|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$334.07 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna Commercial |
$447.65
|
| Rate for Payer: Aetna Medicare |
$334.07
|
| Rate for Payer: BCBS Complete |
$350.77
|
| Rate for Payer: BCBS MAPPO |
$334.07
|
| Rate for Payer: BCN Commercial |
$568.20
|
| Rate for Payer: BCN Medicare Advantage |
$334.07
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cofinity Commercial |
$481.06
|
| Rate for Payer: Cofinity Commercial |
$447.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.07
|
| Rate for Payer: Healthscope Commercial |
$367.48
|
| Rate for Payer: Healthscope Whirlpool |
$367.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.77
|
| Rate for Payer: Meridian Medicaid |
$350.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$367.48
|
| Rate for Payer: Nomi Health Commercial |
$400.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.75
|
| Rate for Payer: PACE SWMI |
$334.07
|
| Rate for Payer: PHP Medicare Advantage |
$334.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$598.52
|
| Rate for Payer: Priority Health Medicare |
$334.07
|
| Rate for Payer: Priority Health Narrow Network |
$598.52
|
| Rate for Payer: Railroad Medicare Medicare |
$334.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$334.07
|
| Rate for Payer: UHC Exchange |
$564.52
|
| Rate for Payer: UHC Medicaid |
$334.07
|
| Rate for Payer: UHCCP DNSP |
$334.07
|
| Rate for Payer: UHCCP Medicaid |
$334.07
|
|
|
PR SUBSEQUENT INJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$302.92 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Aetna Commercial |
$406.31
|
| Rate for Payer: Aetna Medicare |
$303.22
|
| Rate for Payer: BCBS Complete |
$318.07
|
| Rate for Payer: BCBS MAPPO |
$303.22
|
| Rate for Payer: BCN Commercial |
$500.97
|
| Rate for Payer: BCN Medicare Advantage |
$303.22
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cofinity Commercial |
$406.31
|
| Rate for Payer: Cofinity Commercial |
$436.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.22
|
| Rate for Payer: Healthscope Commercial |
$333.54
|
| Rate for Payer: Healthscope Whirlpool |
$333.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.38
|
| Rate for Payer: Meridian Medicaid |
$318.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.54
|
| Rate for Payer: Nomi Health Commercial |
$363.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.50
|
| Rate for Payer: PACE SWMI |
$303.22
|
| Rate for Payer: PHP Medicare Advantage |
$303.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$450.63
|
| Rate for Payer: Priority Health Medicare |
$303.22
|
| Rate for Payer: Priority Health Narrow Network |
$450.63
|
| Rate for Payer: Railroad Medicare Medicare |
$303.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$491.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.22
|
| Rate for Payer: UHC Exchange |
$491.05
|
| Rate for Payer: UHC Medicaid |
$302.92
|
| Rate for Payer: UHCCP DNSP |
$303.22
|
| Rate for Payer: UHCCP Medicaid |
$302.92
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$348.52 |
| Max. Negotiated Rate |
$619.98 |
| Rate for Payer: Aetna Commercial |
$467.02
|
| Rate for Payer: Aetna Medicare |
$348.52
|
| Rate for Payer: BCBS Complete |
$365.95
|
| Rate for Payer: BCBS MAPPO |
$348.52
|
| Rate for Payer: BCN Commercial |
$590.60
|
| Rate for Payer: BCN Medicare Advantage |
$348.52
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$501.87
|
| Rate for Payer: Cofinity Commercial |
$467.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.52
|
| Rate for Payer: Healthscope Commercial |
$383.37
|
| Rate for Payer: Healthscope Whirlpool |
$383.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.95
|
| Rate for Payer: Meridian Medicaid |
$365.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.37
|
| Rate for Payer: Nomi Health Commercial |
$418.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.75
|
| Rate for Payer: PACE SWMI |
$348.52
|
| Rate for Payer: PHP Medicare Advantage |
$348.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$619.98
|
| Rate for Payer: Priority Health Medicare |
$348.52
|
| Rate for Payer: Priority Health Narrow Network |
$619.98
|
| Rate for Payer: Railroad Medicare Medicare |
$348.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$348.52
|
| Rate for Payer: UHC Exchange |
$570.29
|
| Rate for Payer: UHC Medicaid |
$348.52
|
| Rate for Payer: UHCCP DNSP |
$348.52
|
| Rate for Payer: UHCCP Medicaid |
$348.52
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$4,363.00
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$910.58 |
| Max. Negotiated Rate |
$3,272.25 |
| Rate for Payer: Aetna Commercial |
$1,903.31
|
| Rate for Payer: Aetna Medicare |
$1,420.38
|
| Rate for Payer: BCBS Complete |
$956.11
|
| Rate for Payer: BCBS MAPPO |
$1,420.38
|
| Rate for Payer: BCN Commercial |
$3,041.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,420.38
|
| Rate for Payer: Cash Price |
$3,490.40
|
| Rate for Payer: Cash Price |
$3,490.40
|
| Rate for Payer: Cofinity Commercial |
$2,045.35
|
| Rate for Payer: Cofinity Commercial |
$1,903.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,420.38
|
| Rate for Payer: Healthscope Commercial |
$1,704.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,491.40
|
| Rate for Payer: Meridian Medicaid |
$956.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,562.42
|
| Rate for Payer: Nomi Health Commercial |
$1,704.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,272.25
|
| Rate for Payer: PACE SWMI |
$1,420.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,420.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$910.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,557.09
|
| Rate for Payer: Priority Health Medicare |
$1,420.38
|
| Rate for Payer: Priority Health Narrow Network |
$2,557.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,420.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,536.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,420.38
|
| Rate for Payer: UHC Exchange |
$2,536.12
|
| Rate for Payer: UHC Medicaid |
$910.58
|
| Rate for Payer: UHCCP DNSP |
$1,420.38
|
| Rate for Payer: UHCCP Medicaid |
$910.58
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Commercial |
$367.50
|
| Rate for Payer: BCBS Complete |
$488.01
|
| Rate for Payer: BCN Commercial |
$878.21
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Meridian Medicaid |
$488.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.36
|
| Rate for Payer: Priority Health Narrow Network |
$217.36
|
| Rate for Payer: UHC Medicaid |
$464.77
|
| Rate for Payer: UHCCP Medicaid |
$464.77
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$3,257.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: BCN Commercial |
$900.16
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.36
|
| Rate for Payer: Priority Health Narrow Network |
$217.36
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$2,127.75 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: BCN Commercial |
$878.21
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.36
|
| Rate for Payer: Priority Health Narrow Network |
$217.36
|
|
|
PR SUMATRIPTAN SUCCINATE / 6 MG
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS J3030
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$60.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.00
|
| Rate for Payer: UHC Exchange |
$49.00
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.22
|
| Rate for Payer: Priority Health Narrow Network |
$71.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.67
|
| Rate for Payer: UHC Exchange |
$80.67
|
|
|
PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99485
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Commercial |
$75.97
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCN Commercial |
$108.06
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.20
|
| Rate for Payer: Priority Health Narrow Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.70
|
| Rate for Payer: UHC Exchange |
$109.70
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 99379
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.22
|
| Rate for Payer: Priority Health Narrow Network |
$71.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.67
|
| Rate for Payer: UHC Exchange |
$80.67
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: BCN Commercial |
$125.99
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.34
|
| Rate for Payer: Priority Health Narrow Network |
$113.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.74
|
| Rate for Payer: UHC Exchange |
$126.74
|
|
|
PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 99375
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCN Commercial |
$125.99
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$113.34
|
| Rate for Payer: Priority Health Narrow Network |
$113.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.74
|
| Rate for Payer: UHC Exchange |
$126.74
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,337.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$552.74 |
| Max. Negotiated Rate |
$2,502.75 |
| Rate for Payer: Aetna Commercial |
$1,152.73
|
| Rate for Payer: Aetna Medicare |
$860.25
|
| Rate for Payer: BCBS Complete |
$580.38
|
| Rate for Payer: BCBS MAPPO |
$860.25
|
| Rate for Payer: BCN Commercial |
$1,442.65
|
| Rate for Payer: BCN Medicare Advantage |
$860.25
|
| Rate for Payer: Cash Price |
$2,669.60
|
| Rate for Payer: Cash Price |
$2,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,238.76
|
| Rate for Payer: Cofinity Commercial |
$1,152.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.25
|
| Rate for Payer: Healthscope Commercial |
$1,032.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.26
|
| Rate for Payer: Meridian Medicaid |
$580.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$946.27
|
| Rate for Payer: Nomi Health Commercial |
$1,032.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,502.75
|
| Rate for Payer: PACE SWMI |
$860.25
|
| Rate for Payer: PHP Medicare Advantage |
$860.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,461.10
|
| Rate for Payer: Priority Health Medicare |
$860.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,461.10
|
| Rate for Payer: Railroad Medicare Medicare |
$860.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,702.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$860.25
|
| Rate for Payer: UHC Exchange |
$1,702.02
|
| Rate for Payer: UHC Medicaid |
$552.74
|
| Rate for Payer: UHCCP DNSP |
$860.25
|
| Rate for Payer: UHCCP Medicaid |
$552.74
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$452.84 |
| Max. Negotiated Rate |
$1,616.74 |
| Rate for Payer: Aetna Commercial |
$936.04
|
| Rate for Payer: Aetna Medicare |
$698.54
|
| Rate for Payer: BCBS Complete |
$475.48
|
| Rate for Payer: BCBS MAPPO |
$698.54
|
| Rate for Payer: BCN Commercial |
$1,215.07
|
| Rate for Payer: BCN Medicare Advantage |
$698.54
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cofinity Commercial |
$936.04
|
| Rate for Payer: Cofinity Commercial |
$1,005.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.54
|
| Rate for Payer: Healthscope Commercial |
$838.25
|
| Rate for Payer: Healthscope Whirlpool |
$838.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$733.47
|
| Rate for Payer: Meridian Medicaid |
$475.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$768.39
|
| Rate for Payer: Nomi Health Commercial |
$838.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,128.00
|
| Rate for Payer: PACE SWMI |
$698.54
|
| Rate for Payer: PHP Medicare Advantage |
$698.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$452.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,616.74
|
| Rate for Payer: Priority Health Medicare |
$698.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,616.74
|
| Rate for Payer: Railroad Medicare Medicare |
$698.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,404.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$698.54
|
| Rate for Payer: UHC Exchange |
$1,404.32
|
| Rate for Payer: UHC Medicaid |
$452.84
|
| Rate for Payer: UHCCP DNSP |
$698.54
|
| Rate for Payer: UHCCP Medicaid |
$452.84
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$194.47 |
| Max. Negotiated Rate |
$637.83 |
| Rate for Payer: Aetna Commercial |
$409.32
|
| Rate for Payer: Aetna Medicare |
$305.46
|
| Rate for Payer: BCBS Complete |
$204.19
|
| Rate for Payer: BCBS MAPPO |
$305.46
|
| Rate for Payer: BCN Commercial |
$515.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.46
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$439.86
|
| Rate for Payer: Cofinity Commercial |
$409.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.46
|
| Rate for Payer: Healthscope Commercial |
$366.55
|
| Rate for Payer: Healthscope Whirlpool |
$366.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.73
|
| Rate for Payer: Meridian Medicaid |
$204.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.01
|
| Rate for Payer: Nomi Health Commercial |
$366.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PACE SWMI |
$305.46
|
| Rate for Payer: PHP Medicare Advantage |
$305.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$554.26
|
| Rate for Payer: Priority Health Medicare |
$305.46
|
| Rate for Payer: Priority Health Narrow Network |
$554.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.46
|
| Rate for Payer: UHC Exchange |
$637.83
|
| Rate for Payer: UHC Medicaid |
$194.47
|
| Rate for Payer: UHCCP DNSP |
$305.46
|
| Rate for Payer: UHCCP Medicaid |
$194.47
|
|
|
PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 99374
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.22
|
| Rate for Payer: Priority Health Narrow Network |
$71.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.67
|
| Rate for Payer: UHC Exchange |
$80.67
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 31820
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$391.63
|
| Rate for Payer: Aetna Medicare |
$292.26
|
| Rate for Payer: BCBS Complete |
$201.06
|
| Rate for Payer: BCBS MAPPO |
$292.26
|
| Rate for Payer: BCN Commercial |
$499.48
|
| Rate for Payer: BCN Medicare Advantage |
$292.26
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$420.85
|
| Rate for Payer: Cofinity Commercial |
$391.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.26
|
| Rate for Payer: Healthscope Commercial |
$350.71
|
| Rate for Payer: Healthscope Whirlpool |
$350.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.87
|
| Rate for Payer: Meridian Medicaid |
$201.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$321.49
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PACE SWMI |
$292.26
|
| Rate for Payer: PHP Medicare Advantage |
$292.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$470.36
|
| Rate for Payer: Priority Health Medicare |
$292.26
|
| Rate for Payer: Priority Health Narrow Network |
$470.36
|
| Rate for Payer: Railroad Medicare Medicare |
$292.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$292.26
|
| Rate for Payer: UHC Exchange |
$564.91
|
| Rate for Payer: UHC Medicaid |
$191.49
|
| Rate for Payer: UHCCP DNSP |
$292.26
|
| Rate for Payer: UHCCP Medicaid |
$191.49
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 31825
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$828.99 |
| Rate for Payer: Aetna Commercial |
$563.20
|
| Rate for Payer: Aetna Medicare |
$420.30
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS MAPPO |
$420.30
|
| Rate for Payer: BCN Commercial |
$732.03
|
| Rate for Payer: BCN Medicare Advantage |
$420.30
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cofinity Commercial |
$605.23
|
| Rate for Payer: Cofinity Commercial |
$563.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.30
|
| Rate for Payer: Healthscope Commercial |
$504.36
|
| Rate for Payer: Healthscope Whirlpool |
$504.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.31
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$462.33
|
| Rate for Payer: Nomi Health Commercial |
$504.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$796.50
|
| Rate for Payer: PACE SWMI |
$420.30
|
| Rate for Payer: PHP Medicare Advantage |
$420.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$689.35
|
| Rate for Payer: Priority Health Medicare |
$420.30
|
| Rate for Payer: Priority Health Narrow Network |
$689.35
|
| Rate for Payer: Railroad Medicare Medicare |
$420.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$828.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$420.30
|
| Rate for Payer: UHC Exchange |
$828.99
|
| Rate for Payer: UHC Medicaid |
$274.34
|
| Rate for Payer: UHCCP DNSP |
$420.30
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$3,066.00
|
|
|
Service Code
|
HCPCS 29828
|
| Min. Negotiated Rate |
$538.04 |
| Max. Negotiated Rate |
$2,299.50 |
| Rate for Payer: Aetna Commercial |
$1,107.11
|
| Rate for Payer: Aetna Medicare |
$826.20
|
| Rate for Payer: BCBS Complete |
$564.94
|
| Rate for Payer: BCBS MAPPO |
$826.20
|
| Rate for Payer: BCN Commercial |
$1,389.36
|
| Rate for Payer: BCN Medicare Advantage |
$826.20
|
| Rate for Payer: Cash Price |
$2,452.80
|
| Rate for Payer: Cash Price |
$2,452.80
|
| Rate for Payer: Cofinity Commercial |
$1,189.73
|
| Rate for Payer: Cofinity Commercial |
$1,107.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.20
|
| Rate for Payer: Healthscope Commercial |
$991.44
|
| Rate for Payer: Healthscope Whirlpool |
$991.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.51
|
| Rate for Payer: Meridian Medicaid |
$564.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$908.82
|
| Rate for Payer: Nomi Health Commercial |
$991.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,299.50
|
| Rate for Payer: PACE SWMI |
$826.20
|
| Rate for Payer: PHP Medicare Advantage |
$826.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,485.20
|
| Rate for Payer: Priority Health Medicare |
$826.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,485.20
|
| Rate for Payer: Railroad Medicare Medicare |
$826.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,607.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$826.20
|
| Rate for Payer: UHC Exchange |
$1,607.33
|
| Rate for Payer: UHC Medicaid |
$538.04
|
| Rate for Payer: UHCCP DNSP |
$826.20
|
| Rate for Payer: UHCCP Medicaid |
$538.04
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Professional
|
Both
|
$3,333.00
|
|
|
Service Code
|
HCPCS 29806
|
| Min. Negotiated Rate |
$620.47 |
| Max. Negotiated Rate |
$2,499.75 |
| Rate for Payer: Aetna Commercial |
$1,277.02
|
| Rate for Payer: Aetna Medicare |
$953.00
|
| Rate for Payer: BCBS Complete |
$651.49
|
| Rate for Payer: BCBS MAPPO |
$953.00
|
| Rate for Payer: BCN Commercial |
$1,604.50
|
| Rate for Payer: BCN Medicare Advantage |
$953.00
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cofinity Commercial |
$1,372.32
|
| Rate for Payer: Cofinity Commercial |
$1,277.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.00
|
| Rate for Payer: Healthscope Commercial |
$1,143.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,000.65
|
| Rate for Payer: Meridian Medicaid |
$651.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,048.30
|
| Rate for Payer: Nomi Health Commercial |
$1,143.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,499.75
|
| Rate for Payer: PACE SWMI |
$953.00
|
| Rate for Payer: PHP Medicare Advantage |
$953.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$620.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,715.15
|
| Rate for Payer: Priority Health Medicare |
$953.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.15
|
| Rate for Payer: Railroad Medicare Medicare |
$953.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,850.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$953.00
|
| Rate for Payer: UHC Exchange |
$1,850.94
|
| Rate for Payer: UHC Medicaid |
$620.47
|
| Rate for Payer: UHCCP DNSP |
$953.00
|
| Rate for Payer: UHCCP Medicaid |
$620.47
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 29821
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,751.25 |
| Rate for Payer: Aetna Commercial |
$726.84
|
| Rate for Payer: Aetna Medicare |
$542.42
|
| Rate for Payer: BCBS Complete |
$373.27
|
| Rate for Payer: BCBS MAPPO |
$542.42
|
| Rate for Payer: BCN Commercial |
$908.32
|
| Rate for Payer: BCN Medicare Advantage |
$542.42
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cofinity Commercial |
$781.08
|
| Rate for Payer: Cofinity Commercial |
$726.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$542.42
|
| Rate for Payer: Healthscope Commercial |
$650.90
|
| Rate for Payer: Healthscope Whirlpool |
$650.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$569.54
|
| Rate for Payer: Meridian Medicaid |
$373.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$596.66
|
| Rate for Payer: Nomi Health Commercial |
$650.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,751.25
|
| Rate for Payer: PACE SWMI |
$542.42
|
| Rate for Payer: PHP Medicare Advantage |
$542.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$970.97
|
| Rate for Payer: Priority Health Medicare |
$542.42
|
| Rate for Payer: Priority Health Narrow Network |
$970.97
|
| Rate for Payer: Railroad Medicare Medicare |
$542.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,032.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$542.42
|
| Rate for Payer: UHC Exchange |
$1,032.62
|
| Rate for Payer: UHC Medicaid |
$355.50
|
| Rate for Payer: UHCCP DNSP |
$542.42
|
| Rate for Payer: UHCCP Medicaid |
$355.50
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
HCPCS 29824
|
| Min. Negotiated Rate |
$407.47 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna Commercial |
$832.84
|
| Rate for Payer: Aetna Medicare |
$621.52
|
| Rate for Payer: BCBS Complete |
$427.84
|
| Rate for Payer: BCBS MAPPO |
$621.52
|
| Rate for Payer: BCN Commercial |
$1,136.26
|
| Rate for Payer: BCN Medicare Advantage |
$621.52
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cofinity Commercial |
$894.99
|
| Rate for Payer: Cofinity Commercial |
$832.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.52
|
| Rate for Payer: Healthscope Commercial |
$745.82
|
| Rate for Payer: Healthscope Whirlpool |
$745.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.60
|
| Rate for Payer: Meridian Medicaid |
$427.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$683.67
|
| Rate for Payer: Nomi Health Commercial |
$745.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,624.50
|
| Rate for Payer: PACE SWMI |
$621.52
|
| Rate for Payer: PHP Medicare Advantage |
$621.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$621.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,105.65
|
| Rate for Payer: Railroad Medicare Medicare |
$621.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,175.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$621.52
|
| Rate for Payer: UHC Exchange |
$1,175.04
|
| Rate for Payer: UHC Medicaid |
$407.47
|
| Rate for Payer: UHCCP DNSP |
$621.52
|
| Rate for Payer: UHCCP Medicaid |
$407.47
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 29822
|
| Min. Negotiated Rate |
$329.09 |
| Max. Negotiated Rate |
$1,700.25 |
| Rate for Payer: Aetna Commercial |
$671.65
|
| Rate for Payer: Aetna Medicare |
$501.23
|
| Rate for Payer: BCBS Complete |
$345.54
|
| Rate for Payer: BCBS MAPPO |
$501.23
|
| Rate for Payer: BCN Commercial |
$911.42
|
| Rate for Payer: BCN Medicare Advantage |
$501.23
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$721.77
|
| Rate for Payer: Cofinity Commercial |
$671.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$501.23
|
| Rate for Payer: Healthscope Commercial |
$601.48
|
| Rate for Payer: Healthscope Whirlpool |
$601.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$526.29
|
| Rate for Payer: Meridian Medicaid |
$345.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$551.35
|
| Rate for Payer: Nomi Health Commercial |
$601.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,700.25
|
| Rate for Payer: PACE SWMI |
$501.23
|
| Rate for Payer: PHP Medicare Advantage |
$501.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$886.85
|
| Rate for Payer: Priority Health Medicare |
$501.23
|
| Rate for Payer: Priority Health Narrow Network |
$886.85
|
| Rate for Payer: Railroad Medicare Medicare |
$501.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,003.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$501.23
|
| Rate for Payer: UHC Exchange |
$1,003.81
|
| Rate for Payer: UHC Medicaid |
$329.09
|
| Rate for Payer: UHCCP DNSP |
$501.23
|
| Rate for Payer: UHCCP Medicaid |
$329.09
|
|
