|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$422.38 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Aetna Commercial |
$877.42
|
| Rate for Payer: Aetna Medicare |
$654.79
|
| Rate for Payer: BCBS Complete |
$443.50
|
| Rate for Payer: BCBS MAPPO |
$654.79
|
| Rate for Payer: BCN Commercial |
$1,058.71
|
| Rate for Payer: BCN Medicare Advantage |
$654.79
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,332.80
|
| Rate for Payer: Cofinity Commercial |
$942.90
|
| Rate for Payer: Cofinity Commercial |
$877.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.79
|
| Rate for Payer: Healthscope Commercial |
$785.75
|
| Rate for Payer: Healthscope Whirlpool |
$785.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.53
|
| Rate for Payer: Meridian Medicaid |
$443.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$720.27
|
| Rate for Payer: Nomi Health Commercial |
$785.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,187.00
|
| Rate for Payer: PACE SWMI |
$654.79
|
| Rate for Payer: PHP Medicare Advantage |
$654.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,408.70
|
| Rate for Payer: Priority Health Medicare |
$654.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,408.70
|
| Rate for Payer: Railroad Medicare Medicare |
$654.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,247.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$654.79
|
| Rate for Payer: UHC Exchange |
$1,247.01
|
| Rate for Payer: UHC Medicaid |
$422.38
|
| Rate for Payer: UHCCP DNSP |
$654.79
|
| Rate for Payer: UHCCP Medicaid |
$422.38
|
|
|
PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$113.25 |
| Rate for Payer: Aetna Commercial |
$77.48
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$57.82
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: BCN Medicare Advantage |
$57.82
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$83.26
|
| Rate for Payer: Cofinity Commercial |
$77.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.82
|
| Rate for Payer: Healthscope Commercial |
$69.38
|
| Rate for Payer: Healthscope Whirlpool |
$69.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.71
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.60
|
| Rate for Payer: Nomi Health Commercial |
$69.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.25
|
| Rate for Payer: PACE SWMI |
$57.82
|
| Rate for Payer: PHP Medicare Advantage |
$57.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.46
|
| Rate for Payer: Priority Health Medicare |
$57.82
|
| Rate for Payer: Priority Health Narrow Network |
$92.46
|
| Rate for Payer: Railroad Medicare Medicare |
$57.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.82
|
| Rate for Payer: UHC Exchange |
$91.79
|
| Rate for Payer: UHC Medicaid |
$37.49
|
| Rate for Payer: UHCCP DNSP |
$57.82
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$1,669.00
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$339.52 |
| Max. Negotiated Rate |
$1,251.75 |
| Rate for Payer: Aetna Commercial |
$693.06
|
| Rate for Payer: Aetna Medicare |
$517.21
|
| Rate for Payer: BCBS Complete |
$356.50
|
| Rate for Payer: BCBS MAPPO |
$517.21
|
| Rate for Payer: BCN Commercial |
$870.97
|
| Rate for Payer: BCN Medicare Advantage |
$517.21
|
| Rate for Payer: Cash Price |
$1,335.20
|
| Rate for Payer: Cash Price |
$1,335.20
|
| Rate for Payer: Cofinity Commercial |
$744.78
|
| Rate for Payer: Cofinity Commercial |
$693.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.21
|
| Rate for Payer: Healthscope Commercial |
$620.65
|
| Rate for Payer: Healthscope Whirlpool |
$620.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.07
|
| Rate for Payer: Meridian Medicaid |
$356.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$568.93
|
| Rate for Payer: Nomi Health Commercial |
$620.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.75
|
| Rate for Payer: PACE SWMI |
$517.21
|
| Rate for Payer: PHP Medicare Advantage |
$517.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$931.04
|
| Rate for Payer: Priority Health Medicare |
$517.21
|
| Rate for Payer: Priority Health Narrow Network |
$931.04
|
| Rate for Payer: Railroad Medicare Medicare |
$517.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$982.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$517.21
|
| Rate for Payer: UHC Exchange |
$982.93
|
| Rate for Payer: UHC Medicaid |
$339.52
|
| Rate for Payer: UHCCP DNSP |
$517.21
|
| Rate for Payer: UHCCP Medicaid |
$339.52
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$1,403.00
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$320.78 |
| Max. Negotiated Rate |
$1,052.25 |
| Rate for Payer: Aetna Commercial |
$656.64
|
| Rate for Payer: Aetna Medicare |
$490.03
|
| Rate for Payer: BCBS Complete |
$336.82
|
| Rate for Payer: BCBS MAPPO |
$490.03
|
| Rate for Payer: BCN Commercial |
$808.22
|
| Rate for Payer: BCN Medicare Advantage |
$490.03
|
| Rate for Payer: Cash Price |
$1,122.40
|
| Rate for Payer: Cash Price |
$1,122.40
|
| Rate for Payer: Cofinity Commercial |
$705.64
|
| Rate for Payer: Cofinity Commercial |
$656.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.03
|
| Rate for Payer: Healthscope Commercial |
$588.04
|
| Rate for Payer: Healthscope Whirlpool |
$588.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.53
|
| Rate for Payer: Meridian Medicaid |
$336.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$539.03
|
| Rate for Payer: Nomi Health Commercial |
$588.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.25
|
| Rate for Payer: PACE SWMI |
$490.03
|
| Rate for Payer: PHP Medicare Advantage |
$490.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$863.96
|
| Rate for Payer: Priority Health Medicare |
$490.03
|
| Rate for Payer: Priority Health Narrow Network |
$863.96
|
| Rate for Payer: Railroad Medicare Medicare |
$490.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.03
|
| Rate for Payer: UHC Exchange |
$944.84
|
| Rate for Payer: UHC Medicaid |
$320.78
|
| Rate for Payer: UHCCP DNSP |
$490.03
|
| Rate for Payer: UHCCP Medicaid |
$320.78
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$1,876.00
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$282.86 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$576.95
|
| Rate for Payer: Aetna Medicare |
$430.56
|
| Rate for Payer: BCBS Complete |
$297.00
|
| Rate for Payer: BCBS MAPPO |
$430.56
|
| Rate for Payer: BCN Commercial |
$710.12
|
| Rate for Payer: BCN Medicare Advantage |
$430.56
|
| Rate for Payer: Cash Price |
$1,500.80
|
| Rate for Payer: Cash Price |
$1,500.80
|
| Rate for Payer: Cofinity Commercial |
$620.01
|
| Rate for Payer: Cofinity Commercial |
$576.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$430.56
|
| Rate for Payer: Healthscope Commercial |
$516.67
|
| Rate for Payer: Healthscope Whirlpool |
$516.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.09
|
| Rate for Payer: Meridian Medicaid |
$297.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$473.62
|
| Rate for Payer: Nomi Health Commercial |
$516.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,407.00
|
| Rate for Payer: PACE SWMI |
$430.56
|
| Rate for Payer: PHP Medicare Advantage |
$430.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$759.10
|
| Rate for Payer: Priority Health Medicare |
$430.56
|
| Rate for Payer: Priority Health Narrow Network |
$759.10
|
| Rate for Payer: Railroad Medicare Medicare |
$430.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$430.56
|
| Rate for Payer: UHC Exchange |
$808.04
|
| Rate for Payer: UHC Medicaid |
$282.86
|
| Rate for Payer: UHCCP DNSP |
$430.56
|
| Rate for Payer: UHCCP Medicaid |
$282.86
|
|
|
PR LOCM 250-299MG/ML IODINE,1ML
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q9948
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
|
|
PR LORAZEPAM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2060
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: BCBS MAPPO |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.47
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: BCN Medicare Advantage |
$1.66
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Healthscope Whirlpool |
$1.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.83
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: PACE SWMI |
$1.66
|
| Rate for Payer: PHP Medicare Advantage |
$1.66
|
| Rate for Payer: Priority Health Medicare |
$1.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.66
|
| Rate for Payer: UHC Exchange |
$1.41
|
| Rate for Payer: UHCCP DNSP |
$1.66
|
|
|
PR LOWER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$2,704.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$2,028.00 |
| Rate for Payer: BCBS Complete |
$1,081.60
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,028.00
|
|
|
PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 20979
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: Aetna Commercial |
$35.30
|
| Rate for Payer: Aetna Medicare |
$26.34
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$26.34
|
| Rate for Payer: BCN Commercial |
$46.31
|
| Rate for Payer: BCN Medicare Advantage |
$26.34
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$37.93
|
| Rate for Payer: Cofinity Commercial |
$35.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$31.61
|
| Rate for Payer: Healthscope Whirlpool |
$31.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.97
|
| Rate for Payer: Nomi Health Commercial |
$31.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: PACE SWMI |
$26.34
|
| Rate for Payer: PHP Medicare Advantage |
$26.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.50
|
| Rate for Payer: Priority Health Medicare |
$26.34
|
| Rate for Payer: Priority Health Narrow Network |
$49.50
|
| Rate for Payer: Railroad Medicare Medicare |
$26.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.34
|
| Rate for Payer: UHC Exchange |
$57.23
|
| Rate for Payer: UHCCP DNSP |
$26.34
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.00
|
| Rate for Payer: Healthscope Whirlpool |
$3.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.50
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHCCP DNSP |
$2.50
|
|
|
PR LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$1.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.64
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.97
|
| Rate for Payer: Healthscope Whirlpool |
$1.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PACE SWMI |
$1.64
|
| Rate for Payer: PHP Medicare Advantage |
$1.64
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.64
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHCCP DNSP |
$1.64
|
|
|
PR LT COMPRES BAND >=5""/YD
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A6450
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.00
|
| Rate for Payer: Healthscope Whirlpool |
$3.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.50
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UHCCP DNSP |
$2.50
|
|
|
PR LUX IR ABD/BACK
|
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 LUX IR ARMS
|
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 LUX IR BUTTOCKS
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR LUX IR CHEST
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR LUX IR 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 LUX IR UP LEGS
|
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 LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 38308
|
| Min. Negotiated Rate |
$285.42 |
| Max. Negotiated Rate |
$950.18 |
| Rate for Payer: Aetna Commercial |
$588.02
|
| Rate for Payer: Aetna Medicare |
$438.82
|
| Rate for Payer: BCBS Complete |
$299.69
|
| Rate for Payer: BCBS MAPPO |
$438.82
|
| Rate for Payer: BCN Commercial |
$714.11
|
| Rate for Payer: BCN Medicare Advantage |
$438.82
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cofinity Commercial |
$631.90
|
| Rate for Payer: Cofinity Commercial |
$588.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.82
|
| Rate for Payer: Healthscope Commercial |
$526.58
|
| Rate for Payer: Healthscope Whirlpool |
$526.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$460.76
|
| Rate for Payer: Meridian Medicaid |
$299.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$482.70
|
| Rate for Payer: Nomi Health Commercial |
$526.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.50
|
| Rate for Payer: PACE SWMI |
$438.82
|
| Rate for Payer: PHP Medicare Advantage |
$438.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$950.18
|
| Rate for Payer: Priority Health Medicare |
$438.82
|
| Rate for Payer: Priority Health Narrow Network |
$950.18
|
| Rate for Payer: Railroad Medicare Medicare |
$438.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$438.82
|
| Rate for Payer: UHC Exchange |
$800.99
|
| Rate for Payer: UHC Medicaid |
$285.42
|
| Rate for Payer: UHCCP DNSP |
$438.82
|
| Rate for Payer: UHCCP Medicaid |
$285.42
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$402.75 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$180.78
|
| Rate for Payer: BCBS Complete |
$123.46
|
| Rate for Payer: BCBS MAPPO |
$180.78
|
| Rate for Payer: BCN Commercial |
$301.78
|
| Rate for Payer: BCN Medicare Advantage |
$180.78
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cofinity Commercial |
$260.32
|
| Rate for Payer: Cofinity Commercial |
$242.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.78
|
| Rate for Payer: Healthscope Commercial |
$216.94
|
| Rate for Payer: Healthscope Whirlpool |
$216.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.82
|
| Rate for Payer: Meridian Medicaid |
$123.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.86
|
| Rate for Payer: Nomi Health Commercial |
$216.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.75
|
| Rate for Payer: PACE SWMI |
$180.78
|
| Rate for Payer: PHP Medicare Advantage |
$180.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$328.73
|
| Rate for Payer: Priority Health Medicare |
$180.78
|
| Rate for Payer: Priority Health Narrow Network |
$328.73
|
| Rate for Payer: Railroad Medicare Medicare |
$180.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.78
|
| Rate for Payer: UHC Exchange |
$350.16
|
| Rate for Payer: UHC Medicaid |
$117.58
|
| Rate for Payer: UHCCP DNSP |
$180.78
|
| Rate for Payer: UHCCP Medicaid |
$117.58
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 30560
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$398.25 |
| Rate for Payer: Aetna Commercial |
$177.63
|
| Rate for Payer: Aetna Medicare |
$132.56
|
| Rate for Payer: BCBS Complete |
$93.48
|
| Rate for Payer: BCBS MAPPO |
$132.56
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$132.56
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$190.89
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.56
|
| Rate for Payer: Healthscope Commercial |
$159.07
|
| Rate for Payer: Healthscope Whirlpool |
$159.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.19
|
| Rate for Payer: Meridian Medicaid |
$93.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.82
|
| Rate for Payer: Nomi Health Commercial |
$159.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.25
|
| Rate for Payer: PACE SWMI |
$132.56
|
| Rate for Payer: PHP Medicare Advantage |
$132.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$212.90
|
| Rate for Payer: Priority Health Medicare |
$132.56
|
| Rate for Payer: Priority Health Narrow Network |
$212.90
|
| Rate for Payer: Railroad Medicare Medicare |
$132.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.56
|
| Rate for Payer: UHC Exchange |
$238.92
|
| Rate for Payer: UHC Medicaid |
$89.03
|
| Rate for Payer: UHCCP DNSP |
$132.56
|
| Rate for Payer: UHCCP Medicaid |
$89.03
|
|
|
PR LYSIS LABIAL ADHESIONS
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 56441
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$182.99
|
| Rate for Payer: Aetna Medicare |
$136.56
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS MAPPO |
$136.56
|
| Rate for Payer: BCN Commercial |
$233.06
|
| Rate for Payer: BCN Medicare Advantage |
$136.56
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Cofinity Commercial |
$182.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.56
|
| Rate for Payer: Healthscope Commercial |
$163.87
|
| Rate for Payer: Healthscope Whirlpool |
$163.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.39
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.22
|
| Rate for Payer: Nomi Health Commercial |
$163.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.25
|
| Rate for Payer: PACE SWMI |
$136.56
|
| Rate for Payer: PHP Medicare Advantage |
$136.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$236.03
|
| Rate for Payer: Priority Health Medicare |
$136.56
|
| Rate for Payer: Priority Health Narrow Network |
$236.03
|
| Rate for Payer: Railroad Medicare Medicare |
$136.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$136.56
|
| Rate for Payer: UHC Exchange |
$255.88
|
| Rate for Payer: UHC Medicaid |
$89.67
|
| Rate for Payer: UHCCP DNSP |
$136.56
|
| Rate for Payer: UHCCP Medicaid |
$89.67
|
|
|
PR LYSIS OF ADHESIONS SALPINX/OVARY
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 58740
|
| Min. Negotiated Rate |
$526.11 |
| Max. Negotiated Rate |
$1,875.75 |
| Rate for Payer: Aetna Commercial |
$1,094.14
|
| Rate for Payer: Aetna Medicare |
$816.52
|
| Rate for Payer: BCBS Complete |
$552.42
|
| Rate for Payer: BCBS MAPPO |
$816.52
|
| Rate for Payer: BCN Commercial |
$1,359.49
|
| Rate for Payer: BCN Medicare Advantage |
$816.52
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cofinity Commercial |
$1,175.79
|
| Rate for Payer: Cofinity Commercial |
$1,094.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.52
|
| Rate for Payer: Healthscope Commercial |
$979.82
|
| Rate for Payer: Healthscope Whirlpool |
$979.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$857.35
|
| Rate for Payer: Meridian Medicaid |
$552.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$898.17
|
| Rate for Payer: Nomi Health Commercial |
$979.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: PACE SWMI |
$816.52
|
| Rate for Payer: PHP Medicare Advantage |
$816.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,376.87
|
| Rate for Payer: Priority Health Medicare |
$816.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.87
|
| Rate for Payer: Railroad Medicare Medicare |
$816.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,584.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$816.52
|
| Rate for Payer: UHC Exchange |
$1,584.76
|
| Rate for Payer: UHC Medicaid |
$526.11
|
| Rate for Payer: UHCCP DNSP |
$816.52
|
| Rate for Payer: UHCCP Medicaid |
$526.11
|
|
|
PR MA/EC CONTRACEPTIVEINJECTION
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS J1056
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
|
|
PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC
|
Professional
|
Both
|
$3,448.00
|
|
|
Service Code
|
HCPCS 32820
|
| Min. Negotiated Rate |
$837.94 |
| Max. Negotiated Rate |
$2,586.00 |
| Rate for Payer: Aetna Commercial |
$1,746.11
|
| Rate for Payer: Aetna Medicare |
$1,303.07
|
| Rate for Payer: BCBS Complete |
$879.84
|
| Rate for Payer: BCBS MAPPO |
$1,303.07
|
| Rate for Payer: BCN Commercial |
$2,074.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.07
|
| Rate for Payer: Cash Price |
$2,758.40
|
| Rate for Payer: Cash Price |
$2,758.40
|
| Rate for Payer: Cofinity Commercial |
$1,746.11
|
| Rate for Payer: Cofinity Commercial |
$1,876.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.07
|
| Rate for Payer: Healthscope Commercial |
$1,563.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,563.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,368.22
|
| Rate for Payer: Meridian Medicaid |
$879.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,433.38
|
| Rate for Payer: Nomi Health Commercial |
$1,563.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,586.00
|
| Rate for Payer: PACE SWMI |
$1,303.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,953.18
|
| Rate for Payer: Priority Health Medicare |
$1,303.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,953.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,303.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,353.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,303.07
|
| Rate for Payer: UHC Exchange |
$2,353.04
|
| Rate for Payer: UHC Medicaid |
$837.94
|
| Rate for Payer: UHCCP DNSP |
$1,303.07
|
| Rate for Payer: UHCCP Medicaid |
$837.94
|
|
