|
PR BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 56605
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$2,173.43 |
| Rate for Payer: Aetna Commercial |
$76.07
|
| Rate for Payer: Aetna Medicare |
$59.04
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS MAPPO |
$56.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,173.43
|
| Rate for Payer: BCN Commercial |
$114.27
|
| Rate for Payer: BCN Medicare Advantage |
$56.77
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Cofinity Commercial |
$76.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.77
|
| Rate for Payer: Mclaren Medicaid |
$37.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Nomi Health Commercial |
$68.12
|
| Rate for Payer: PACE SWMI |
$56.77
|
| Rate for Payer: PHP Medicare Advantage |
$56.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO |
$87.80
|
| Rate for Payer: Priority Health Medicare |
$57.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.77
|
| Rate for Payer: UHC Exchange |
$56.77
|
| Rate for Payer: UHC Medicare Advantage |
$56.77
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
|
|
PR BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 56606
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$28.70
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$27.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.96
|
| Rate for Payer: BCN Commercial |
$56.68
|
| Rate for Payer: BCN Medicare Advantage |
$27.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$39.74
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.60
|
| Rate for Payer: Mclaren Medicaid |
$18.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.98
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Nomi Health Commercial |
$33.12
|
| Rate for Payer: PACE SWMI |
$27.60
|
| Rate for Payer: PHP Medicare Advantage |
$27.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO |
$43.16
|
| Rate for Payer: Priority Health Medicare |
$27.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.60
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UHC Medicare Advantage |
$27.60
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
|
|
PR BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 33933
|
| Min. Negotiated Rate |
$251.71 |
| Max. Negotiated Rate |
$1,305.43 |
| Rate for Payer: Aetna Commercial |
$536.72
|
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: BCBS Complete |
$264.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.43
|
| Rate for Payer: BCN Commercial |
$627.12
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Mclaren Medicaid |
$251.71
|
| Rate for Payer: Meridian Medicaid |
$264.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health HMO/PPO |
$676.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.49
|
| Rate for Payer: UHCCP Medicaid |
$251.71
|
|
|
PR BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 51720
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$56.44
|
| Rate for Payer: Aetna Medicare |
$43.80
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$42.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.35
|
| Rate for Payer: BCN Commercial |
$102.88
|
| Rate for Payer: BCN Medicare Advantage |
$42.12
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$56.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.12
|
| Rate for Payer: Mclaren Medicaid |
$27.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.23
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Nomi Health Commercial |
$50.54
|
| Rate for Payer: PACE SWMI |
$42.12
|
| Rate for Payer: PHP Medicare Advantage |
$42.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Medicare |
$42.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.12
|
| Rate for Payer: UHC Exchange |
$42.12
|
| Rate for Payer: UHC Medicare Advantage |
$42.12
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 51726
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$3,274.93 |
| Rate for Payer: Aetna Commercial |
$337.17
|
| Rate for Payer: Aetna Medicare |
$261.68
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS MAPPO |
$251.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,274.93
|
| Rate for Payer: BCN Commercial |
$441.76
|
| Rate for Payer: BCN Medicare Advantage |
$251.62
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$362.33
|
| Rate for Payer: Cofinity Commercial |
$337.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.62
|
| Rate for Payer: Mclaren Medicaid |
$53.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.20
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Nomi Health Commercial |
$301.94
|
| Rate for Payer: PACE SWMI |
$251.62
|
| Rate for Payer: PHP Medicare Advantage |
$251.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO |
$132.08
|
| Rate for Payer: Priority Health Medicare |
$254.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.62
|
| Rate for Payer: UHC Exchange |
$251.62
|
| Rate for Payer: UHC Medicare Advantage |
$251.62
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
|
|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 38206
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$1,117.35 |
| Rate for Payer: Aetna Commercial |
$103.27
|
| Rate for Payer: Aetna Medicare |
$80.15
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$77.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.35
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$77.07
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$103.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.07
|
| Rate for Payer: Mclaren Medicaid |
$51.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.92
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Nomi Health Commercial |
$92.48
|
| Rate for Payer: PACE SWMI |
$77.07
|
| Rate for Payer: PHP Medicare Advantage |
$77.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health HMO/PPO |
$162.44
|
| Rate for Payer: Priority Health Medicare |
$77.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.07
|
| Rate for Payer: UHC Exchange |
$77.07
|
| Rate for Payer: UHC Medicare Advantage |
$77.07
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: Aetna Medicare |
$29.69
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$28.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.16
|
| Rate for Payer: BCN Commercial |
$89.53
|
| Rate for Payer: BCN Medicare Advantage |
$28.55
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.55
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.98
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE SWMI |
$28.55
|
| Rate for Payer: PHP Medicare Advantage |
$28.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health HMO/PPO |
$47.41
|
| Rate for Payer: Priority Health Medicare |
$28.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.55
|
| Rate for Payer: UHC Exchange |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$28.55
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR BLEPHAROPLASTY LOWER EYELID W/HERNIATED FAT PAD
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$312.59 |
| Max. Negotiated Rate |
$903.57 |
| Rate for Payer: Aetna Commercial |
$684.28
|
| Rate for Payer: Aetna Medicare |
$531.09
|
| Rate for Payer: BCBS Complete |
$368.57
|
| Rate for Payer: BCBS MAPPO |
$510.66
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$903.57
|
| Rate for Payer: BCN Medicare Advantage |
$510.66
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$735.35
|
| Rate for Payer: Cofinity Commercial |
$684.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.66
|
| Rate for Payer: Mclaren Medicaid |
$351.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.19
|
| Rate for Payer: Meridian Medicaid |
$368.57
|
| Rate for Payer: Nomi Health Commercial |
$612.79
|
| Rate for Payer: PACE SWMI |
$510.66
|
| Rate for Payer: PHP Medicare Advantage |
$510.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO |
$745.46
|
| Rate for Payer: Priority Health Medicare |
$515.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.66
|
| Rate for Payer: UHC Exchange |
$510.66
|
| Rate for Payer: UHC Medicare Advantage |
$510.66
|
| Rate for Payer: UHCCP Medicaid |
$351.02
|
|
|
PR BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 15822
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$495.48
|
| Rate for Payer: Aetna Medicare |
$384.55
|
| Rate for Payer: BCBS Complete |
$267.27
|
| Rate for Payer: BCBS MAPPO |
$369.76
|
| Rate for Payer: BCBS Trust/PPO |
$31.71
|
| Rate for Payer: BCN Commercial |
$675.35
|
| Rate for Payer: BCN Medicare Advantage |
$369.76
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$532.45
|
| Rate for Payer: Cofinity Commercial |
$495.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.76
|
| Rate for Payer: Mclaren Medicaid |
$254.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.25
|
| Rate for Payer: Meridian Medicaid |
$267.27
|
| Rate for Payer: Nomi Health Commercial |
$443.71
|
| Rate for Payer: PACE SWMI |
$369.76
|
| Rate for Payer: PHP Medicare Advantage |
$369.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO |
$541.37
|
| Rate for Payer: Priority Health Medicare |
$373.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$541.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.76
|
| Rate for Payer: UHC Exchange |
$369.76
|
| Rate for Payer: UHC Medicare Advantage |
$369.76
|
| Rate for Payer: UHCCP Medicaid |
$254.54
|
|
|
PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15823
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$905.03 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| Rate for Payer: BCBS Complete |
$368.57
|
| Rate for Payer: BCBS MAPPO |
$510.32
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: BCN Medicare Advantage |
$510.32
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$683.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.32
|
| Rate for Payer: Mclaren Medicaid |
$351.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.84
|
| Rate for Payer: Meridian Medicaid |
$368.57
|
| Rate for Payer: Nomi Health Commercial |
$612.38
|
| Rate for Payer: PACE SWMI |
$510.32
|
| Rate for Payer: PHP Medicare Advantage |
$510.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO |
$745.91
|
| Rate for Payer: Priority Health Medicare |
$515.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Exchange |
$510.32
|
| Rate for Payer: UHC Medicare Advantage |
$510.32
|
| Rate for Payer: UHCCP Medicaid |
$351.02
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$498.19 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Aetna Medicare |
$112.21
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$107.89
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$416.84
|
| Rate for Payer: BCN Medicare Advantage |
$107.89
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Cofinity Commercial |
$144.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.89
|
| Rate for Payer: Mclaren Medicaid |
$74.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.28
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Nomi Health Commercial |
$129.47
|
| Rate for Payer: PACE SWMI |
$107.89
|
| Rate for Payer: PHP Medicare Advantage |
$107.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health HMO/PPO |
$202.97
|
| Rate for Payer: Priority Health Medicare |
$108.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.89
|
| Rate for Payer: UHC Exchange |
$107.89
|
| Rate for Payer: UHC Medicare Advantage |
$107.89
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
|
|
PR BLUE TIDAL
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00072
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$351.95
|
| Rate for Payer: Aetna Medicare |
$273.16
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS MAPPO |
$262.65
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$400.72
|
| Rate for Payer: BCN Medicare Advantage |
$262.65
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$378.22
|
| Rate for Payer: Cofinity Commercial |
$351.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.65
|
| Rate for Payer: Mclaren Medicaid |
$175.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.78
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Nomi Health Commercial |
$315.18
|
| Rate for Payer: PACE SWMI |
$262.65
|
| Rate for Payer: PHP Medicare Advantage |
$262.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health HMO/PPO |
$418.28
|
| Rate for Payer: Priority Health Medicare |
$265.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.65
|
| Rate for Payer: UHC Exchange |
$262.65
|
| Rate for Payer: UHC Medicare Advantage |
$262.65
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$590.85 |
| Rate for Payer: Aetna Commercial |
$231.27
|
| Rate for Payer: Aetna Medicare |
$179.49
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS MAPPO |
$172.59
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$574.19
|
| Rate for Payer: BCN Medicare Advantage |
$172.59
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$248.53
|
| Rate for Payer: Cofinity Commercial |
$231.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.59
|
| Rate for Payer: Mclaren Medicaid |
$115.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.22
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Nomi Health Commercial |
$207.11
|
| Rate for Payer: PACE SWMI |
$172.59
|
| Rate for Payer: PHP Medicare Advantage |
$172.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.85
|
| Rate for Payer: Priority Health HMO/PPO |
$274.28
|
| Rate for Payer: Priority Health Medicare |
$174.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.59
|
| Rate for Payer: UHC Exchange |
$172.59
|
| Rate for Payer: UHC Medicare Advantage |
$172.59
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR
|
Professional
|
Both
|
$4,588.00
|
|
|
Service Code
|
HCPCS 20962
|
| Min. Negotiated Rate |
$1,721.25 |
| Max. Negotiated Rate |
$4,077.50 |
| Rate for Payer: Aetna Commercial |
$3,433.25
|
| Rate for Payer: Aetna Medicare |
$2,664.62
|
| Rate for Payer: BCBS Complete |
$1,807.31
|
| Rate for Payer: BCBS MAPPO |
$2,562.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$3,886.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,562.13
|
| Rate for Payer: Cash Price |
$3,670.40
|
| Rate for Payer: Cash Price |
$3,670.40
|
| Rate for Payer: Cofinity Commercial |
$3,689.47
|
| Rate for Payer: Cofinity Commercial |
$3,433.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,562.13
|
| Rate for Payer: Mclaren Medicaid |
$1,721.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,690.24
|
| Rate for Payer: Meridian Medicaid |
$1,807.31
|
| Rate for Payer: Nomi Health Commercial |
$3,074.56
|
| Rate for Payer: PACE SWMI |
$2,562.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,562.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,721.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,982.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4,077.50
|
| Rate for Payer: Priority Health Medicare |
$2,587.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,077.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,562.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,562.13
|
| Rate for Payer: UHC Exchange |
$2,562.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,562.13
|
| Rate for Payer: UHCCP Medicaid |
$1,721.25
|
|
|
PR BOTOX UNIT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 00084
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
|
|
PR BRACHIOPLASTY
|
Professional
|
Both
|
$4,590.00
|
|
|
Service Code
|
HCPCS 00537
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Aetna Medicare |
$2,295.00
|
| Rate for Payer: BCBS Complete |
$1,836.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Commercial |
$788.74
|
| Rate for Payer: Aetna Medicare |
$612.15
|
| Rate for Payer: BCBS Complete |
$419.35
|
| Rate for Payer: BCBS MAPPO |
$588.61
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$901.13
|
| Rate for Payer: BCN Medicare Advantage |
$588.61
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$788.74
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.61
|
| Rate for Payer: Mclaren Medicaid |
$399.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.04
|
| Rate for Payer: Meridian Medicaid |
$419.35
|
| Rate for Payer: Nomi Health Commercial |
$706.33
|
| Rate for Payer: PACE SWMI |
$588.61
|
| Rate for Payer: PHP Medicare Advantage |
$588.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: Priority Health HMO/PPO |
$838.02
|
| Rate for Payer: Priority Health Medicare |
$594.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$838.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.61
|
| Rate for Payer: UHC Exchange |
$588.61
|
| Rate for Payer: UHC Medicare Advantage |
$588.61
|
| Rate for Payer: UHCCP Medicaid |
$399.38
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 2.5
|
Professional
|
Both
|
$6,671.00
|
|
|
Service Code
|
HCPCS 00258
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,668.40 |
| Max. Negotiated Rate |
$4,336.15 |
| Rate for Payer: Aetna Medicare |
$3,335.50
|
| Rate for Payer: BCBS Complete |
$2,668.40
|
| Rate for Payer: Cash Price |
$5,336.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,336.15
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 3.5
|
Professional
|
Both
|
$7,589.00
|
|
|
Service Code
|
HCPCS 00260
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$3,035.60 |
| Max. Negotiated Rate |
$4,932.85 |
| Rate for Payer: Aetna Medicare |
$3,794.50
|
| Rate for Payer: BCBS Complete |
$3,035.60
|
| Rate for Payer: Cash Price |
$6,071.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,932.85
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5
|
Professional
|
Both
|
$5,610.00
|
|
|
Service Code
|
HCPCS 00257
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,244.00 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Aetna Medicare |
$2,805.00
|
| Rate for Payer: BCBS Complete |
$2,244.00
|
| Rate for Payer: Cash Price |
$4,488.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,646.50
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5
|
Professional
|
Both
|
$6,528.00
|
|
|
Service Code
|
HCPCS 00259
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,611.20 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Aetna Medicare |
$3,264.00
|
| Rate for Payer: BCBS Complete |
$2,611.20
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,243.20
|
|
|
PR BREAST IMPLANT WARRANTY
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00523
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$4,809.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,327.27 |
| Max. Negotiated Rate |
$3,163.69 |
| Rate for Payer: Aetna Commercial |
$2,781.24
|
| Rate for Payer: Aetna Medicare |
$2,158.57
|
| Rate for Payer: BCBS Complete |
$1,461.33
|
| Rate for Payer: BCBS MAPPO |
$2,075.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$3,163.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,075.55
|
| Rate for Payer: Cash Price |
$3,847.20
|
| Rate for Payer: Cash Price |
$3,847.20
|
| Rate for Payer: Cofinity Commercial |
$2,988.79
|
| Rate for Payer: Cofinity Commercial |
$2,781.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,075.55
|
| Rate for Payer: Mclaren Medicaid |
$1,391.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,179.33
|
| Rate for Payer: Meridian Medicaid |
$1,461.33
|
| Rate for Payer: Nomi Health Commercial |
$2,490.66
|
| Rate for Payer: PACE SWMI |
$2,075.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,075.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,391.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,125.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,926.28
|
| Rate for Payer: Priority Health Medicare |
$2,096.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,926.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,075.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,075.55
|
| Rate for Payer: UHC Exchange |
$2,075.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,075.55
|
| Rate for Payer: UHCCP Medicaid |
$1,391.74
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$199.98 |
| Max. Negotiated Rate |
$2,939.88 |
| Rate for Payer: Aetna Commercial |
$2,583.48
|
| Rate for Payer: Aetna Medicare |
$2,005.09
|
| Rate for Payer: BCBS Complete |
$1,358.01
|
| Rate for Payer: BCBS MAPPO |
$1,927.97
|
| Rate for Payer: BCBS Trust/PPO |
$199.98
|
| Rate for Payer: BCN Commercial |
$2,939.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,927.97
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cofinity Commercial |
$2,776.28
|
| Rate for Payer: Cofinity Commercial |
$2,583.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,927.97
|
| Rate for Payer: Mclaren Medicaid |
$1,293.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,024.37
|
| Rate for Payer: Meridian Medicaid |
$1,358.01
|
| Rate for Payer: Nomi Health Commercial |
$2,313.56
|
| Rate for Payer: PACE SWMI |
$1,927.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,927.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,293.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,719.49
|
| Rate for Payer: Priority Health Medicare |
$1,947.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,719.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,927.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,927.97
|
| Rate for Payer: UHC Exchange |
$1,927.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,927.97
|
| Rate for Payer: UHCCP Medicaid |
$1,293.34
|
|
