|
PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY
|
Professional
|
Both
|
$3,550.00
|
|
|
Service Code
|
HCPCS 53854
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$2,307.50 |
| Rate for Payer: Aetna Commercial |
$487.40
|
| Rate for Payer: Aetna Medicare |
$363.73
|
| Rate for Payer: BCBS Complete |
$1,420.00
|
| Rate for Payer: BCBS MAPPO |
$363.73
|
| Rate for Payer: BCN Medicare Advantage |
$363.73
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cofinity Commercial |
$523.77
|
| Rate for Payer: Cofinity Commercial |
$487.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.73
|
| Rate for Payer: Healthscope Commercial |
$436.48
|
| Rate for Payer: Healthscope Whirlpool |
$436.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.92
|
| Rate for Payer: Nomi Health Commercial |
$436.48
|
| Rate for Payer: PACE SWMI |
$363.73
|
| Rate for Payer: PHP Medicare Advantage |
$363.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,307.50
|
| Rate for Payer: Priority Health Medicare |
$363.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.73
|
| Rate for Payer: UHC Medicare Advantage |
$363.73
|
| Rate for Payer: UHCCP DNSP |
$363.73
|
|
|
PR TRURL DSTRJ PRSTATE TISS RF THERMOTH
|
Professional
|
Both
|
$2,935.00
|
|
|
Service Code
|
HCPCS 53852
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$1,907.75 |
| Rate for Payer: Aetna Commercial |
$487.40
|
| Rate for Payer: Aetna Medicare |
$363.73
|
| Rate for Payer: BCBS Complete |
$1,174.00
|
| Rate for Payer: BCBS MAPPO |
$363.73
|
| Rate for Payer: BCN Medicare Advantage |
$363.73
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cofinity Commercial |
$523.77
|
| Rate for Payer: Cofinity Commercial |
$487.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.73
|
| Rate for Payer: Healthscope Commercial |
$436.48
|
| Rate for Payer: Healthscope Whirlpool |
$436.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.92
|
| Rate for Payer: Nomi Health Commercial |
$436.48
|
| Rate for Payer: PACE SWMI |
$363.73
|
| Rate for Payer: PHP Medicare Advantage |
$363.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.75
|
| Rate for Payer: Priority Health Medicare |
$363.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.73
|
| Rate for Payer: UHC Medicare Advantage |
$363.73
|
| Rate for Payer: UHCCP DNSP |
$363.73
|
|
|
PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 52601
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$1,033.50 |
| Rate for Payer: Aetna Commercial |
$932.00
|
| Rate for Payer: Aetna Medicare |
$695.52
|
| Rate for Payer: BCBS Complete |
$636.00
|
| Rate for Payer: BCBS MAPPO |
$695.52
|
| Rate for Payer: BCN Medicare Advantage |
$695.52
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Commercial |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$1,001.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$834.62
|
| Rate for Payer: Healthscope Whirlpool |
$834.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.30
|
| Rate for Payer: Nomi Health Commercial |
$834.62
|
| Rate for Payer: PACE SWMI |
$695.52
|
| Rate for Payer: PHP Medicare Advantage |
$695.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.50
|
| Rate for Payer: Priority Health Medicare |
$695.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.52
|
| Rate for Payer: UHC Medicare Advantage |
$695.52
|
| Rate for Payer: UHCCP DNSP |
$695.52
|
|
|
PR TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 52640
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$470.60 |
| Rate for Payer: Aetna Commercial |
$413.73
|
| Rate for Payer: Aetna Medicare |
$308.75
|
| Rate for Payer: BCBS Complete |
$289.60
|
| Rate for Payer: BCBS MAPPO |
$308.75
|
| Rate for Payer: BCN Medicare Advantage |
$308.75
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$444.60
|
| Rate for Payer: Cofinity Commercial |
$413.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.75
|
| Rate for Payer: Healthscope Commercial |
$370.50
|
| Rate for Payer: Healthscope Whirlpool |
$370.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.19
|
| Rate for Payer: Nomi Health Commercial |
$370.50
|
| Rate for Payer: PACE SWMI |
$308.75
|
| Rate for Payer: PHP Medicare Advantage |
$308.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$308.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.75
|
| Rate for Payer: UHC Medicare Advantage |
$308.75
|
| Rate for Payer: UHCCP DNSP |
$308.75
|
|
|
PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 52630
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$559.27 |
| Rate for Payer: Aetna Commercial |
$520.43
|
| Rate for Payer: Aetna Medicare |
$388.38
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$388.38
|
| Rate for Payer: BCN Medicare Advantage |
$388.38
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$559.27
|
| Rate for Payer: Cofinity Commercial |
$520.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.38
|
| Rate for Payer: Healthscope Commercial |
$466.06
|
| Rate for Payer: Healthscope Whirlpool |
$466.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.80
|
| Rate for Payer: Nomi Health Commercial |
$466.06
|
| Rate for Payer: PACE SWMI |
$388.38
|
| Rate for Payer: PHP Medicare Advantage |
$388.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$388.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.38
|
| Rate for Payer: UHC Medicare Advantage |
$388.38
|
| Rate for Payer: UHCCP DNSP |
$388.38
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 95921
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$114.12 |
| Rate for Payer: Aetna Commercial |
$106.19
|
| Rate for Payer: Aetna Medicare |
$79.25
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$79.25
|
| Rate for Payer: BCN Medicare Advantage |
$79.25
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$114.12
|
| Rate for Payer: Cofinity Commercial |
$106.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.25
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Healthscope Whirlpool |
$95.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.21
|
| Rate for Payer: Nomi Health Commercial |
$95.10
|
| Rate for Payer: PACE SWMI |
$79.25
|
| Rate for Payer: PHP Medicare Advantage |
$79.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$79.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.25
|
| Rate for Payer: UHC Medicare Advantage |
$79.25
|
| Rate for Payer: UHCCP DNSP |
$79.25
|
|
|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 95924
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$195.52 |
| Rate for Payer: Aetna Commercial |
$181.95
|
| Rate for Payer: Aetna Medicare |
$135.78
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$135.78
|
| Rate for Payer: BCN Medicare Advantage |
$135.78
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$181.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.78
|
| Rate for Payer: Healthscope Commercial |
$162.94
|
| Rate for Payer: Healthscope Whirlpool |
$162.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.57
|
| Rate for Payer: Nomi Health Commercial |
$162.94
|
| Rate for Payer: PACE SWMI |
$135.78
|
| Rate for Payer: PHP Medicare Advantage |
$135.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$135.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.78
|
| Rate for Payer: UHC Medicare Advantage |
$135.78
|
| Rate for Payer: UHCCP DNSP |
$135.78
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 95922
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna Medicare |
$81.66
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$117.59
|
| Rate for Payer: Cofinity Commercial |
$109.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Healthscope Commercial |
$97.99
|
| Rate for Payer: Healthscope Whirlpool |
$97.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.74
|
| Rate for Payer: Nomi Health Commercial |
$97.99
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$81.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.66
|
| Rate for Payer: UHC Medicare Advantage |
$81.66
|
| Rate for Payer: UHCCP DNSP |
$81.66
|
|
|
PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 31730
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Aetna Commercial |
$193.52
|
| Rate for Payer: Aetna Medicare |
$144.42
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$144.42
|
| Rate for Payer: BCN Medicare Advantage |
$144.42
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$207.96
|
| Rate for Payer: Cofinity Commercial |
$193.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$173.30
|
| Rate for Payer: Healthscope Whirlpool |
$173.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.64
|
| Rate for Payer: Nomi Health Commercial |
$173.30
|
| Rate for Payer: PACE SWMI |
$144.42
|
| Rate for Payer: PHP Medicare Advantage |
$144.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$144.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.42
|
| Rate for Payer: UHC Medicare Advantage |
$144.42
|
| Rate for Payer: UHCCP DNSP |
$144.42
|
|
|
PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 44015
|
| Min. Negotiated Rate |
$136.65 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$183.11
|
| Rate for Payer: Aetna Medicare |
$136.65
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$136.65
|
| Rate for Payer: BCN Medicare Advantage |
$136.65
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$196.78
|
| Rate for Payer: Cofinity Commercial |
$183.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.65
|
| Rate for Payer: Healthscope Commercial |
$163.98
|
| Rate for Payer: Healthscope Whirlpool |
$163.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.48
|
| Rate for Payer: Nomi Health Commercial |
$163.98
|
| Rate for Payer: PACE SWMI |
$136.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$136.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.65
|
| Rate for Payer: UHC Medicare Advantage |
$136.65
|
| Rate for Payer: UHCCP DNSP |
$136.65
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 32551
|
| Min. Negotiated Rate |
$149.09 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$199.78
|
| Rate for Payer: Aetna Medicare |
$149.09
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: BCBS MAPPO |
$149.09
|
| Rate for Payer: BCN Medicare Advantage |
$149.09
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$214.69
|
| Rate for Payer: Cofinity Commercial |
$199.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.09
|
| Rate for Payer: Healthscope Commercial |
$178.91
|
| Rate for Payer: Healthscope Whirlpool |
$178.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.54
|
| Rate for Payer: Nomi Health Commercial |
$178.91
|
| Rate for Payer: PACE SWMI |
$149.09
|
| Rate for Payer: PHP Medicare Advantage |
$149.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health Medicare |
$149.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.09
|
| Rate for Payer: UHC Medicare Advantage |
$149.09
|
| Rate for Payer: UHCCP DNSP |
$149.09
|
|
|
PR TUBOTUBAL ANASTATOMOSIS
|
Professional
|
Both
|
$1,653.00
|
|
|
Service Code
|
HCPCS 58750
|
| Min. Negotiated Rate |
$661.20 |
| Max. Negotiated Rate |
$1,258.33 |
| Rate for Payer: Aetna Commercial |
$1,170.95
|
| Rate for Payer: Aetna Medicare |
$873.84
|
| Rate for Payer: BCBS Complete |
$661.20
|
| Rate for Payer: BCBS MAPPO |
$873.84
|
| Rate for Payer: BCN Medicare Advantage |
$873.84
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.33
|
| Rate for Payer: Cofinity Commercial |
$1,170.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.84
|
| Rate for Payer: Healthscope Commercial |
$1,048.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,048.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.53
|
| Rate for Payer: Nomi Health Commercial |
$1,048.61
|
| Rate for Payer: PACE SWMI |
$873.84
|
| Rate for Payer: PHP Medicare Advantage |
$873.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.45
|
| Rate for Payer: Priority Health Medicare |
$873.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.84
|
| Rate for Payer: UHC Medicare Advantage |
$873.84
|
| Rate for Payer: UHCCP DNSP |
$873.84
|
|
|
PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
HCPCS 61108
|
| Min. Negotiated Rate |
$895.06 |
| Max. Negotiated Rate |
$2,541.50 |
| Rate for Payer: Aetna Commercial |
$1,199.38
|
| Rate for Payer: Aetna Medicare |
$895.06
|
| Rate for Payer: BCBS Complete |
$1,564.00
|
| Rate for Payer: BCBS MAPPO |
$895.06
|
| Rate for Payer: BCN Medicare Advantage |
$895.06
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.89
|
| Rate for Payer: Cofinity Commercial |
$1,199.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$895.06
|
| Rate for Payer: Healthscope Commercial |
$1,074.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,074.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$939.81
|
| Rate for Payer: Nomi Health Commercial |
$1,074.07
|
| Rate for Payer: PACE SWMI |
$895.06
|
| Rate for Payer: PHP Medicare Advantage |
$895.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,541.50
|
| Rate for Payer: Priority Health Medicare |
$895.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$895.06
|
| Rate for Payer: UHC Medicare Advantage |
$895.06
|
| Rate for Payer: UHCCP DNSP |
$895.06
|
|
|
PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Professional
|
Both
|
$2,479.00
|
|
|
Service Code
|
HCPCS 61107
|
| Min. Negotiated Rate |
$309.66 |
| Max. Negotiated Rate |
$1,611.35 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$309.66
|
| Rate for Payer: BCBS Complete |
$991.60
|
| Rate for Payer: BCBS MAPPO |
$309.66
|
| Rate for Payer: BCN Medicare Advantage |
$309.66
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cofinity Commercial |
$445.91
|
| Rate for Payer: Cofinity Commercial |
$414.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.66
|
| Rate for Payer: Healthscope Commercial |
$371.59
|
| Rate for Payer: Healthscope Whirlpool |
$371.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.14
|
| Rate for Payer: Nomi Health Commercial |
$371.59
|
| Rate for Payer: PACE SWMI |
$309.66
|
| Rate for Payer: PHP Medicare Advantage |
$309.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,611.35
|
| Rate for Payer: Priority Health Medicare |
$309.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.66
|
| Rate for Payer: UHC Medicare Advantage |
$309.66
|
| Rate for Payer: UHCCP DNSP |
$309.66
|
|
|
PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 61105
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,396.85 |
| Rate for Payer: Aetna Commercial |
$615.86
|
| Rate for Payer: Aetna Medicare |
$459.60
|
| Rate for Payer: BCBS Complete |
$859.60
|
| Rate for Payer: BCBS MAPPO |
$459.60
|
| Rate for Payer: BCN Medicare Advantage |
$459.60
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cofinity Commercial |
$661.82
|
| Rate for Payer: Cofinity Commercial |
$615.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.60
|
| Rate for Payer: Healthscope Commercial |
$551.52
|
| Rate for Payer: Healthscope Whirlpool |
$551.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.58
|
| Rate for Payer: Nomi Health Commercial |
$551.52
|
| Rate for Payer: PACE SWMI |
$459.60
|
| Rate for Payer: PHP Medicare Advantage |
$459.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.85
|
| Rate for Payer: Priority Health Medicare |
$459.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.60
|
| Rate for Payer: UHC Medicare Advantage |
$459.60
|
| Rate for Payer: UHCCP DNSP |
$459.60
|
|
|
PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 00528
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
|
|
PR TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 46280
|
| Min. Negotiated Rate |
$460.26 |
| Max. Negotiated Rate |
$952.25 |
| Rate for Payer: Aetna Commercial |
$616.75
|
| Rate for Payer: Aetna Medicare |
$460.26
|
| Rate for Payer: BCBS Complete |
$586.00
|
| Rate for Payer: BCBS MAPPO |
$460.26
|
| Rate for Payer: BCN Medicare Advantage |
$460.26
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cofinity Commercial |
$662.77
|
| Rate for Payer: Cofinity Commercial |
$616.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.26
|
| Rate for Payer: Healthscope Commercial |
$552.31
|
| Rate for Payer: Healthscope Whirlpool |
$552.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.27
|
| Rate for Payer: Nomi Health Commercial |
$552.31
|
| Rate for Payer: PACE SWMI |
$460.26
|
| Rate for Payer: PHP Medicare Advantage |
$460.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.25
|
| Rate for Payer: Priority Health Medicare |
$460.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.26
|
| Rate for Payer: UHC Medicare Advantage |
$460.26
|
| Rate for Payer: UHCCP DNSP |
$460.26
|
|
|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,333.45 |
| Rate for Payer: Aetna Commercial |
$1,240.85
|
| Rate for Payer: Aetna Medicare |
$926.01
|
| Rate for Payer: BCBS Complete |
$602.00
|
| Rate for Payer: BCBS MAPPO |
$926.01
|
| Rate for Payer: BCN Medicare Advantage |
$926.01
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.45
|
| Rate for Payer: Cofinity Commercial |
$1,240.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.01
|
| Rate for Payer: Healthscope Commercial |
$1,111.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.31
|
| Rate for Payer: Nomi Health Commercial |
$1,111.21
|
| Rate for Payer: PACE SWMI |
$926.01
|
| Rate for Payer: PHP Medicare Advantage |
$926.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health Medicare |
$926.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$926.01
|
| Rate for Payer: UHC Medicare Advantage |
$926.01
|
| Rate for Payer: UHCCP DNSP |
$926.01
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$1,146.64 |
| Rate for Payer: Aetna Commercial |
$1,067.02
|
| Rate for Payer: Aetna Medicare |
$796.28
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$796.28
|
| Rate for Payer: BCN Medicare Advantage |
$796.28
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$1,146.64
|
| Rate for Payer: Cofinity Commercial |
$1,067.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.28
|
| Rate for Payer: Healthscope Commercial |
$955.54
|
| Rate for Payer: Healthscope Whirlpool |
$955.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.09
|
| Rate for Payer: Nomi Health Commercial |
$955.54
|
| Rate for Payer: PACE SWMI |
$796.28
|
| Rate for Payer: PHP Medicare Advantage |
$796.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$796.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.28
|
| Rate for Payer: UHC Medicare Advantage |
$796.28
|
| Rate for Payer: UHCCP DNSP |
$796.28
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$726.80 |
| Max. Negotiated Rate |
$1,265.80 |
| Rate for Payer: Aetna Commercial |
$1,177.90
|
| Rate for Payer: Aetna Medicare |
$879.03
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$879.03
|
| Rate for Payer: BCN Medicare Advantage |
$879.03
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,265.80
|
| Rate for Payer: Cofinity Commercial |
$1,177.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$879.03
|
| Rate for Payer: Healthscope Commercial |
$1,054.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,054.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.98
|
| Rate for Payer: Nomi Health Commercial |
$1,054.84
|
| Rate for Payer: PACE SWMI |
$879.03
|
| Rate for Payer: PHP Medicare Advantage |
$879.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health Medicare |
$879.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$879.03
|
| Rate for Payer: UHC Medicare Advantage |
$879.03
|
| Rate for Payer: UHCCP DNSP |
$879.03
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,147.61 |
| Rate for Payer: Aetna Commercial |
$1,067.91
|
| Rate for Payer: Aetna Medicare |
$796.95
|
| Rate for Payer: BCBS Complete |
$586.80
|
| Rate for Payer: BCBS MAPPO |
$796.95
|
| Rate for Payer: BCN Medicare Advantage |
$796.95
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,147.61
|
| Rate for Payer: Cofinity Commercial |
$1,067.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.95
|
| Rate for Payer: Healthscope Commercial |
$956.34
|
| Rate for Payer: Healthscope Whirlpool |
$956.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.80
|
| Rate for Payer: Nomi Health Commercial |
$956.34
|
| Rate for Payer: PACE SWMI |
$796.95
|
| Rate for Payer: PHP Medicare Advantage |
$796.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health Medicare |
$796.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.95
|
| Rate for Payer: UHC Medicare Advantage |
$796.95
|
| Rate for Payer: UHCCP DNSP |
$796.95
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,514.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$828.71 |
| Max. Negotiated Rate |
$2,284.10 |
| Rate for Payer: Aetna Commercial |
$1,110.47
|
| Rate for Payer: Aetna Medicare |
$828.71
|
| Rate for Payer: BCBS Complete |
$1,405.60
|
| Rate for Payer: BCBS MAPPO |
$828.71
|
| Rate for Payer: BCN Medicare Advantage |
$828.71
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,193.34
|
| Rate for Payer: Cofinity Commercial |
$1,110.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.71
|
| Rate for Payer: Healthscope Commercial |
$994.45
|
| Rate for Payer: Healthscope Whirlpool |
$994.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$870.15
|
| Rate for Payer: Nomi Health Commercial |
$994.45
|
| Rate for Payer: PACE SWMI |
$828.71
|
| Rate for Payer: PHP Medicare Advantage |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,284.10
|
| Rate for Payer: Priority Health Medicare |
$828.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$828.71
|
| Rate for Payer: UHC Medicare Advantage |
$828.71
|
| Rate for Payer: UHCCP DNSP |
$828.71
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$299.07 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$400.75
|
| Rate for Payer: Aetna Medicare |
$299.07
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$299.07
|
| Rate for Payer: BCN Medicare Advantage |
$299.07
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$430.66
|
| Rate for Payer: Cofinity Commercial |
$400.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.07
|
| Rate for Payer: Healthscope Commercial |
$358.88
|
| Rate for Payer: Healthscope Whirlpool |
$358.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.02
|
| Rate for Payer: Nomi Health Commercial |
$358.88
|
| Rate for Payer: PACE SWMI |
$299.07
|
| Rate for Payer: PHP Medicare Advantage |
$299.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$299.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.07
|
| Rate for Payer: UHC Medicare Advantage |
$299.07
|
| Rate for Payer: UHCCP DNSP |
$299.07
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$1,181.03 |
| Max. Negotiated Rate |
$2,668.90 |
| Rate for Payer: Aetna Commercial |
$1,582.58
|
| Rate for Payer: Aetna Medicare |
$1,181.03
|
| Rate for Payer: BCBS Complete |
$1,642.40
|
| Rate for Payer: BCBS MAPPO |
$1,181.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,181.03
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cofinity Commercial |
$1,700.68
|
| Rate for Payer: Cofinity Commercial |
$1,582.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,181.03
|
| Rate for Payer: Healthscope Commercial |
$1,417.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,417.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,240.08
|
| Rate for Payer: Nomi Health Commercial |
$1,417.24
|
| Rate for Payer: PACE SWMI |
$1,181.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,181.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,668.90
|
| Rate for Payer: Priority Health Medicare |
$1,181.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,181.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,181.03
|
| Rate for Payer: UHCCP DNSP |
$1,181.03
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$1,182.67 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$1,584.78
|
| Rate for Payer: Aetna Medicare |
$1,182.67
|
| Rate for Payer: BCBS Complete |
$1,388.40
|
| Rate for Payer: BCBS MAPPO |
$1,182.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.67
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$1,703.04
|
| Rate for Payer: Cofinity Commercial |
$1,584.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.67
|
| Rate for Payer: Healthscope Commercial |
$1,419.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,419.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.80
|
| Rate for Payer: Nomi Health Commercial |
$1,419.20
|
| Rate for Payer: PACE SWMI |
$1,182.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health Medicare |
$1,182.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.67
|
| Rate for Payer: UHCCP DNSP |
$1,182.67
|
|
