|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 51725
|
| Min. Negotiated Rate |
$186.85 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Aetna Commercial |
$250.38
|
| Rate for Payer: Aetna Medicare |
$186.85
|
| Rate for Payer: BCBS MAPPO |
$186.85
|
| Rate for Payer: BCN Commercial |
$309.24
|
| Rate for Payer: BCN Medicare Advantage |
$186.85
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cofinity Commercial |
$250.38
|
| Rate for Payer: Cofinity Commercial |
$269.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.85
|
| Rate for Payer: Healthscope Commercial |
$224.22
|
| Rate for Payer: Healthscope Whirlpool |
$224.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$205.53
|
| Rate for Payer: Nomi Health Commercial |
$224.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.75
|
| Rate for Payer: PACE SWMI |
$186.85
|
| Rate for Payer: PHP Medicare Advantage |
$186.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$186.85
|
| Rate for Payer: Priority Health Narrow Network |
$336.87
|
| Rate for Payer: Railroad Medicare Medicare |
$186.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.85
|
| Rate for Payer: UHC Exchange |
$355.90
|
| Rate for Payer: UHCCP DNSP |
$186.85
|
|
|
PR SIMPLE IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$1,803.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$721.20 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,352.25
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,021.00
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$2,047.57 |
| Max. Negotiated Rate |
$7,515.75 |
| Rate for Payer: Aetna Commercial |
$4,314.29
|
| Rate for Payer: Aetna Medicare |
$3,219.62
|
| Rate for Payer: BCBS Complete |
$2,149.95
|
| Rate for Payer: BCBS MAPPO |
$3,219.62
|
| Rate for Payer: BCN Commercial |
$7,136.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,219.62
|
| Rate for Payer: Cash Price |
$8,016.80
|
| Rate for Payer: Cash Price |
$8,016.80
|
| Rate for Payer: Cofinity Commercial |
$4,636.25
|
| Rate for Payer: Cofinity Commercial |
$4,314.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,219.62
|
| Rate for Payer: Healthscope Commercial |
$3,863.54
|
| Rate for Payer: Healthscope Whirlpool |
$3,863.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,380.60
|
| Rate for Payer: Meridian Medicaid |
$2,149.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,541.58
|
| Rate for Payer: Nomi Health Commercial |
$3,863.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,515.75
|
| Rate for Payer: PACE SWMI |
$3,219.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,219.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,047.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,999.69
|
| Rate for Payer: Priority Health Medicare |
$3,219.62
|
| Rate for Payer: Priority Health Narrow Network |
$5,999.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,219.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,044.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,219.62
|
| Rate for Payer: UHC Exchange |
$6,044.57
|
| Rate for Payer: UHC Medicaid |
$2,047.57
|
| Rate for Payer: UHCCP DNSP |
$3,219.62
|
| Rate for Payer: UHCCP Medicaid |
$2,047.57
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$8,929.00
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$2,435.02 |
| Max. Negotiated Rate |
$8,407.03 |
| Rate for Payer: Aetna Commercial |
$5,138.43
|
| Rate for Payer: Aetna Medicare |
$3,834.65
|
| Rate for Payer: BCBS Complete |
$2,556.77
|
| Rate for Payer: BCBS MAPPO |
$3,834.65
|
| Rate for Payer: BCN Commercial |
$8,407.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,834.65
|
| Rate for Payer: Cash Price |
$7,143.20
|
| Rate for Payer: Cash Price |
$7,143.20
|
| Rate for Payer: Cofinity Commercial |
$5,521.90
|
| Rate for Payer: Cofinity Commercial |
$5,138.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,834.65
|
| Rate for Payer: Healthscope Commercial |
$4,601.58
|
| Rate for Payer: Healthscope Whirlpool |
$4,601.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,026.38
|
| Rate for Payer: Meridian Medicaid |
$2,556.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,218.11
|
| Rate for Payer: Nomi Health Commercial |
$4,601.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,696.75
|
| Rate for Payer: PACE SWMI |
$3,834.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,834.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,435.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,067.99
|
| Rate for Payer: Priority Health Medicare |
$3,834.65
|
| Rate for Payer: Priority Health Narrow Network |
$7,067.99
|
| Rate for Payer: Railroad Medicare Medicare |
$3,834.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,170.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,834.65
|
| Rate for Payer: UHC Exchange |
$7,170.57
|
| Rate for Payer: UHC Medicaid |
$2,435.02
|
| Rate for Payer: UHCCP DNSP |
$3,834.65
|
| Rate for Payer: UHCCP Medicaid |
$2,435.02
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$165.62
|
| Rate for Payer: Aetna Medicare |
$123.60
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$123.60
|
| Rate for Payer: BCN Commercial |
$189.73
|
| Rate for Payer: BCN Medicare Advantage |
$123.60
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$177.98
|
| Rate for Payer: Cofinity Commercial |
$165.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.60
|
| Rate for Payer: Healthscope Commercial |
$148.32
|
| Rate for Payer: Healthscope Whirlpool |
$148.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.78
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.96
|
| Rate for Payer: Nomi Health Commercial |
$148.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PACE SWMI |
$123.60
|
| Rate for Payer: PHP Medicare Advantage |
$123.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$173.65
|
| Rate for Payer: Priority Health Medicare |
$123.60
|
| Rate for Payer: Priority Health Narrow Network |
$173.65
|
| Rate for Payer: Railroad Medicare Medicare |
$123.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$123.60
|
| Rate for Payer: UHC Exchange |
$233.66
|
| Rate for Payer: UHC Medicaid |
$77.96
|
| Rate for Payer: UHCCP DNSP |
$123.60
|
| Rate for Payer: UHCCP Medicaid |
$77.96
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$277.70 |
| Rate for Payer: Aetna Commercial |
$208.40
|
| Rate for Payer: Aetna Medicare |
$155.52
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS MAPPO |
$155.52
|
| Rate for Payer: BCN Commercial |
$229.08
|
| Rate for Payer: BCN Medicare Advantage |
$155.52
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$223.95
|
| Rate for Payer: Cofinity Commercial |
$208.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.52
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Healthscope Whirlpool |
$186.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.30
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.07
|
| Rate for Payer: Nomi Health Commercial |
$186.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.25
|
| Rate for Payer: PACE SWMI |
$155.52
|
| Rate for Payer: PHP Medicare Advantage |
$155.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.65
|
| Rate for Payer: Priority Health Medicare |
$155.52
|
| Rate for Payer: Priority Health Narrow Network |
$209.65
|
| Rate for Payer: Railroad Medicare Medicare |
$155.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.52
|
| Rate for Payer: UHC Exchange |
$277.70
|
| Rate for Payer: UHC Medicaid |
$98.41
|
| Rate for Payer: UHCCP DNSP |
$155.52
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Commercial |
$72.88
|
| Rate for Payer: Aetna Medicare |
$54.39
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$54.39
|
| Rate for Payer: BCN Commercial |
$83.16
|
| Rate for Payer: BCN Medicare Advantage |
$54.39
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$78.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.39
|
| Rate for Payer: Healthscope Commercial |
$65.27
|
| Rate for Payer: Healthscope Whirlpool |
$65.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.11
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.83
|
| Rate for Payer: Nomi Health Commercial |
$65.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PACE SWMI |
$54.39
|
| Rate for Payer: PHP Medicare Advantage |
$54.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.12
|
| Rate for Payer: Priority Health Medicare |
$54.39
|
| Rate for Payer: Priority Health Narrow Network |
$76.12
|
| Rate for Payer: Railroad Medicare Medicare |
$54.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$54.39
|
| Rate for Payer: UHC Exchange |
$100.47
|
| Rate for Payer: UHC Medicaid |
$34.72
|
| Rate for Payer: UHCCP DNSP |
$54.39
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$276.75 |
| Rate for Payer: Aetna Commercial |
$75.48
|
| Rate for Payer: Aetna Medicare |
$56.33
|
| Rate for Payer: BCBS Complete |
$37.35
|
| Rate for Payer: BCBS MAPPO |
$56.33
|
| Rate for Payer: BCN Commercial |
$86.15
|
| Rate for Payer: BCN Medicare Advantage |
$56.33
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$75.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.33
|
| Rate for Payer: Healthscope Commercial |
$67.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.15
|
| Rate for Payer: Meridian Medicaid |
$37.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.96
|
| Rate for Payer: Nomi Health Commercial |
$67.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.75
|
| Rate for Payer: PACE SWMI |
$56.33
|
| Rate for Payer: PHP Medicare Advantage |
$56.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.85
|
| Rate for Payer: Priority Health Medicare |
$56.33
|
| Rate for Payer: Priority Health Narrow Network |
$78.85
|
| Rate for Payer: Railroad Medicare Medicare |
$56.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.33
|
| Rate for Payer: UHC Exchange |
$106.61
|
| Rate for Payer: UHC Medicaid |
$35.57
|
| Rate for Payer: UHCCP DNSP |
$56.33
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$110.97 |
| Max. Negotiated Rate |
$1,050.75 |
| Rate for Payer: Aetna Commercial |
$235.12
|
| Rate for Payer: Aetna Medicare |
$175.46
|
| Rate for Payer: BCBS Complete |
$116.52
|
| Rate for Payer: BCBS MAPPO |
$175.46
|
| Rate for Payer: BCN Commercial |
$259.44
|
| Rate for Payer: BCN Medicare Advantage |
$175.46
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$235.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.46
|
| Rate for Payer: Healthscope Commercial |
$210.55
|
| Rate for Payer: Healthscope Whirlpool |
$210.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.23
|
| Rate for Payer: Meridian Medicaid |
$116.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.01
|
| Rate for Payer: Nomi Health Commercial |
$210.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.75
|
| Rate for Payer: PACE SWMI |
$175.46
|
| Rate for Payer: PHP Medicare Advantage |
$175.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$237.47
|
| Rate for Payer: Priority Health Medicare |
$175.46
|
| Rate for Payer: Priority Health Narrow Network |
$237.47
|
| Rate for Payer: Railroad Medicare Medicare |
$175.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.46
|
| Rate for Payer: UHC Exchange |
$315.01
|
| Rate for Payer: UHC Medicaid |
$110.97
|
| Rate for Payer: UHCCP DNSP |
$175.46
|
| Rate for Payer: UHCCP Medicaid |
$110.97
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$379.50 |
| Rate for Payer: Aetna Commercial |
$97.70
|
| Rate for Payer: Aetna Medicare |
$72.91
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$72.91
|
| Rate for Payer: BCN Commercial |
$110.55
|
| Rate for Payer: BCN Medicare Advantage |
$72.91
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$97.70
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.91
|
| Rate for Payer: Healthscope Commercial |
$87.49
|
| Rate for Payer: Healthscope Whirlpool |
$87.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.56
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.20
|
| Rate for Payer: Nomi Health Commercial |
$87.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.50
|
| Rate for Payer: PACE SWMI |
$72.91
|
| Rate for Payer: PHP Medicare Advantage |
$72.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.18
|
| Rate for Payer: Priority Health Medicare |
$72.91
|
| Rate for Payer: Priority Health Narrow Network |
$101.18
|
| Rate for Payer: Railroad Medicare Medicare |
$72.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.91
|
| Rate for Payer: UHC Exchange |
$136.36
|
| Rate for Payer: UHC Medicaid |
$46.01
|
| Rate for Payer: UHCCP DNSP |
$72.91
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$489.75 |
| Rate for Payer: Aetna Commercial |
$122.10
|
| Rate for Payer: Aetna Medicare |
$91.12
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$91.12
|
| Rate for Payer: BCN Commercial |
$139.93
|
| Rate for Payer: BCN Medicare Advantage |
$91.12
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Cofinity Commercial |
$122.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.12
|
| Rate for Payer: Healthscope Commercial |
$109.34
|
| Rate for Payer: Healthscope Whirlpool |
$109.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.68
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.23
|
| Rate for Payer: Nomi Health Commercial |
$109.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$489.75
|
| Rate for Payer: PACE SWMI |
$91.12
|
| Rate for Payer: PHP Medicare Advantage |
$91.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$128.07
|
| Rate for Payer: Priority Health Medicare |
$91.12
|
| Rate for Payer: Priority Health Narrow Network |
$128.07
|
| Rate for Payer: Railroad Medicare Medicare |
$91.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91.12
|
| Rate for Payer: UHC Exchange |
$172.31
|
| Rate for Payer: UHC Medicaid |
$57.51
|
| Rate for Payer: UHCCP DNSP |
$91.12
|
| Rate for Payer: UHCCP Medicaid |
$57.51
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Aetna Commercial |
$58.87
|
| Rate for Payer: Aetna Medicare |
$43.93
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS MAPPO |
$43.93
|
| Rate for Payer: BCN Commercial |
$66.73
|
| Rate for Payer: BCN Medicare Advantage |
$43.93
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cofinity Commercial |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$58.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.93
|
| Rate for Payer: Healthscope Commercial |
$52.72
|
| Rate for Payer: Healthscope Whirlpool |
$52.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.13
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.32
|
| Rate for Payer: Nomi Health Commercial |
$52.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.50
|
| Rate for Payer: PACE SWMI |
$43.93
|
| Rate for Payer: PHP Medicare Advantage |
$43.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.07
|
| Rate for Payer: Priority Health Medicare |
$43.93
|
| Rate for Payer: Priority Health Narrow Network |
$61.07
|
| Rate for Payer: Railroad Medicare Medicare |
$43.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43.93
|
| Rate for Payer: UHC Exchange |
$79.97
|
| Rate for Payer: UHC Medicaid |
$28.12
|
| Rate for Payer: UHCCP DNSP |
$43.93
|
| Rate for Payer: UHCCP Medicaid |
$28.12
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Aetna Commercial |
$180.87
|
| Rate for Payer: Aetna Medicare |
$134.98
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS MAPPO |
$134.98
|
| Rate for Payer: BCN Commercial |
$215.63
|
| Rate for Payer: BCN Medicare Advantage |
$134.98
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cofinity Commercial |
$194.37
|
| Rate for Payer: Cofinity Commercial |
$180.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.98
|
| Rate for Payer: Healthscope Commercial |
$161.98
|
| Rate for Payer: Healthscope Whirlpool |
$161.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.73
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.48
|
| Rate for Payer: Nomi Health Commercial |
$161.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$426.00
|
| Rate for Payer: PACE SWMI |
$134.98
|
| Rate for Payer: PHP Medicare Advantage |
$134.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$197.35
|
| Rate for Payer: Priority Health Medicare |
$134.98
|
| Rate for Payer: Priority Health Narrow Network |
$197.35
|
| Rate for Payer: Railroad Medicare Medicare |
$134.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.98
|
| Rate for Payer: UHC Exchange |
$261.38
|
| Rate for Payer: UHC Medicaid |
$85.41
|
| Rate for Payer: UHCCP DNSP |
$134.98
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$96.91
|
| Rate for Payer: Aetna Medicare |
$72.32
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$72.32
|
| Rate for Payer: BCN Commercial |
$109.06
|
| Rate for Payer: BCN Medicare Advantage |
$72.32
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$96.91
|
| Rate for Payer: Cofinity Commercial |
$104.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$86.78
|
| Rate for Payer: Healthscope Whirlpool |
$86.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.94
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.55
|
| Rate for Payer: Nomi Health Commercial |
$86.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.50
|
| Rate for Payer: PACE SWMI |
$72.32
|
| Rate for Payer: PHP Medicare Advantage |
$72.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99.82
|
| Rate for Payer: Priority Health Medicare |
$72.32
|
| Rate for Payer: Priority Health Narrow Network |
$99.82
|
| Rate for Payer: Railroad Medicare Medicare |
$72.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.32
|
| Rate for Payer: UHC Exchange |
$132.64
|
| Rate for Payer: UHC Medicaid |
$46.01
|
| Rate for Payer: UHCCP DNSP |
$72.32
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna Medicare |
$14.13
|
| Rate for Payer: BCBS MAPPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: BCN Medicare Advantage |
$14.13
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.13
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Healthscope Whirlpool |
$16.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.54
|
| Rate for Payer: Nomi Health Commercial |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: PACE SWMI |
$14.13
|
| Rate for Payer: PHP Medicare Advantage |
$14.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.24
|
| Rate for Payer: Priority Health Medicare |
$14.13
|
| Rate for Payer: Priority Health Narrow Network |
$22.24
|
| Rate for Payer: Railroad Medicare Medicare |
$14.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.13
|
| Rate for Payer: UHC Exchange |
$23.42
|
| Rate for Payer: UHCCP DNSP |
$14.13
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$638.15 |
| Max. Negotiated Rate |
$1,884.35 |
| Rate for Payer: Aetna Commercial |
$1,299.61
|
| Rate for Payer: Aetna Medicare |
$969.86
|
| Rate for Payer: BCBS Complete |
$670.06
|
| Rate for Payer: BCBS MAPPO |
$969.86
|
| Rate for Payer: BCN Commercial |
$1,677.20
|
| Rate for Payer: BCN Medicare Advantage |
$969.86
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,396.60
|
| Rate for Payer: Cofinity Commercial |
$1,299.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$969.86
|
| Rate for Payer: Healthscope Commercial |
$1,163.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,163.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,018.35
|
| Rate for Payer: Meridian Medicaid |
$670.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,066.85
|
| Rate for Payer: Nomi Health Commercial |
$1,163.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,655.25
|
| Rate for Payer: PACE SWMI |
$969.86
|
| Rate for Payer: PHP Medicare Advantage |
$969.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$638.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,579.42
|
| Rate for Payer: Priority Health Medicare |
$969.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,579.42
|
| Rate for Payer: Railroad Medicare Medicare |
$969.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,884.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$969.86
|
| Rate for Payer: UHC Exchange |
$1,884.35
|
| Rate for Payer: UHC Medicaid |
$638.15
|
| Rate for Payer: UHCCP DNSP |
$969.86
|
| Rate for Payer: UHCCP Medicaid |
$638.15
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,148.00
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$668.82 |
| Max. Negotiated Rate |
$1,945.89 |
| Rate for Payer: Aetna Commercial |
$1,356.52
|
| Rate for Payer: Aetna Medicare |
$1,012.33
|
| Rate for Payer: BCBS Complete |
$702.26
|
| Rate for Payer: BCBS MAPPO |
$1,012.33
|
| Rate for Payer: BCN Commercial |
$1,743.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,012.33
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cofinity Commercial |
$1,457.76
|
| Rate for Payer: Cofinity Commercial |
$1,356.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,012.33
|
| Rate for Payer: Healthscope Commercial |
$1,214.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,214.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.95
|
| Rate for Payer: Meridian Medicaid |
$702.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,113.56
|
| Rate for Payer: Nomi Health Commercial |
$1,214.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.00
|
| Rate for Payer: PACE SWMI |
$1,012.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,012.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,642.26
|
| Rate for Payer: Priority Health Medicare |
$1,012.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,642.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,012.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,945.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,012.33
|
| Rate for Payer: UHC Exchange |
$1,945.89
|
| Rate for Payer: UHC Medicaid |
$668.82
|
| Rate for Payer: UHCCP DNSP |
$1,012.33
|
| Rate for Payer: UHCCP Medicaid |
$668.82
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,747.00
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$2,084.50 |
| Rate for Payer: Aetna Commercial |
$1,443.54
|
| Rate for Payer: Aetna Medicare |
$1,077.27
|
| Rate for Payer: BCBS Complete |
$745.88
|
| Rate for Payer: BCBS MAPPO |
$1,077.27
|
| Rate for Payer: BCN Commercial |
$1,859.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.27
|
| Rate for Payer: Cash Price |
$2,197.60
|
| Rate for Payer: Cash Price |
$2,197.60
|
| Rate for Payer: Cofinity Commercial |
$1,551.27
|
| Rate for Payer: Cofinity Commercial |
$1,443.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.27
|
| Rate for Payer: Healthscope Commercial |
$1,292.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,292.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.13
|
| Rate for Payer: Meridian Medicaid |
$745.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,185.00
|
| Rate for Payer: Nomi Health Commercial |
$1,292.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,060.25
|
| Rate for Payer: PACE SWMI |
$1,077.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$710.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,751.53
|
| Rate for Payer: Priority Health Medicare |
$1,077.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,751.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,077.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,084.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,077.27
|
| Rate for Payer: UHC Exchange |
$2,084.50
|
| Rate for Payer: UHC Medicaid |
$710.36
|
| Rate for Payer: UHCCP DNSP |
$1,077.27
|
| Rate for Payer: UHCCP Medicaid |
$710.36
|
|
|
PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
HCPCS 31032
|
| Min. Negotiated Rate |
$351.88 |
| Max. Negotiated Rate |
$989.92 |
| Rate for Payer: Aetna Commercial |
$709.44
|
| Rate for Payer: Aetna Medicare |
$529.43
|
| Rate for Payer: BCBS Complete |
$369.47
|
| Rate for Payer: BCBS MAPPO |
$529.43
|
| Rate for Payer: BCN Commercial |
$893.88
|
| Rate for Payer: BCN Medicare Advantage |
$529.43
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cofinity Commercial |
$762.38
|
| Rate for Payer: Cofinity Commercial |
$709.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.43
|
| Rate for Payer: Healthscope Commercial |
$635.32
|
| Rate for Payer: Healthscope Whirlpool |
$635.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.90
|
| Rate for Payer: Meridian Medicaid |
$369.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$582.37
|
| Rate for Payer: Nomi Health Commercial |
$635.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$868.50
|
| Rate for Payer: PACE SWMI |
$529.43
|
| Rate for Payer: PHP Medicare Advantage |
$529.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$841.77
|
| Rate for Payer: Priority Health Medicare |
$529.43
|
| Rate for Payer: Priority Health Narrow Network |
$841.77
|
| Rate for Payer: Railroad Medicare Medicare |
$529.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$989.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$529.43
|
| Rate for Payer: UHC Exchange |
$989.92
|
| Rate for Payer: UHC Medicaid |
$351.88
|
| Rate for Payer: UHCCP DNSP |
$529.43
|
| Rate for Payer: UHCCP Medicaid |
$351.88
|
|
|
PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
HCPCS 31080
|
| Min. Negotiated Rate |
$626.65 |
| Max. Negotiated Rate |
$1,806.05 |
| Rate for Payer: Aetna Commercial |
$1,267.96
|
| Rate for Payer: Aetna Medicare |
$946.24
|
| Rate for Payer: BCBS Complete |
$657.98
|
| Rate for Payer: BCBS MAPPO |
$946.24
|
| Rate for Payer: BCN Commercial |
$1,626.90
|
| Rate for Payer: BCN Medicare Advantage |
$946.24
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cofinity Commercial |
$1,362.59
|
| Rate for Payer: Cofinity Commercial |
$1,267.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.24
|
| Rate for Payer: Healthscope Commercial |
$1,135.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.55
|
| Rate for Payer: Meridian Medicaid |
$657.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,040.86
|
| Rate for Payer: Nomi Health Commercial |
$1,135.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,749.00
|
| Rate for Payer: PACE SWMI |
$946.24
|
| Rate for Payer: PHP Medicare Advantage |
$946.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,532.06
|
| Rate for Payer: Priority Health Medicare |
$946.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,532.06
|
| Rate for Payer: Railroad Medicare Medicare |
$946.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,806.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$946.24
|
| Rate for Payer: UHC Exchange |
$1,806.05
|
| Rate for Payer: UHC Medicaid |
$626.65
|
| Rate for Payer: UHCCP DNSP |
$946.24
|
| Rate for Payer: UHCCP Medicaid |
$626.65
|
|
|
PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 31070
|
| Min. Negotiated Rate |
$282.44 |
| Max. Negotiated Rate |
$769.01 |
| Rate for Payer: Aetna Commercial |
$564.54
|
| Rate for Payer: Aetna Medicare |
$421.30
|
| Rate for Payer: BCBS Complete |
$296.56
|
| Rate for Payer: BCBS MAPPO |
$421.30
|
| Rate for Payer: BCN Commercial |
$712.11
|
| Rate for Payer: BCN Medicare Advantage |
$421.30
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$606.67
|
| Rate for Payer: Cofinity Commercial |
$564.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.30
|
| Rate for Payer: Healthscope Commercial |
$505.56
|
| Rate for Payer: Healthscope Whirlpool |
$505.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.37
|
| Rate for Payer: Meridian Medicaid |
$296.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$463.43
|
| Rate for Payer: Nomi Health Commercial |
$505.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE SWMI |
$421.30
|
| Rate for Payer: PHP Medicare Advantage |
$421.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$670.59
|
| Rate for Payer: Priority Health Medicare |
$421.30
|
| Rate for Payer: Priority Health Narrow Network |
$670.59
|
| Rate for Payer: Railroad Medicare Medicare |
$421.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$421.30
|
| Rate for Payer: UHC Exchange |
$769.01
|
| Rate for Payer: UHC Medicaid |
$282.44
|
| Rate for Payer: UHCCP DNSP |
$421.30
|
| Rate for Payer: UHCCP Medicaid |
$282.44
|
|
|
PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 31020
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$627.60 |
| Rate for Payer: Aetna Commercial |
$415.27
|
| Rate for Payer: Aetna Medicare |
$309.90
|
| Rate for Payer: BCBS Complete |
$218.96
|
| Rate for Payer: BCBS MAPPO |
$309.90
|
| Rate for Payer: BCN Commercial |
$516.91
|
| Rate for Payer: BCN Medicare Advantage |
$309.90
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$446.26
|
| Rate for Payer: Cofinity Commercial |
$415.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.90
|
| Rate for Payer: Healthscope Commercial |
$371.88
|
| Rate for Payer: Healthscope Whirlpool |
$371.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.39
|
| Rate for Payer: Meridian Medicaid |
$218.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.89
|
| Rate for Payer: Nomi Health Commercial |
$371.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PACE SWMI |
$309.90
|
| Rate for Payer: PHP Medicare Advantage |
$309.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$486.78
|
| Rate for Payer: Priority Health Medicare |
$309.90
|
| Rate for Payer: Priority Health Narrow Network |
$486.78
|
| Rate for Payer: Railroad Medicare Medicare |
$309.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$309.90
|
| Rate for Payer: UHC Exchange |
$627.60
|
| Rate for Payer: UHC Medicaid |
$208.53
|
| Rate for Payer: UHCCP DNSP |
$309.90
|
| Rate for Payer: UHCCP Medicaid |
$208.53
|
|
|
PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
HCPCS 31030
|
| Min. Negotiated Rate |
$302.46 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Aetna Commercial |
$610.62
|
| Rate for Payer: Aetna Medicare |
$455.69
|
| Rate for Payer: BCBS Complete |
$317.58
|
| Rate for Payer: BCBS MAPPO |
$455.69
|
| Rate for Payer: BCN Commercial |
$774.86
|
| Rate for Payer: BCN Medicare Advantage |
$455.69
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cofinity Commercial |
$656.19
|
| Rate for Payer: Cofinity Commercial |
$610.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.69
|
| Rate for Payer: Healthscope Commercial |
$546.83
|
| Rate for Payer: Healthscope Whirlpool |
$546.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.47
|
| Rate for Payer: Meridian Medicaid |
$317.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$501.26
|
| Rate for Payer: Nomi Health Commercial |
$546.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.25
|
| Rate for Payer: PACE SWMI |
$455.69
|
| Rate for Payer: PHP Medicare Advantage |
$455.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$729.68
|
| Rate for Payer: Priority Health Medicare |
$455.69
|
| Rate for Payer: Priority Health Narrow Network |
$729.68
|
| Rate for Payer: Railroad Medicare Medicare |
$455.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$455.69
|
| Rate for Payer: UHC Exchange |
$880.09
|
| Rate for Payer: UHC Medicaid |
$302.46
|
| Rate for Payer: UHCCP DNSP |
$455.69
|
| Rate for Payer: UHCCP Medicaid |
$302.46
|
|
|
PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP
|
Professional
|
Both
|
$1,923.00
|
|
|
Service Code
|
HCPCS 31051
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$1,442.25 |
| Rate for Payer: Aetna Commercial |
$814.91
|
| Rate for Payer: Aetna Medicare |
$608.14
|
| Rate for Payer: BCBS Complete |
$425.39
|
| Rate for Payer: BCBS MAPPO |
$608.14
|
| Rate for Payer: BCN Commercial |
$1,034.80
|
| Rate for Payer: BCN Medicare Advantage |
$608.14
|
| Rate for Payer: Cash Price |
$1,538.40
|
| Rate for Payer: Cash Price |
$1,538.40
|
| Rate for Payer: Cofinity Commercial |
$814.91
|
| Rate for Payer: Cofinity Commercial |
$875.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.14
|
| Rate for Payer: Healthscope Commercial |
$729.77
|
| Rate for Payer: Healthscope Whirlpool |
$729.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$638.55
|
| Rate for Payer: Meridian Medicaid |
$425.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$668.95
|
| Rate for Payer: Nomi Health Commercial |
$729.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,442.25
|
| Rate for Payer: PACE SWMI |
$608.14
|
| Rate for Payer: PHP Medicare Advantage |
$608.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$974.48
|
| Rate for Payer: Priority Health Medicare |
$608.14
|
| Rate for Payer: Priority Health Narrow Network |
$974.48
|
| Rate for Payer: Railroad Medicare Medicare |
$608.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,135.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$608.14
|
| Rate for Payer: UHC Exchange |
$1,135.63
|
| Rate for Payer: UHC Medicaid |
$405.13
|
| Rate for Payer: UHCCP DNSP |
$608.14
|
| Rate for Payer: UHCCP Medicaid |
$405.13
|
|
|
PR SKIN LESION SHAVE/EXCISION (15 MIN)
|
Professional
|
Both
|
$450.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
|
