|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 38206
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$1,117.35 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Medicare |
$84.27
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$81.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.35
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$81.03
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$116.68
|
| Rate for Payer: Cofinity Commercial |
$108.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.03
|
| Rate for Payer: Mclaren Medicaid |
$51.97
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.08
|
| Rate for Payer: PACE SWMI |
$81.03
|
| Rate for Payer: PHP Medicare Advantage |
$81.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.18
|
| Rate for Payer: Priority Health Medicare |
$81.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.03
|
| Rate for Payer: UHC Medicare Advantage |
$83.46
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: Aetna Medicare |
$30.92
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$29.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.16
|
| Rate for Payer: BCN Commercial |
$89.53
|
| Rate for Payer: BCN Medicare Advantage |
$29.73
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.73
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.22
|
| Rate for Payer: PACE SWMI |
$29.73
|
| Rate for Payer: PHP Medicare Advantage |
$29.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.09
|
| Rate for Payer: Priority Health Medicare |
$29.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.73
|
| Rate for Payer: UHC Medicare Advantage |
$30.62
|
|
|
PR BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$312.59 |
| Max. Negotiated Rate |
$903.57 |
| Rate for Payer: Aetna Commercial |
$708.54
|
| Rate for Payer: Aetna Medicare |
$549.91
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS MAPPO |
$528.76
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$903.57
|
| Rate for Payer: BCN Medicare Advantage |
$528.76
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$761.41
|
| Rate for Payer: Cofinity Commercial |
$708.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.76
|
| Rate for Payer: Mclaren Medicaid |
$351.66
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$555.20
|
| Rate for Payer: PACE SWMI |
$528.76
|
| Rate for Payer: PHP Medicare Advantage |
$528.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$671.64
|
| Rate for Payer: Priority Health Medicare |
$528.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.76
|
| Rate for Payer: UHC Medicare Advantage |
$544.62
|
|
|
PR BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 15822
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$514.35
|
| Rate for Payer: Aetna Medicare |
$399.19
|
| Rate for Payer: BCBS Complete |
$268.16
|
| Rate for Payer: BCBS MAPPO |
$383.84
|
| Rate for Payer: BCBS Trust/PPO |
$31.71
|
| Rate for Payer: BCN Commercial |
$675.35
|
| Rate for Payer: BCN Medicare Advantage |
$383.84
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$514.35
|
| Rate for Payer: Cofinity Commercial |
$552.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.84
|
| Rate for Payer: Mclaren Medicaid |
$255.39
|
| Rate for Payer: Meridian Medicaid |
$268.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$403.03
|
| Rate for Payer: PACE SWMI |
$383.84
|
| Rate for Payer: PHP Medicare Advantage |
$383.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$488.73
|
| Rate for Payer: Priority Health Medicare |
$383.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.84
|
| Rate for Payer: UHC Medicare Advantage |
$395.36
|
|
|
PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 15823
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$905.03 |
| Rate for Payer: Aetna Commercial |
$708.65
|
| Rate for Payer: Aetna Medicare |
$549.99
|
| Rate for Payer: BCBS Complete |
$369.47
|
| Rate for Payer: BCBS MAPPO |
$528.84
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: BCN Medicare Advantage |
$528.84
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$761.53
|
| Rate for Payer: Cofinity Commercial |
$708.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.84
|
| Rate for Payer: Mclaren Medicaid |
$351.88
|
| Rate for Payer: Meridian Medicaid |
$369.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$555.28
|
| Rate for Payer: PACE SWMI |
$528.84
|
| Rate for Payer: PHP Medicare Advantage |
$528.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.45
|
| Rate for Payer: Priority Health Medicare |
$528.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$672.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.84
|
| Rate for Payer: UHC Medicare Advantage |
$544.71
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$498.19 |
| Rate for Payer: Aetna Commercial |
$148.38
|
| Rate for Payer: Aetna Medicare |
$115.16
|
| Rate for Payer: BCBS Complete |
$77.61
|
| Rate for Payer: BCBS MAPPO |
$110.73
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$416.84
|
| Rate for Payer: BCN Medicare Advantage |
$110.73
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cofinity Commercial |
$159.45
|
| Rate for Payer: Cofinity Commercial |
$148.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.73
|
| Rate for Payer: Mclaren Medicaid |
$73.91
|
| Rate for Payer: Meridian Medicaid |
$77.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$116.27
|
| Rate for Payer: PACE SWMI |
$110.73
|
| Rate for Payer: PHP Medicare Advantage |
$110.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.79
|
| Rate for Payer: Priority Health Medicare |
$110.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.73
|
| Rate for Payer: UHC Medicare Advantage |
$114.05
|
|
|
PR BLUE TIDAL
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 00072
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$175.09 |
| Max. Negotiated Rate |
$859.60 |
| Rate for Payer: Aetna Commercial |
$363.94
|
| Rate for Payer: Aetna Medicare |
$282.46
|
| Rate for Payer: BCBS Complete |
$183.84
|
| Rate for Payer: BCBS MAPPO |
$271.60
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$400.72
|
| Rate for Payer: BCN Medicare Advantage |
$271.60
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cofinity Commercial |
$391.10
|
| Rate for Payer: Cofinity Commercial |
$363.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.60
|
| Rate for Payer: Mclaren Medicaid |
$175.09
|
| Rate for Payer: Meridian Medicaid |
$183.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$285.18
|
| Rate for Payer: PACE SWMI |
$271.60
|
| Rate for Payer: PHP Medicare Advantage |
$271.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.74
|
| Rate for Payer: Priority Health Medicare |
$271.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.60
|
| Rate for Payer: UHC Medicare Advantage |
$279.75
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna Commercial |
$239.32
|
| Rate for Payer: Aetna Medicare |
$185.74
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$574.19
|
| Rate for Payer: BCN Medicare Advantage |
$178.60
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cofinity Commercial |
$239.32
|
| Rate for Payer: Cofinity Commercial |
$257.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.60
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.53
|
| Rate for Payer: PACE SWMI |
$178.60
|
| Rate for Payer: PHP Medicare Advantage |
$178.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.75
|
| Rate for Payer: Priority Health Medicare |
$178.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.60
|
| Rate for Payer: UHC Medicare Advantage |
$183.96
|
|
|
PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR
|
Professional
|
Both
|
$4,498.00
|
|
|
Service Code
|
HCPCS 20962
|
| Min. Negotiated Rate |
$1,706.77 |
| Max. Negotiated Rate |
$4,061.20 |
| Rate for Payer: Aetna Commercial |
$3,507.61
|
| Rate for Payer: Aetna Medicare |
$2,722.32
|
| Rate for Payer: BCBS Complete |
$1,792.11
|
| Rate for Payer: BCBS MAPPO |
$2,617.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$3,886.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,617.62
|
| Rate for Payer: Cash Price |
$3,598.40
|
| Rate for Payer: Cash Price |
$3,598.40
|
| Rate for Payer: Cofinity Commercial |
$3,507.61
|
| Rate for Payer: Cofinity Commercial |
$3,769.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,617.62
|
| Rate for Payer: Mclaren Medicaid |
$1,706.77
|
| Rate for Payer: Meridian Medicaid |
$1,792.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,748.50
|
| Rate for Payer: PACE SWMI |
$2,617.62
|
| Rate for Payer: PHP Medicare Advantage |
$2,617.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,706.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,148.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,061.20
|
| Rate for Payer: Priority Health Medicare |
$2,617.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,061.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,617.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,617.62
|
| Rate for Payer: UHC Medicare Advantage |
$2,696.15
|
|
|
PR BOTOX UNIT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 00084
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
|
|
PR BRACHIOPLASTY
|
Professional
|
Both
|
$4,500.00
|
|
|
Service Code
|
HCPCS 00537
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: BCBS Complete |
$1,800.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,150.00
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$806.72
|
| Rate for Payer: Aetna Medicare |
$626.11
|
| Rate for Payer: BCBS Complete |
$415.10
|
| Rate for Payer: BCBS MAPPO |
$602.03
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$901.13
|
| Rate for Payer: BCN Medicare Advantage |
$602.03
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cofinity Commercial |
$806.72
|
| Rate for Payer: Cofinity Commercial |
$866.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.03
|
| Rate for Payer: Mclaren Medicaid |
$395.33
|
| Rate for Payer: Meridian Medicaid |
$415.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$632.13
|
| Rate for Payer: PACE SWMI |
$602.03
|
| Rate for Payer: PHP Medicare Advantage |
$602.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$757.96
|
| Rate for Payer: Priority Health Medicare |
$602.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$757.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.03
|
| Rate for Payer: UHC Medicare Advantage |
$620.09
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 2.5
|
Professional
|
Both
|
$6,540.00
|
|
|
Service Code
|
HCPCS 00258
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,616.00 |
| Max. Negotiated Rate |
$4,578.00 |
| Rate for Payer: BCBS Complete |
$2,616.00
|
| Rate for Payer: Cash Price |
$5,232.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,578.00
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 3.5
|
Professional
|
Both
|
$7,440.00
|
|
|
Service Code
|
HCPCS 00260
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,976.00 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: BCBS Complete |
$2,976.00
|
| Rate for Payer: Cash Price |
$5,952.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,208.00
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 00257
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: BCBS Complete |
$2,200.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,850.00
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5
|
Professional
|
Both
|
$6,400.00
|
|
|
Service Code
|
HCPCS 00259
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,560.00 |
| Max. Negotiated Rate |
$4,480.00 |
| Rate for Payer: BCBS Complete |
$2,560.00
|
| Rate for Payer: Cash Price |
$5,120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,480.00
|
|
|
PR BREAST IMPLANT WARRANTY
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00523
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$4,715.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,327.27 |
| Max. Negotiated Rate |
$3,300.50 |
| Rate for Payer: Aetna Commercial |
$2,860.83
|
| Rate for Payer: Aetna Medicare |
$2,220.35
|
| Rate for Payer: BCBS Complete |
$1,449.47
|
| Rate for Payer: BCBS MAPPO |
$2,134.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$3,163.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,134.95
|
| Rate for Payer: Cash Price |
$3,772.00
|
| Rate for Payer: Cash Price |
$3,772.00
|
| Rate for Payer: Cofinity Commercial |
$3,074.33
|
| Rate for Payer: Cofinity Commercial |
$2,860.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,134.95
|
| Rate for Payer: Mclaren Medicaid |
$1,380.45
|
| Rate for Payer: Meridian Medicaid |
$1,449.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,241.70
|
| Rate for Payer: PACE SWMI |
$2,134.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,134.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,380.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,300.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,661.07
|
| Rate for Payer: Priority Health Medicare |
$2,134.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,661.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,134.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,134.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,199.00
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,130.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$199.98 |
| Max. Negotiated Rate |
$2,939.88 |
| Rate for Payer: Aetna Commercial |
$2,657.46
|
| Rate for Payer: Aetna Medicare |
$2,062.51
|
| Rate for Payer: BCBS Complete |
$1,347.04
|
| Rate for Payer: BCBS MAPPO |
$1,983.18
|
| Rate for Payer: BCBS Trust/PPO |
$199.98
|
| Rate for Payer: BCN Commercial |
$2,939.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,983.18
|
| Rate for Payer: Cash Price |
$3,304.00
|
| Rate for Payer: Cash Price |
$3,304.00
|
| Rate for Payer: Cofinity Commercial |
$2,657.46
|
| Rate for Payer: Cofinity Commercial |
$2,855.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,983.18
|
| Rate for Payer: Mclaren Medicaid |
$1,282.90
|
| Rate for Payer: Meridian Medicaid |
$1,347.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,082.34
|
| Rate for Payer: PACE SWMI |
$1,983.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,983.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,282.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,891.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,472.80
|
| Rate for Payer: Priority Health Medicare |
$1,983.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,472.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,983.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,983.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,042.68
|
|
|
PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP
|
Professional
|
Both
|
$2,973.00
|
|
|
Service Code
|
HCPCS 19367
|
| Min. Negotiated Rate |
$1,128.69 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Aetna Commercial |
$2,331.10
|
| Rate for Payer: Aetna Medicare |
$1,809.22
|
| Rate for Payer: BCBS Complete |
$1,185.12
|
| Rate for Payer: BCBS MAPPO |
$1,739.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$2,583.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,739.63
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cofinity Commercial |
$2,331.10
|
| Rate for Payer: Cofinity Commercial |
$2,505.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,739.63
|
| Rate for Payer: Mclaren Medicaid |
$1,128.69
|
| Rate for Payer: Meridian Medicaid |
$1,185.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,826.61
|
| Rate for Payer: PACE SWMI |
$1,739.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,739.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,128.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,081.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,172.75
|
| Rate for Payer: Priority Health Medicare |
$1,739.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,172.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,739.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,739.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,791.82
|
|
|
PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP
|
Professional
|
Both
|
$2,863.00
|
|
|
Service Code
|
HCPCS 19361
|
| Min. Negotiated Rate |
$312.59 |
| Max. Negotiated Rate |
$2,274.31 |
| Rate for Payer: Aetna Commercial |
$2,051.49
|
| Rate for Payer: Aetna Medicare |
$1,592.20
|
| Rate for Payer: BCBS Complete |
$1,043.99
|
| Rate for Payer: BCBS MAPPO |
$1,530.96
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$2,274.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,530.96
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cofinity Commercial |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,051.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,530.96
|
| Rate for Payer: Mclaren Medicaid |
$994.28
|
| Rate for Payer: Meridian Medicaid |
$1,043.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,607.51
|
| Rate for Payer: PACE SWMI |
$1,530.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,530.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$994.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,004.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,912.97
|
| Rate for Payer: Priority Health Medicare |
$1,530.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,912.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,530.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,530.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,576.89
|
|
|
PR BREAST RECONSTRUC W OTHR TECHNIQ
|
Professional
|
Both
|
$2,846.00
|
|
|
Service Code
|
HCPCS 19366
|
| Min. Negotiated Rate |
$1,138.40 |
| Max. Negotiated Rate |
$1,992.20 |
| Rate for Payer: BCBS Complete |
$1,138.40
|
| Rate for Payer: Cash Price |
$2,276.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,992.20
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 19318
|
| Min. Negotiated Rate |
$293.06 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$1,439.52
|
| Rate for Payer: Aetna Medicare |
$1,117.24
|
| Rate for Payer: BCBS Complete |
$734.24
|
| Rate for Payer: BCBS MAPPO |
$1,074.27
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,074.27
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,546.95
|
| Rate for Payer: Cofinity Commercial |
$1,439.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,074.27
|
| Rate for Payer: Mclaren Medicaid |
$699.28
|
| Rate for Payer: Meridian Medicaid |
$734.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,127.98
|
| Rate for Payer: PACE SWMI |
$1,074.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,074.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$699.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.10
|
| Rate for Payer: Priority Health Medicare |
$1,074.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,344.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,074.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,074.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,106.50
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 91065
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$105.20
|
| Rate for Payer: Aetna Medicare |
$81.65
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$78.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$78.51
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$113.05
|
| Rate for Payer: Cofinity Commercial |
$105.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.44
|
| Rate for Payer: PACE SWMI |
$78.51
|
| Rate for Payer: PHP Medicare Advantage |
$78.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.19
|
| Rate for Payer: Priority Health Medicare |
$78.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.51
|
| Rate for Payer: UHC Medicare Advantage |
$80.87
|
|
