|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$1,085.13 |
| Rate for Payer: Aetna Commercial |
$159.96
|
| Rate for Payer: Aetna Medicare |
$124.14
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$119.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$119.37
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Cofinity Commercial |
$171.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.37
|
| Rate for Payer: Mclaren Medicaid |
$75.83
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.34
|
| Rate for Payer: PACE SWMI |
$119.37
|
| Rate for Payer: PHP Medicare Advantage |
$119.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.32
|
| Rate for Payer: Priority Health Medicare |
$119.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.37
|
| Rate for Payer: UHC Medicare Advantage |
$122.95
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99150
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 99143
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$660.90 |
| Rate for Payer: Aetna Commercial |
$81.58
|
| Rate for Payer: Aetna Medicare |
$63.32
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$60.88
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$98.47
|
| Rate for Payer: BCN Medicare Advantage |
$60.88
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Cofinity Commercial |
$87.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.88
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.92
|
| Rate for Payer: PACE SWMI |
$60.88
|
| Rate for Payer: PHP Medicare Advantage |
$60.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.14
|
| Rate for Payer: Priority Health Medicare |
$60.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.88
|
| Rate for Payer: UHC Medicare Advantage |
$62.71
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$880.15 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Aetna Medicare |
$85.46
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$82.17
|
| Rate for Payer: BCBS Trust/PPO |
$880.15
|
| Rate for Payer: BCN Commercial |
$131.29
|
| Rate for Payer: BCN Medicare Advantage |
$82.17
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$110.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.17
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.28
|
| Rate for Payer: PACE SWMI |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$82.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.19
|
| Rate for Payer: Priority Health Medicare |
$82.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.17
|
| Rate for Payer: UHC Medicare Advantage |
$84.64
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$100.67
|
| Rate for Payer: Aetna Medicare |
$78.14
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$75.13
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.53
|
| Rate for Payer: BCN Medicare Advantage |
$75.13
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$108.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.13
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.89
|
| Rate for Payer: PACE SWMI |
$75.13
|
| Rate for Payer: PHP Medicare Advantage |
$75.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.11
|
| Rate for Payer: Priority Health Medicare |
$75.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.13
|
| Rate for Payer: UHC Medicare Advantage |
$77.38
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$674.11 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$10.30
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.30
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.82
|
| Rate for Payer: PACE SWMI |
$10.30
|
| Rate for Payer: PHP Medicare Advantage |
$10.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.20
|
| Rate for Payer: Priority Health Medicare |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.30
|
| Rate for Payer: UHC Medicare Advantage |
$10.61
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$23.96
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$96.86
|
| Rate for Payer: BCN Medicare Advantage |
$23.96
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$32.11
|
| Rate for Payer: Cofinity Commercial |
$34.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.96
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.16
|
| Rate for Payer: PACE SWMI |
$23.96
|
| Rate for Payer: PHP Medicare Advantage |
$23.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.36
|
| Rate for Payer: Priority Health Medicare |
$23.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.96
|
| Rate for Payer: UHC Medicare Advantage |
$24.68
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$16.62
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS MAPPO |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.40
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.40
|
| Rate for Payer: Mclaren Medicaid |
$7.67
|
| Rate for Payer: Meridian Medicaid |
$8.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.02
|
| Rate for Payer: PACE SWMI |
$12.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.51
|
| Rate for Payer: Priority Health Medicare |
$12.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.40
|
| Rate for Payer: UHC Medicare Advantage |
$12.77
|
|
|
PR MONALISA TOUCH, SERIES, UP TO 7 VISITS, LICHEN SCLEROSUS
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 00560
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: BCBS Complete |
$840.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,470.00
|
|
|
PR MONOVISC INJ PER DOSE
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS J7327
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$997.56 |
| Rate for Payer: Aetna Commercial |
$928.29
|
| Rate for Payer: Aetna Medicare |
$720.46
|
| Rate for Payer: BCBS Complete |
$369.20
|
| Rate for Payer: BCBS MAPPO |
$692.75
|
| Rate for Payer: BCBS Trust/PPO |
$727.84
|
| Rate for Payer: BCN Commercial |
$800.00
|
| Rate for Payer: BCN Medicare Advantage |
$692.75
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$928.29
|
| Rate for Payer: Cofinity Commercial |
$997.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$727.39
|
| Rate for Payer: PACE SWMI |
$692.75
|
| Rate for Payer: PHP Medicare Advantage |
$692.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health Medicare |
$692.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$692.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$692.75
|
| Rate for Payer: UHC Medicare Advantage |
$713.53
|
|
|
PR MORPHINE SULFATE INJECTION
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.09
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.83
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.74
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$1,790.41 |
| Rate for Payer: Aetna Commercial |
$42.96
|
| Rate for Payer: Aetna Medicare |
$33.34
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$32.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,790.41
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: BCN Medicare Advantage |
$32.06
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$46.17
|
| Rate for Payer: Cofinity Commercial |
$42.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.66
|
| Rate for Payer: PACE SWMI |
$32.06
|
| Rate for Payer: PHP Medicare Advantage |
$32.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.26
|
| Rate for Payer: Priority Health Medicare |
$32.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.06
|
| Rate for Payer: UHC Medicare Advantage |
$33.02
|
|
|
PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 90733
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$125.50 |
| Rate for Payer: Aetna Commercial |
$125.50
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS Trust/PPO |
$125.49
|
| Rate for Payer: BCN Commercial |
$123.17
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
|
|
PR MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 97157
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$997.43 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$997.43
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.17
|
|
|
PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 90849
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$37.69
|
| Rate for Payer: Aetna Medicare |
$29.26
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$28.13
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$53.75
|
| Rate for Payer: BCN Medicare Advantage |
$28.13
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$40.51
|
| Rate for Payer: Cofinity Commercial |
$37.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.54
|
| Rate for Payer: PACE SWMI |
$28.13
|
| Rate for Payer: PHP Medicare Advantage |
$28.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.14
|
| Rate for Payer: Priority Health Medicare |
$28.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.13
|
| Rate for Payer: UHC Medicare Advantage |
$28.97
|
|
|
PR MUSCLE-SKIN FLAP,HEAD/NECK
|
Professional
|
Both
|
$3,183.00
|
|
|
Service Code
|
HCPCS 15732
|
| Min. Negotiated Rate |
$1,273.20 |
| Max. Negotiated Rate |
$2,228.10 |
| Rate for Payer: BCBS Complete |
$1,273.20
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,228.10
|
|
|
PR MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE
|
Professional
|
Both
|
$1,118.00
|
|
|
Service Code
|
HCPCS 24301
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$1,159.18 |
| Rate for Payer: Aetna Commercial |
$996.50
|
| Rate for Payer: Aetna Medicare |
$773.41
|
| Rate for Payer: BCBS Complete |
$510.37
|
| Rate for Payer: BCBS MAPPO |
$743.66
|
| Rate for Payer: BCBS Trust/PPO |
$114.64
|
| Rate for Payer: BCN Commercial |
$1,109.30
|
| Rate for Payer: BCN Medicare Advantage |
$743.66
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cofinity Commercial |
$1,070.87
|
| Rate for Payer: Cofinity Commercial |
$996.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.66
|
| Rate for Payer: Mclaren Medicaid |
$486.07
|
| Rate for Payer: Meridian Medicaid |
$510.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$780.84
|
| Rate for Payer: PACE SWMI |
$743.66
|
| Rate for Payer: PHP Medicare Advantage |
$743.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$486.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,159.18
|
| Rate for Payer: Priority Health Medicare |
$743.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,159.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$743.66
|
| Rate for Payer: UHC Medicare Advantage |
$765.97
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 23397
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$2,103.50 |
| Rate for Payer: Aetna Commercial |
$1,504.97
|
| Rate for Payer: Aetna Medicare |
$1,168.03
|
| Rate for Payer: BCBS Complete |
$770.48
|
| Rate for Payer: BCBS MAPPO |
$1,123.11
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$1,668.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.11
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$1,504.97
|
| Rate for Payer: Cofinity Commercial |
$1,617.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.11
|
| Rate for Payer: Mclaren Medicaid |
$733.79
|
| Rate for Payer: Meridian Medicaid |
$770.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,179.27
|
| Rate for Payer: PACE SWMI |
$1,123.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,103.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,743.36
|
| Rate for Payer: Priority Health Medicare |
$1,123.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,743.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,123.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,156.80
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE
|
Professional
|
Both
|
$3,347.00
|
|
|
Service Code
|
HCPCS 23395
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$2,342.90 |
| Rate for Payer: Aetna Commercial |
$1,689.43
|
| Rate for Payer: Aetna Medicare |
$1,311.20
|
| Rate for Payer: BCBS Complete |
$866.87
|
| Rate for Payer: BCBS MAPPO |
$1,260.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.98
|
| Rate for Payer: BCN Commercial |
$1,875.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,260.77
|
| Rate for Payer: Cash Price |
$2,677.60
|
| Rate for Payer: Cash Price |
$2,677.60
|
| Rate for Payer: Cofinity Commercial |
$1,689.43
|
| Rate for Payer: Cofinity Commercial |
$1,815.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,260.77
|
| Rate for Payer: Mclaren Medicaid |
$825.59
|
| Rate for Payer: Meridian Medicaid |
$866.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,323.81
|
| Rate for Payer: PACE SWMI |
$1,260.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,260.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,342.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,959.87
|
| Rate for Payer: Priority Health Medicare |
$1,260.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,959.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,260.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,260.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,298.59
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR
|
Professional
|
Both
|
$2,426.00
|
|
|
Service Code
|
HCPCS 15738
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$1,850.62 |
| Rate for Payer: Aetna Commercial |
$1,670.35
|
| Rate for Payer: Aetna Medicare |
$1,296.39
|
| Rate for Payer: BCBS Complete |
$849.65
|
| Rate for Payer: BCBS MAPPO |
$1,246.53
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$1,850.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,246.53
|
| Rate for Payer: Cash Price |
$1,940.80
|
| Rate for Payer: Cash Price |
$1,940.80
|
| Rate for Payer: Cofinity Commercial |
$1,795.00
|
| Rate for Payer: Cofinity Commercial |
$1,670.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,246.53
|
| Rate for Payer: Mclaren Medicaid |
$809.19
|
| Rate for Payer: Meridian Medicaid |
$849.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,308.86
|
| Rate for Payer: PACE SWMI |
$1,246.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,246.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$809.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,698.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,556.61
|
| Rate for Payer: Priority Health Medicare |
$1,246.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,556.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,246.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,246.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,283.93
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$4,510.00
|
|
|
Service Code
|
HCPCS 15734
|
| Hospital Charge Code |
15734
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$3,157.00 |
| Rate for Payer: Aetna Commercial |
$1,981.73
|
| Rate for Payer: Aetna Medicare |
$1,538.06
|
| Rate for Payer: BCBS Complete |
$1,006.65
|
| Rate for Payer: BCBS MAPPO |
$1,478.90
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$2,188.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,478.90
|
| Rate for Payer: Cash Price |
$3,608.00
|
| Rate for Payer: Cash Price |
$3,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,981.73
|
| Rate for Payer: Cofinity Commercial |
$2,129.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,478.90
|
| Rate for Payer: Mclaren Medicaid |
$958.71
|
| Rate for Payer: Meridian Medicaid |
$1,006.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,552.84
|
| Rate for Payer: PACE SWMI |
$1,478.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,478.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$958.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,157.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,840.63
|
| Rate for Payer: Priority Health Medicare |
$1,478.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,840.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,478.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,523.27
|
|
