| Rate for Payer: UHC Medicaid |
$768.08
|
| Rate for Payer: UHCCP DNSP |
$1,206.67
|
| Rate for Payer: UHCCP Medicaid |
$768.08
|
|
