|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 31529
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$220.82 |
| Rate for Payer: Aetna Commercial |
$205.49
|
| Rate for Payer: Aetna Medicare |
$153.35
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$153.35
|
| Rate for Payer: BCN Medicare Advantage |
$153.35
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$220.82
|
| Rate for Payer: Cofinity Commercial |
$205.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.35
|
| Rate for Payer: Healthscope Commercial |
$184.02
|
| Rate for Payer: Healthscope Whirlpool |
$184.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.02
|
| Rate for Payer: Nomi Health Commercial |
$184.02
|
| Rate for Payer: PACE SWMI |
$153.35
|
| Rate for Payer: PHP Medicare Advantage |
$153.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$153.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.35
|
| Rate for Payer: UHC Medicare Advantage |
$153.35
|
| Rate for Payer: UHCCP DNSP |
$153.35
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 31525
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$405.60 |
| Rate for Payer: Aetna Commercial |
$204.51
|
| Rate for Payer: Aetna Medicare |
$152.62
|
| Rate for Payer: BCBS Complete |
$249.60
|
| Rate for Payer: BCBS MAPPO |
$152.62
|
| Rate for Payer: BCN Medicare Advantage |
$152.62
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Cofinity Commercial |
$204.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.62
|
| Rate for Payer: Healthscope Commercial |
$183.14
|
| Rate for Payer: Healthscope Whirlpool |
$183.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.25
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE SWMI |
$152.62
|
| Rate for Payer: PHP Medicare Advantage |
$152.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.60
|
| Rate for Payer: Priority Health Medicare |
$152.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.62
|
| Rate for Payer: UHC Medicare Advantage |
$152.62
|
| Rate for Payer: UHCCP DNSP |
$152.62
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 31528
|
| Min. Negotiated Rate |
$137.68 |
| Max. Negotiated Rate |
$514.80 |
| Rate for Payer: Aetna Commercial |
$184.49
|
| Rate for Payer: Aetna Medicare |
$137.68
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCBS MAPPO |
$137.68
|
| Rate for Payer: BCN Medicare Advantage |
$137.68
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$198.26
|
| Rate for Payer: Cofinity Commercial |
$184.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.68
|
| Rate for Payer: Healthscope Commercial |
$165.22
|
| Rate for Payer: Healthscope Whirlpool |
$165.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.56
|
| Rate for Payer: Nomi Health Commercial |
$165.22
|
| Rate for Payer: PACE SWMI |
$137.68
|
| Rate for Payer: PHP Medicare Advantage |
$137.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health Medicare |
$137.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.68
|
| Rate for Payer: UHC Medicare Advantage |
$137.68
|
| Rate for Payer: UHCCP DNSP |
$137.68
|
|
|
PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 31526
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$216.13 |
| Rate for Payer: Aetna Commercial |
$201.12
|
| Rate for Payer: Aetna Medicare |
$150.09
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$150.09
|
| Rate for Payer: BCN Medicare Advantage |
$150.09
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$216.13
|
| Rate for Payer: Cofinity Commercial |
$201.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.09
|
| Rate for Payer: Healthscope Commercial |
$180.11
|
| Rate for Payer: Healthscope Whirlpool |
$180.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.59
|
| Rate for Payer: Nomi Health Commercial |
$180.11
|
| Rate for Payer: PACE SWMI |
$150.09
|
| Rate for Payer: PHP Medicare Advantage |
$150.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$150.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.09
|
| Rate for Payer: UHC Medicare Advantage |
$150.09
|
| Rate for Payer: UHCCP DNSP |
$150.09
|
|
|
PR LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY
|
Professional
|
Both
|
$2,271.00
|
|
|
Service Code
|
HCPCS 31300
|
| Min. Negotiated Rate |
$908.40 |
| Max. Negotiated Rate |
$1,688.37 |
| Rate for Payer: Aetna Commercial |
$1,571.12
|
| Rate for Payer: Aetna Medicare |
$1,172.48
|
| Rate for Payer: BCBS Complete |
$908.40
|
| Rate for Payer: BCBS MAPPO |
$1,172.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,172.48
|
| Rate for Payer: Cash Price |
$1,816.80
|
| Rate for Payer: Cash Price |
$1,816.80
|
| Rate for Payer: Cofinity Commercial |
$1,688.37
|
| Rate for Payer: Cofinity Commercial |
$1,571.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,172.48
|
| Rate for Payer: Healthscope Commercial |
$1,406.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,231.10
|
| Rate for Payer: Nomi Health Commercial |
$1,406.98
|
| Rate for Payer: PACE SWMI |
$1,172.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,172.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,476.15
|
| Rate for Payer: Priority Health Medicare |
$1,172.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,172.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,172.48
|
| Rate for Payer: UHCCP DNSP |
$1,172.48
|
|
|
PR LASER CO2 - FULL FACE
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 00263
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$1,823.25 |
| Rate for Payer: Aetna Medicare |
$1,402.50
|
| Rate for Payer: BCBS Complete |
$1,122.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,823.25
|
|
|
PR LASER CO2 - ONE AREA
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 00181
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$1,160.25 |
| Rate for Payer: Aetna Medicare |
$892.50
|
| Rate for Payer: BCBS Complete |
$714.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,160.25
|
|
|
PR LASER CO2 - TWO AREAS
|
Professional
|
Both
|
$2,295.00
|
|
|
Service Code
|
HCPCS 00182
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: Aetna Medicare |
$1,147.50
|
| Rate for Payer: BCBS Complete |
$918.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,491.75
|
|
|
PR LASER ENUCLEATION PROSTATE W/MORCELLATION
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
HCPCS 52649
|
| Min. Negotiated Rate |
$683.60 |
| Max. Negotiated Rate |
$1,133.88 |
| Rate for Payer: Aetna Commercial |
$1,055.14
|
| Rate for Payer: Aetna Medicare |
$787.42
|
| Rate for Payer: BCBS Complete |
$683.60
|
| Rate for Payer: BCBS MAPPO |
$787.42
|
| Rate for Payer: BCN Medicare Advantage |
$787.42
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Cofinity Commercial |
$1,133.88
|
| Rate for Payer: Cofinity Commercial |
$1,055.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.42
|
| Rate for Payer: Healthscope Commercial |
$944.90
|
| Rate for Payer: Healthscope Whirlpool |
$944.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.79
|
| Rate for Payer: Nomi Health Commercial |
$944.90
|
| Rate for Payer: PACE SWMI |
$787.42
|
| Rate for Payer: PHP Medicare Advantage |
$787.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.85
|
| Rate for Payer: Priority Health Medicare |
$787.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.42
|
| Rate for Payer: UHC Medicare Advantage |
$787.42
|
| Rate for Payer: UHCCP DNSP |
$787.42
|
|
|
PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW
|
Professional
|
Both
|
$3,308.00
|
|
|
Service Code
|
HCPCS 52648
|
| Min. Negotiated Rate |
$662.13 |
| Max. Negotiated Rate |
$2,150.20 |
| Rate for Payer: Aetna Commercial |
$887.25
|
| Rate for Payer: Aetna Medicare |
$662.13
|
| Rate for Payer: BCBS Complete |
$1,323.20
|
| Rate for Payer: BCBS MAPPO |
$662.13
|
| Rate for Payer: BCN Medicare Advantage |
$662.13
|
| Rate for Payer: Cash Price |
$2,646.40
|
| Rate for Payer: Cash Price |
$2,646.40
|
| Rate for Payer: Cofinity Commercial |
$953.47
|
| Rate for Payer: Cofinity Commercial |
$887.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.13
|
| Rate for Payer: Healthscope Commercial |
$794.56
|
| Rate for Payer: Healthscope Whirlpool |
$794.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.24
|
| Rate for Payer: Nomi Health Commercial |
$794.56
|
| Rate for Payer: PACE SWMI |
$662.13
|
| Rate for Payer: PHP Medicare Advantage |
$662.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,150.20
|
| Rate for Payer: Priority Health Medicare |
$662.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.13
|
| Rate for Payer: UHC Medicare Advantage |
$662.13
|
| Rate for Payer: UHCCP DNSP |
$662.13
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
HCPCS 27425
|
| Hospital Charge Code |
27425
|
| Min. Negotiated Rate |
$440.04 |
| Max. Negotiated Rate |
$1,103.05 |
| Rate for Payer: Aetna Commercial |
$589.65
|
| Rate for Payer: Aetna Medicare |
$440.04
|
| Rate for Payer: BCBS Complete |
$678.80
|
| Rate for Payer: BCBS MAPPO |
$440.04
|
| Rate for Payer: BCN Medicare Advantage |
$440.04
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cofinity Commercial |
$633.66
|
| Rate for Payer: Cofinity Commercial |
$589.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.04
|
| Rate for Payer: Healthscope Commercial |
$528.05
|
| Rate for Payer: Healthscope Whirlpool |
$528.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.04
|
| Rate for Payer: Nomi Health Commercial |
$528.05
|
| Rate for Payer: PACE SWMI |
$440.04
|
| Rate for Payer: PHP Medicare Advantage |
$440.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.05
|
| Rate for Payer: Priority Health Medicare |
$440.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.04
|
| Rate for Payer: UHC Medicare Advantage |
$440.04
|
| Rate for Payer: UHCCP DNSP |
$440.04
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
HCPCS 27425
|
| Min. Negotiated Rate |
$440.04 |
| Max. Negotiated Rate |
$1,103.05 |
| Rate for Payer: Aetna Commercial |
$589.65
|
| Rate for Payer: Aetna Medicare |
$440.04
|
| Rate for Payer: BCBS Complete |
$678.80
|
| Rate for Payer: BCBS MAPPO |
$440.04
|
| Rate for Payer: BCN Medicare Advantage |
$440.04
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cofinity Commercial |
$633.66
|
| Rate for Payer: Cofinity Commercial |
$589.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.04
|
| Rate for Payer: Healthscope Commercial |
$528.05
|
| Rate for Payer: Healthscope Whirlpool |
$528.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.04
|
| Rate for Payer: Nomi Health Commercial |
$528.05
|
| Rate for Payer: PACE SWMI |
$440.04
|
| Rate for Payer: PHP Medicare Advantage |
$440.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.05
|
| Rate for Payer: Priority Health Medicare |
$440.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.04
|
| Rate for Payer: UHC Medicare Advantage |
$440.04
|
| Rate for Payer: UHCCP DNSP |
$440.04
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
27425
|
| Min. Negotiated Rate |
$1,103.05 |
| Max. Negotiated Rate |
$1,697.00 |
| Rate for Payer: Aetna Commercial |
$1,527.30
|
| Rate for Payer: ASR ASR |
$1,646.09
|
| Rate for Payer: ASR Commercial |
$1,646.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,382.89
|
| Rate for Payer: BCN Commercial |
$1,315.68
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cofinity Commercial |
$1,595.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.60
|
| Rate for Payer: Healthscope Commercial |
$1,697.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,646.09
|
| Rate for Payer: Mclaren Commercial |
$1,527.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.45
|
| Rate for Payer: Nomi Health Commercial |
$1,391.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,493.36
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
27425
|
| Min. Negotiated Rate |
$1,103.05 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,527.30
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$1,646.09
|
| Rate for Payer: ASR Commercial |
$1,646.09
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,389.67
|
| Rate for Payer: BCN Commercial |
$1,315.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cash Price |
$1,357.60
|
| Rate for Payer: Cofinity Commercial |
$1,595.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,697.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,646.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,527.30
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,442.45
|
| Rate for Payer: Nomi Health Commercial |
$1,391.54
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,486.91
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,493.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR LATISSE
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 00267
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Medicare |
$91.50
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
|
|
PR LAVAGE CANNULATION MAXILLARY SINUS
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 31000
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$139.12
|
| Rate for Payer: Aetna Medicare |
$103.82
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$103.82
|
| Rate for Payer: BCN Medicare Advantage |
$103.82
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$149.50
|
| Rate for Payer: Cofinity Commercial |
$139.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.82
|
| Rate for Payer: Healthscope Commercial |
$124.58
|
| Rate for Payer: Healthscope Whirlpool |
$124.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.01
|
| Rate for Payer: Nomi Health Commercial |
$124.58
|
| Rate for Payer: PACE SWMI |
$103.82
|
| Rate for Payer: PHP Medicare Advantage |
$103.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$103.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.82
|
| Rate for Payer: UHC Medicare Advantage |
$103.82
|
| Rate for Payer: UHCCP DNSP |
$103.82
|
|
|
PR LAVAGE CANNULATION SPHENOID SINUS
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 31002
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$248.62 |
| Rate for Payer: Aetna Commercial |
$231.35
|
| Rate for Payer: Aetna Medicare |
$172.65
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$248.62
|
| Rate for Payer: Cofinity Commercial |
$231.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Healthscope Commercial |
$207.18
|
| Rate for Payer: Healthscope Whirlpool |
$207.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.28
|
| Rate for Payer: Nomi Health Commercial |
$207.18
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$172.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$172.65
|
| Rate for Payer: UHCCP DNSP |
$172.65
|
|
|
PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 93462
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Aetna Commercial |
$263.11
|
| Rate for Payer: Aetna Medicare |
$196.35
|
| Rate for Payer: BCBS Complete |
$176.80
|
| Rate for Payer: BCBS MAPPO |
$196.35
|
| Rate for Payer: BCN Medicare Advantage |
$196.35
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Cofinity Commercial |
$263.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.35
|
| Rate for Payer: Healthscope Commercial |
$235.62
|
| Rate for Payer: Healthscope Whirlpool |
$235.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.17
|
| Rate for Payer: Nomi Health Commercial |
$235.62
|
| Rate for Payer: PACE SWMI |
$196.35
|
| Rate for Payer: PHP Medicare Advantage |
$196.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health Medicare |
$196.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.35
|
| Rate for Payer: UHC Medicare Advantage |
$196.35
|
| Rate for Payer: UHCCP DNSP |
$196.35
|
|
|
PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 26476
|
| Min. Negotiated Rate |
$539.20 |
| Max. Negotiated Rate |
$876.20 |
| Rate for Payer: Aetna Commercial |
$802.73
|
| Rate for Payer: Aetna Medicare |
$599.05
|
| Rate for Payer: BCBS Complete |
$539.20
|
| Rate for Payer: BCBS MAPPO |
$599.05
|
| Rate for Payer: BCN Medicare Advantage |
$599.05
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$862.63
|
| Rate for Payer: Cofinity Commercial |
$802.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.05
|
| Rate for Payer: Healthscope Commercial |
$718.86
|
| Rate for Payer: Healthscope Whirlpool |
$718.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.00
|
| Rate for Payer: Nomi Health Commercial |
$718.86
|
| Rate for Payer: PACE SWMI |
$599.05
|
| Rate for Payer: PHP Medicare Advantage |
$599.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health Medicare |
$599.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.05
|
| Rate for Payer: UHC Medicare Advantage |
$599.05
|
| Rate for Payer: UHCCP DNSP |
$599.05
|
|
|
PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 26478
|
| Min. Negotiated Rate |
$615.57 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Commercial |
$824.86
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$886.42
|
| Rate for Payer: Cofinity Commercial |
$824.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$738.68
|
| Rate for Payer: Healthscope Whirlpool |
$738.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Nomi Health Commercial |
$738.68
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.57
|
| Rate for Payer: UHC Medicare Advantage |
$615.57
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
|
|
PR LESION <15
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00074
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR LESION FL FACE/NECK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00075
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR LESION REMOVAL COLONOSCOPY
|
Professional
|
Both
|
$1,584.00
|
|
|
Service Code
|
HCPCS G6024
|
| Min. Negotiated Rate |
$633.60 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Aetna Medicare |
$792.00
|
| Rate for Payer: BCBS Complete |
$633.60
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.60
|
|
|
PR LESION SINGLE
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00073
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS J1950
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$2,491.66 |
| Rate for Payer: Aetna Commercial |
$2,318.63
|
| Rate for Payer: Aetna Medicare |
$1,730.32
|
| Rate for Payer: BCBS Complete |
$441.20
|
| Rate for Payer: BCBS MAPPO |
$1,730.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$2,318.63
|
| Rate for Payer: Cofinity Commercial |
$2,491.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$2,076.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,076.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Nomi Health Commercial |
$2,076.38
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,730.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,730.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,730.32
|
| Rate for Payer: UHCCP DNSP |
$1,730.32
|
|
