|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$531.77 |
| Max. Negotiated Rate |
$1,832.35 |
| Rate for Payer: Aetna Commercial |
$712.57
|
| Rate for Payer: Aetna Medicare |
$531.77
|
| Rate for Payer: BCBS Complete |
$1,127.60
|
| Rate for Payer: BCBS MAPPO |
$531.77
|
| Rate for Payer: BCN Medicare Advantage |
$531.77
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cofinity Commercial |
$765.75
|
| Rate for Payer: Cofinity Commercial |
$712.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.77
|
| Rate for Payer: Healthscope Commercial |
$638.12
|
| Rate for Payer: Healthscope Whirlpool |
$638.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.36
|
| Rate for Payer: Nomi Health Commercial |
$638.12
|
| Rate for Payer: PACE SWMI |
$531.77
|
| Rate for Payer: PHP Medicare Advantage |
$531.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,832.35
|
| Rate for Payer: Priority Health Medicare |
$531.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.77
|
| Rate for Payer: UHC Medicare Advantage |
$531.77
|
| Rate for Payer: UHCCP DNSP |
$531.77
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$922.40 |
| Max. Negotiated Rate |
$1,659.46 |
| Rate for Payer: Aetna Commercial |
$1,544.22
|
| Rate for Payer: Aetna Medicare |
$1,152.40
|
| Rate for Payer: BCBS Complete |
$922.40
|
| Rate for Payer: BCBS MAPPO |
$1,152.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,152.40
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cofinity Commercial |
$1,659.46
|
| Rate for Payer: Cofinity Commercial |
$1,544.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,152.40
|
| Rate for Payer: Healthscope Commercial |
$1,382.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,382.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,210.02
|
| Rate for Payer: Nomi Health Commercial |
$1,382.88
|
| Rate for Payer: PACE SWMI |
$1,152.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,152.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.90
|
| Rate for Payer: Priority Health Medicare |
$1,152.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,152.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.40
|
| Rate for Payer: UHCCP DNSP |
$1,152.40
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$116.71
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Aetna Commercial |
$105.04
|
| Rate for Payer: Aetna Medicare |
$58.35
|
| Rate for Payer: ASR ASR |
$113.21
|
| Rate for Payer: ASR Commercial |
$113.21
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: BCBS Trust/PPO |
$95.57
|
| Rate for Payer: BCN Commercial |
$90.49
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$109.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$116.71
|
| Rate for Payer: Healthscope Whirlpool |
$113.21
|
| Rate for Payer: Mclaren Commercial |
$105.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.20
|
| Rate for Payer: Nomi Health Commercial |
$95.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.26
|
| Rate for Payer: Priority Health Narrow Network |
$81.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.70
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$102.35
|
| Rate for Payer: ASR ASR |
$110.31
|
| Rate for Payer: ASR Commercial |
$110.31
|
| Rate for Payer: BCBS Trust/PPO |
$92.67
|
| Rate for Payer: BCN Commercial |
$88.17
|
| Rate for Payer: Cash Price |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$113.72
|
| Rate for Payer: Healthscope Whirlpool |
$110.31
|
| Rate for Payer: Mclaren Commercial |
$102.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.07
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$116.71
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.86 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Aetna Commercial |
$105.04
|
| Rate for Payer: ASR ASR |
$113.21
|
| Rate for Payer: ASR Commercial |
$113.21
|
| Rate for Payer: BCBS Trust/PPO |
$95.11
|
| Rate for Payer: BCN Commercial |
$90.49
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$109.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$116.71
|
| Rate for Payer: Healthscope Whirlpool |
$113.21
|
| Rate for Payer: Mclaren Commercial |
$105.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.20
|
| Rate for Payer: Nomi Health Commercial |
$95.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.70
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.06 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: ASR Commercial |
$94.72
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Trust/PPO |
$79.97
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$97.65
|
| Rate for Payer: Healthscope Whirlpool |
$94.72
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.56
|
| Rate for Payer: Priority Health Narrow Network |
$68.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$102.35
|
| Rate for Payer: Aetna Medicare |
$56.86
|
| Rate for Payer: ASR ASR |
$110.31
|
| Rate for Payer: ASR Commercial |
$110.31
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: BCBS Trust/PPO |
$93.13
|
| Rate for Payer: BCN Commercial |
$88.17
|
| Rate for Payer: Cash Price |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$113.72
|
| Rate for Payer: Healthscope Whirlpool |
$110.31
|
| Rate for Payer: Mclaren Commercial |
$102.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.64
|
| Rate for Payer: Priority Health Narrow Network |
$79.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.07
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$106.83
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: ASR Commercial |
$94.72
|
| Rate for Payer: BCBS Trust/PPO |
$79.57
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$97.65
|
| Rate for Payer: Healthscope Whirlpool |
$94.72
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: BCBS Trust/PPO |
$107.35
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.86
|
| Rate for Payer: Priority Health Narrow Network |
$91.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,527.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$1,010.80 |
| Max. Negotiated Rate |
$1,668.84 |
| Rate for Payer: Aetna Commercial |
$1,552.95
|
| Rate for Payer: Aetna Medicare |
$1,158.92
|
| Rate for Payer: BCBS Complete |
$1,010.80
|
| Rate for Payer: BCBS MAPPO |
$1,158.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,158.92
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,668.84
|
| Rate for Payer: Cofinity Commercial |
$1,552.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,158.92
|
| Rate for Payer: Healthscope Commercial |
$1,390.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,390.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,216.87
|
| Rate for Payer: Nomi Health Commercial |
$1,390.70
|
| Rate for Payer: PACE SWMI |
$1,158.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,158.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,642.55
|
| Rate for Payer: Priority Health Medicare |
$1,158.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,158.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,158.92
|
| Rate for Payer: UHCCP DNSP |
$1,158.92
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$5,788.66 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Medicare |
$3,734.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: ASR ASR |
$873.97
|
| Rate for Payer: ASR Commercial |
$873.97
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCBS Trust/PPO |
$737.83
|
| Rate for Payer: BCN Commercial |
$698.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$846.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$901.00
|
| Rate for Payer: Healthscope Whirlpool |
$873.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,734.62
|
| Rate for Payer: Mclaren Commercial |
$810.90
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: Nomi Health Commercial |
$738.82
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,108.08
|
| Rate for Payer: PHP Medicaid |
$2,001.76
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$789.46
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health Narrow Network |
$631.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$5,788.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP DNSP |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$624.14 |
| Rate for Payer: Aetna Commercial |
$580.80
|
| Rate for Payer: Aetna Medicare |
$433.43
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: BCBS MAPPO |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$433.43
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$624.14
|
| Rate for Payer: Cofinity Commercial |
$580.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.43
|
| Rate for Payer: Healthscope Commercial |
$520.12
|
| Rate for Payer: Healthscope Whirlpool |
$520.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.10
|
| Rate for Payer: Nomi Health Commercial |
$520.12
|
| Rate for Payer: PACE SWMI |
$433.43
|
| Rate for Payer: PHP Medicare Advantage |
$433.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$433.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.43
|
| Rate for Payer: UHC Medicare Advantage |
$433.43
|
| Rate for Payer: UHCCP DNSP |
$433.43
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$901.00 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: ASR ASR |
$873.97
|
| Rate for Payer: ASR Commercial |
$873.97
|
| Rate for Payer: BCBS Trust/PPO |
$734.22
|
| Rate for Payer: BCN Commercial |
$698.55
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$846.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Healthscope Commercial |
$901.00
|
| Rate for Payer: Healthscope Whirlpool |
$873.97
|
| Rate for Payer: Mclaren Commercial |
$810.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: Nomi Health Commercial |
$738.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.88
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$624.14 |
| Rate for Payer: Aetna Commercial |
$580.80
|
| Rate for Payer: Aetna Medicare |
$433.43
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: BCBS MAPPO |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$433.43
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$624.14
|
| Rate for Payer: Cofinity Commercial |
$580.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.43
|
| Rate for Payer: Healthscope Commercial |
$520.12
|
| Rate for Payer: Healthscope Whirlpool |
$520.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.10
|
| Rate for Payer: Nomi Health Commercial |
$520.12
|
| Rate for Payer: PACE SWMI |
$433.43
|
| Rate for Payer: PHP Medicare Advantage |
$433.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$433.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.43
|
| Rate for Payer: UHC Medicare Advantage |
$433.43
|
| Rate for Payer: UHCCP DNSP |
$433.43
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,782.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,912.80 |
| Max. Negotiated Rate |
$3,872.69 |
| Rate for Payer: Aetna Commercial |
$3,603.76
|
| Rate for Payer: Aetna Medicare |
$2,689.37
|
| Rate for Payer: BCBS Complete |
$1,912.80
|
| Rate for Payer: BCBS MAPPO |
$2,689.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,689.37
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cofinity Commercial |
$3,872.69
|
| Rate for Payer: Cofinity Commercial |
$3,603.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,689.37
|
| Rate for Payer: Healthscope Commercial |
$3,227.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,227.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,823.84
|
| Rate for Payer: Nomi Health Commercial |
$3,227.24
|
| Rate for Payer: PACE SWMI |
$2,689.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,689.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,108.30
|
| Rate for Payer: Priority Health Medicare |
$2,689.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,689.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,689.37
|
| Rate for Payer: UHCCP DNSP |
$2,689.37
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM
|
Professional
|
Both
|
$4,070.00
|
|
|
Service Code
|
HCPCS 49188
|
| Min. Negotiated Rate |
$1,628.00 |
| Max. Negotiated Rate |
$2,791.57 |
| Rate for Payer: Aetna Commercial |
$2,597.71
|
| Rate for Payer: Aetna Medicare |
$1,938.59
|
| Rate for Payer: BCBS Complete |
$1,628.00
|
| Rate for Payer: BCBS MAPPO |
$1,938.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,938.59
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cofinity Commercial |
$2,791.57
|
| Rate for Payer: Cofinity Commercial |
$2,597.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,938.59
|
| Rate for Payer: Healthscope Commercial |
$2,326.31
|
| Rate for Payer: Healthscope Whirlpool |
$2,326.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,035.52
|
| Rate for Payer: Nomi Health Commercial |
$2,326.31
|
| Rate for Payer: PACE SWMI |
$1,938.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,938.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,645.50
|
| Rate for Payer: Priority Health Medicare |
$1,938.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,938.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,938.59
|
| Rate for Payer: UHCCP DNSP |
$1,938.59
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,694.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$1,077.60 |
| Max. Negotiated Rate |
$1,821.02 |
| Rate for Payer: Aetna Commercial |
$1,694.56
|
| Rate for Payer: Aetna Medicare |
$1,264.60
|
| Rate for Payer: BCBS Complete |
$1,077.60
|
| Rate for Payer: BCBS MAPPO |
$1,264.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.60
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cofinity Commercial |
$1,821.02
|
| Rate for Payer: Cofinity Commercial |
$1,694.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.60
|
| Rate for Payer: Healthscope Commercial |
$1,517.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,327.83
|
| Rate for Payer: Nomi Health Commercial |
$1,517.52
|
| Rate for Payer: PACE SWMI |
$1,264.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.10
|
| Rate for Payer: Priority Health Medicare |
$1,264.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,264.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,264.60
|
| Rate for Payer: UHCCP DNSP |
$1,264.60
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$178.14 |
| Max. Negotiated Rate |
$836.55 |
| Rate for Payer: Aetna Commercial |
$238.71
|
| Rate for Payer: Aetna Medicare |
$178.14
|
| Rate for Payer: BCBS Complete |
$514.80
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cofinity Commercial |
$256.52
|
| Rate for Payer: Cofinity Commercial |
$238.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$213.77
|
| Rate for Payer: Healthscope Whirlpool |
$213.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: Nomi Health Commercial |
$213.77
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.55
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Medicare Advantage |
$178.14
|
| Rate for Payer: UHCCP DNSP |
$178.14
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$582.74 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$780.87
|
| Rate for Payer: Aetna Medicare |
$582.74
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$582.74
|
| Rate for Payer: BCN Medicare Advantage |
$582.74
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$839.15
|
| Rate for Payer: Cofinity Commercial |
$780.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$582.74
|
| Rate for Payer: Healthscope Commercial |
$699.29
|
| Rate for Payer: Healthscope Whirlpool |
$699.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$611.88
|
| Rate for Payer: Nomi Health Commercial |
$699.29
|
| Rate for Payer: PACE SWMI |
$582.74
|
| Rate for Payer: PHP Medicare Advantage |
$582.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$582.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$582.74
|
| Rate for Payer: UHC Medicare Advantage |
$582.74
|
| Rate for Payer: UHCCP DNSP |
$582.74
|
|
|
PR OPEN IMPLANTATION NEA PERIPHERAL NERVE
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 64575
|
| Min. Negotiated Rate |
$300.08 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$402.11
|
| Rate for Payer: Aetna Medicare |
$300.08
|
| Rate for Payer: BCBS Complete |
$398.00
|
| Rate for Payer: BCBS MAPPO |
$300.08
|
| Rate for Payer: BCN Medicare Advantage |
$300.08
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$432.12
|
| Rate for Payer: Cofinity Commercial |
$402.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.08
|
| Rate for Payer: Healthscope Commercial |
$360.10
|
| Rate for Payer: Healthscope Whirlpool |
$360.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.08
|
| Rate for Payer: Nomi Health Commercial |
$360.10
|
| Rate for Payer: PACE SWMI |
$300.08
|
| Rate for Payer: PHP Medicare Advantage |
$300.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Medicare |
$300.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.08
|
| Rate for Payer: UHC Medicare Advantage |
$300.08
|
| Rate for Payer: UHCCP DNSP |
$300.08
|
|
|
PR OPEN IMPLANTATION NEA SACRAL NERVE
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 64581
|
| Min. Negotiated Rate |
$606.80 |
| Max. Negotiated Rate |
$986.05 |
| Rate for Payer: Aetna Commercial |
$844.82
|
| Rate for Payer: Aetna Medicare |
$630.46
|
| Rate for Payer: BCBS Complete |
$606.80
|
| Rate for Payer: BCBS MAPPO |
$630.46
|
| Rate for Payer: BCN Medicare Advantage |
$630.46
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cofinity Commercial |
$907.86
|
| Rate for Payer: Cofinity Commercial |
$844.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.46
|
| Rate for Payer: Healthscope Commercial |
$756.55
|
| Rate for Payer: Healthscope Whirlpool |
$756.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$661.98
|
| Rate for Payer: Nomi Health Commercial |
$756.55
|
| Rate for Payer: PACE SWMI |
$630.46
|
| Rate for Payer: PHP Medicare Advantage |
$630.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.05
|
| Rate for Payer: Priority Health Medicare |
$630.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$630.46
|
| Rate for Payer: UHC Medicare Advantage |
$630.46
|
| Rate for Payer: UHCCP DNSP |
$630.46
|
|
|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$700.40 |
| Max. Negotiated Rate |
$1,152.86 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Medicare |
$800.60
|
| Rate for Payer: BCBS Complete |
$700.40
|
| Rate for Payer: BCBS MAPPO |
$800.60
|
| Rate for Payer: BCN Medicare Advantage |
$800.60
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,152.86
|
| Rate for Payer: Cofinity Commercial |
$1,072.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.60
|
| Rate for Payer: Healthscope Commercial |
$960.72
|
| Rate for Payer: Healthscope Whirlpool |
$960.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.63
|
| Rate for Payer: Nomi Health Commercial |
$960.72
|
| Rate for Payer: PACE SWMI |
$800.60
|
| Rate for Payer: PHP Medicare Advantage |
$800.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health Medicare |
$800.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.60
|
| Rate for Payer: UHC Medicare Advantage |
$800.60
|
| Rate for Payer: UHCCP DNSP |
$800.60
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$192.80
|
| Rate for Payer: Aetna Medicare |
$143.88
|
| Rate for Payer: BCBS Complete |
$256.00
|
| Rate for Payer: BCBS MAPPO |
$143.88
|
| Rate for Payer: BCN Medicare Advantage |
$143.88
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.88
|
| Rate for Payer: Healthscope Commercial |
$172.66
|
| Rate for Payer: Healthscope Whirlpool |
$172.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.07
|
| Rate for Payer: Nomi Health Commercial |
$172.66
|
| Rate for Payer: PACE SWMI |
$143.88
|
| Rate for Payer: PHP Medicare Advantage |
$143.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.00
|
| Rate for Payer: Priority Health Medicare |
$143.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.88
|
| Rate for Payer: UHC Medicare Advantage |
$143.88
|
| Rate for Payer: UHCCP DNSP |
$143.88
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$330.20 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: BCBS Complete |
$203.20
|
| Rate for Payer: BCBS MAPPO |
$202.10
|
| Rate for Payer: BCN Medicare Advantage |
$202.10
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.10
|
| Rate for Payer: Healthscope Commercial |
$242.52
|
| Rate for Payer: Healthscope Whirlpool |
$242.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.21
|
| Rate for Payer: Nomi Health Commercial |
$242.52
|
| Rate for Payer: PACE SWMI |
$202.10
|
| Rate for Payer: PHP Medicare Advantage |
$202.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health Medicare |
$202.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.10
|
| Rate for Payer: UHC Medicare Advantage |
$202.10
|
| Rate for Payer: UHCCP DNSP |
$202.10
|
|
