|
PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,455.00
|
|
|
Service Code
|
HCPCS 27132
|
| Min. Negotiated Rate |
$1,382.00 |
| Max. Negotiated Rate |
$2,315.46 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Medicare |
$1,672.28
|
| Rate for Payer: BCBS Complete |
$1,382.00
|
| Rate for Payer: BCBS MAPPO |
$1,607.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,607.96
|
| Rate for Payer: Cash Price |
$2,764.00
|
| Rate for Payer: Cash Price |
$2,764.00
|
| Rate for Payer: Cofinity Commercial |
$2,315.46
|
| Rate for Payer: Cofinity Commercial |
$2,154.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,607.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,688.36
|
| Rate for Payer: Nomi Health Commercial |
$1,929.55
|
| Rate for Payer: PACE SWMI |
$1,607.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,607.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.75
|
| Rate for Payer: Priority Health Medicare |
$1,624.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,607.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,607.96
|
| Rate for Payer: UHC Exchange |
$1,607.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,607.96
|
|
|
PR CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23415
|
| Min. Negotiated Rate |
$677.03 |
| Max. Negotiated Rate |
$1,153.75 |
| Rate for Payer: Aetna Commercial |
$907.22
|
| Rate for Payer: Aetna Medicare |
$704.11
|
| Rate for Payer: BCBS Complete |
$710.00
|
| Rate for Payer: BCBS MAPPO |
$677.03
|
| Rate for Payer: BCN Medicare Advantage |
$677.03
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cofinity Commercial |
$974.92
|
| Rate for Payer: Cofinity Commercial |
$907.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.88
|
| Rate for Payer: Nomi Health Commercial |
$812.44
|
| Rate for Payer: PACE SWMI |
$677.03
|
| Rate for Payer: PHP Medicare Advantage |
$677.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.75
|
| Rate for Payer: Priority Health Medicare |
$683.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$677.03
|
| Rate for Payer: UHC Exchange |
$677.03
|
| Rate for Payer: UHC Medicare Advantage |
$677.03
|
|
|
PR CORDOCENTESIS INTRAUTERINE
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 59012
|
| Min. Negotiated Rate |
$196.41 |
| Max. Negotiated Rate |
$348.40 |
| Rate for Payer: Aetna Commercial |
$263.19
|
| Rate for Payer: Aetna Medicare |
$204.27
|
| Rate for Payer: BCBS Complete |
$214.40
|
| Rate for Payer: BCBS MAPPO |
$196.41
|
| Rate for Payer: BCN Medicare Advantage |
$196.41
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cofinity Commercial |
$282.83
|
| Rate for Payer: Cofinity Commercial |
$263.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.23
|
| Rate for Payer: Nomi Health Commercial |
$235.69
|
| Rate for Payer: PACE SWMI |
$196.41
|
| Rate for Payer: PHP Medicare Advantage |
$196.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.40
|
| Rate for Payer: Priority Health Medicare |
$198.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.41
|
| Rate for Payer: UHC Exchange |
$196.41
|
| Rate for Payer: UHC Medicare Advantage |
$196.41
|
|
|
PR CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 32408
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$192.18
|
| Rate for Payer: Aetna Medicare |
$149.16
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$143.42
|
| Rate for Payer: BCN Medicare Advantage |
$143.42
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$206.52
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.59
|
| Rate for Payer: Nomi Health Commercial |
$172.10
|
| Rate for Payer: PACE SWMI |
$143.42
|
| Rate for Payer: PHP Medicare Advantage |
$143.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$144.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.42
|
| Rate for Payer: UHC Exchange |
$143.42
|
| Rate for Payer: UHC Medicare Advantage |
$143.42
|
|
|
PR CORF RELATED SERV 15 MINS EA
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0409
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Aetna Commercial |
$28.54
|
| Rate for Payer: Aetna Medicare |
$22.15
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$21.30
|
| Rate for Payer: BCN Medicare Advantage |
$21.30
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$30.67
|
| Rate for Payer: Cofinity Commercial |
$28.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.36
|
| Rate for Payer: Nomi Health Commercial |
$25.56
|
| Rate for Payer: PACE SWMI |
$21.30
|
| Rate for Payer: PHP Medicare Advantage |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Medicare |
$21.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.30
|
| Rate for Payer: UHC Exchange |
$21.30
|
| Rate for Payer: UHC Medicare Advantage |
$21.30
|
|
|
PR CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT
|
Professional
|
Both
|
$4,046.00
|
|
|
Service Code
|
HCPCS 33510
|
| Min. Negotiated Rate |
$1,618.40 |
| Max. Negotiated Rate |
$2,668.46 |
| Rate for Payer: Aetna Commercial |
$2,483.15
|
| Rate for Payer: Aetna Medicare |
$1,927.22
|
| Rate for Payer: BCBS Complete |
$1,618.40
|
| Rate for Payer: BCBS MAPPO |
$1,853.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,853.10
|
| Rate for Payer: Cash Price |
$3,236.80
|
| Rate for Payer: Cash Price |
$3,236.80
|
| Rate for Payer: Cofinity Commercial |
$2,668.46
|
| Rate for Payer: Cofinity Commercial |
$2,483.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,853.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,945.76
|
| Rate for Payer: Nomi Health Commercial |
$2,223.72
|
| Rate for Payer: PACE SWMI |
$1,853.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,853.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.90
|
| Rate for Payer: Priority Health Medicare |
$1,871.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,853.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,853.10
|
| Rate for Payer: UHC Exchange |
$1,853.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,853.10
|
|
|
PR CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$4,444.00
|
|
|
Service Code
|
HCPCS 33511
|
| Min. Negotiated Rate |
$1,777.60 |
| Max. Negotiated Rate |
$2,931.57 |
| Rate for Payer: Aetna Commercial |
$2,727.99
|
| Rate for Payer: Aetna Medicare |
$2,117.24
|
| Rate for Payer: BCBS Complete |
$1,777.60
|
| Rate for Payer: BCBS MAPPO |
$2,035.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,035.81
|
| Rate for Payer: Cash Price |
$3,555.20
|
| Rate for Payer: Cash Price |
$3,555.20
|
| Rate for Payer: Cofinity Commercial |
$2,931.57
|
| Rate for Payer: Cofinity Commercial |
$2,727.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,035.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,137.60
|
| Rate for Payer: Nomi Health Commercial |
$2,442.97
|
| Rate for Payer: PACE SWMI |
$2,035.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,035.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,888.60
|
| Rate for Payer: Priority Health Medicare |
$2,056.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,035.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,035.81
|
| Rate for Payer: UHC Exchange |
$2,035.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,035.81
|
|
|
PR CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$9,917.00
|
|
|
Service Code
|
HCPCS 33512
|
| Min. Negotiated Rate |
$2,317.44 |
| Max. Negotiated Rate |
$6,446.05 |
| Rate for Payer: Aetna Commercial |
$3,105.37
|
| Rate for Payer: Aetna Medicare |
$2,410.14
|
| Rate for Payer: BCBS Complete |
$3,966.80
|
| Rate for Payer: BCBS MAPPO |
$2,317.44
|
| Rate for Payer: BCN Medicare Advantage |
$2,317.44
|
| Rate for Payer: Cash Price |
$7,933.60
|
| Rate for Payer: Cash Price |
$7,933.60
|
| Rate for Payer: Cofinity Commercial |
$3,337.11
|
| Rate for Payer: Cofinity Commercial |
$3,105.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,317.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,433.31
|
| Rate for Payer: Nomi Health Commercial |
$2,780.93
|
| Rate for Payer: PACE SWMI |
$2,317.44
|
| Rate for Payer: PHP Medicare Advantage |
$2,317.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,446.05
|
| Rate for Payer: Priority Health Medicare |
$2,340.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,317.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,317.44
|
| Rate for Payer: UHC Exchange |
$2,317.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,317.44
|
|
|
PR CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$10,120.00
|
|
|
Service Code
|
HCPCS 33513
|
| Min. Negotiated Rate |
$2,368.98 |
| Max. Negotiated Rate |
$6,578.00 |
| Rate for Payer: Aetna Commercial |
$3,174.43
|
| Rate for Payer: Aetna Medicare |
$2,463.74
|
| Rate for Payer: BCBS Complete |
$4,048.00
|
| Rate for Payer: BCBS MAPPO |
$2,368.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,368.98
|
| Rate for Payer: Cash Price |
$8,096.00
|
| Rate for Payer: Cash Price |
$8,096.00
|
| Rate for Payer: Cofinity Commercial |
$3,411.33
|
| Rate for Payer: Cofinity Commercial |
$3,174.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,368.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,487.43
|
| Rate for Payer: Nomi Health Commercial |
$2,842.78
|
| Rate for Payer: PACE SWMI |
$2,368.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,368.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,578.00
|
| Rate for Payer: Priority Health Medicare |
$2,392.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,368.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,368.98
|
| Rate for Payer: UHC Exchange |
$2,368.98
|
| Rate for Payer: UHC Medicare Advantage |
$2,368.98
|
|
|
PR CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT
|
Professional
|
Both
|
$11,382.00
|
|
|
Service Code
|
HCPCS 33516
|
| Min. Negotiated Rate |
$2,579.30 |
| Max. Negotiated Rate |
$7,398.30 |
| Rate for Payer: Aetna Commercial |
$3,456.26
|
| Rate for Payer: Aetna Medicare |
$2,682.47
|
| Rate for Payer: BCBS Complete |
$4,552.80
|
| Rate for Payer: BCBS MAPPO |
$2,579.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,579.30
|
| Rate for Payer: Cash Price |
$9,105.60
|
| Rate for Payer: Cash Price |
$9,105.60
|
| Rate for Payer: Cofinity Commercial |
$3,714.19
|
| Rate for Payer: Cofinity Commercial |
$3,456.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,579.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,708.26
|
| Rate for Payer: Nomi Health Commercial |
$3,095.16
|
| Rate for Payer: PACE SWMI |
$2,579.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,579.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,398.30
|
| Rate for Payer: Priority Health Medicare |
$2,605.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,579.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,579.30
|
| Rate for Payer: UHC Exchange |
$2,579.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,579.30
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 33517
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$522.60 |
| Rate for Payer: Aetna Commercial |
$239.97
|
| Rate for Payer: Aetna Medicare |
$186.24
|
| Rate for Payer: BCBS Complete |
$321.60
|
| Rate for Payer: BCBS MAPPO |
$179.08
|
| Rate for Payer: BCN Medicare Advantage |
$179.08
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cofinity Commercial |
$257.88
|
| Rate for Payer: Cofinity Commercial |
$239.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.03
|
| Rate for Payer: Nomi Health Commercial |
$214.90
|
| Rate for Payer: PACE SWMI |
$179.08
|
| Rate for Payer: PHP Medicare Advantage |
$179.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.60
|
| Rate for Payer: Priority Health Medicare |
$180.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.08
|
| Rate for Payer: UHC Exchange |
$179.08
|
| Rate for Payer: UHC Medicare Advantage |
$179.08
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 33518
|
| Min. Negotiated Rate |
$394.31 |
| Max. Negotiated Rate |
$861.25 |
| Rate for Payer: Aetna Commercial |
$528.38
|
| Rate for Payer: Aetna Medicare |
$410.08
|
| Rate for Payer: BCBS Complete |
$530.00
|
| Rate for Payer: BCBS MAPPO |
$394.31
|
| Rate for Payer: BCN Medicare Advantage |
$394.31
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cofinity Commercial |
$567.81
|
| Rate for Payer: Cofinity Commercial |
$528.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.03
|
| Rate for Payer: Nomi Health Commercial |
$473.17
|
| Rate for Payer: PACE SWMI |
$394.31
|
| Rate for Payer: PHP Medicare Advantage |
$394.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.25
|
| Rate for Payer: Priority Health Medicare |
$398.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.31
|
| Rate for Payer: UHC Exchange |
$394.31
|
| Rate for Payer: UHC Medicare Advantage |
$394.31
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 33519
|
| Min. Negotiated Rate |
$520.05 |
| Max. Negotiated Rate |
$1,254.50 |
| Rate for Payer: Aetna Commercial |
$696.87
|
| Rate for Payer: Aetna Medicare |
$540.85
|
| Rate for Payer: BCBS Complete |
$772.00
|
| Rate for Payer: BCBS MAPPO |
$520.05
|
| Rate for Payer: BCN Medicare Advantage |
$520.05
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cofinity Commercial |
$748.87
|
| Rate for Payer: Cofinity Commercial |
$696.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.05
|
| Rate for Payer: Nomi Health Commercial |
$624.06
|
| Rate for Payer: PACE SWMI |
$520.05
|
| Rate for Payer: PHP Medicare Advantage |
$520.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.50
|
| Rate for Payer: Priority Health Medicare |
$525.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$520.05
|
| Rate for Payer: UHC Exchange |
$520.05
|
| Rate for Payer: UHC Medicare Advantage |
$520.05
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN
|
Professional
|
Both
|
$2,591.00
|
|
|
Service Code
|
HCPCS 33521
|
| Min. Negotiated Rate |
$624.42 |
| Max. Negotiated Rate |
$1,684.15 |
| Rate for Payer: Aetna Commercial |
$836.72
|
| Rate for Payer: Aetna Medicare |
$649.40
|
| Rate for Payer: BCBS Complete |
$1,036.40
|
| Rate for Payer: BCBS MAPPO |
$624.42
|
| Rate for Payer: BCN Medicare Advantage |
$624.42
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cofinity Commercial |
$899.16
|
| Rate for Payer: Cofinity Commercial |
$836.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.64
|
| Rate for Payer: Nomi Health Commercial |
$749.30
|
| Rate for Payer: PACE SWMI |
$624.42
|
| Rate for Payer: PHP Medicare Advantage |
$624.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.15
|
| Rate for Payer: Priority Health Medicare |
$630.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.42
|
| Rate for Payer: UHC Exchange |
$624.42
|
| Rate for Payer: UHC Medicare Advantage |
$624.42
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 33522
|
| Min. Negotiated Rate |
$701.26 |
| Max. Negotiated Rate |
$2,139.80 |
| Rate for Payer: Aetna Commercial |
$939.69
|
| Rate for Payer: Aetna Medicare |
$729.31
|
| Rate for Payer: BCBS Complete |
$1,316.80
|
| Rate for Payer: BCBS MAPPO |
$701.26
|
| Rate for Payer: BCN Medicare Advantage |
$701.26
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cofinity Commercial |
$939.69
|
| Rate for Payer: Cofinity Commercial |
$1,009.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$736.32
|
| Rate for Payer: Nomi Health Commercial |
$841.51
|
| Rate for Payer: PACE SWMI |
$701.26
|
| Rate for Payer: PHP Medicare Advantage |
$701.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.80
|
| Rate for Payer: Priority Health Medicare |
$708.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$701.26
|
| Rate for Payer: UHC Exchange |
$701.26
|
| Rate for Payer: UHC Medicare Advantage |
$701.26
|
|
|
PR CORONARY ENDARTERCOMY OPEN ANY METHOD
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 33572
|
| Min. Negotiated Rate |
$219.91 |
| Max. Negotiated Rate |
$841.75 |
| Rate for Payer: Aetna Commercial |
$294.68
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: BCBS Complete |
$518.00
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$316.67
|
| Rate for Payer: Cofinity Commercial |
$294.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: Nomi Health Commercial |
$263.89
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.75
|
| Rate for Payer: Priority Health Medicare |
$222.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$219.91
|
| Rate for Payer: UHC Medicare Advantage |
$219.91
|
|
|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$611.42 |
| Max. Negotiated Rate |
$1,218.10 |
| Rate for Payer: Aetna Commercial |
$819.30
|
| Rate for Payer: Aetna Medicare |
$635.88
|
| Rate for Payer: BCBS Complete |
$749.60
|
| Rate for Payer: BCBS MAPPO |
$611.42
|
| Rate for Payer: BCN Medicare Advantage |
$611.42
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$880.44
|
| Rate for Payer: Cofinity Commercial |
$819.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$641.99
|
| Rate for Payer: Nomi Health Commercial |
$733.70
|
| Rate for Payer: PACE SWMI |
$611.42
|
| Rate for Payer: PHP Medicare Advantage |
$611.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health Medicare |
$617.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$611.42
|
| Rate for Payer: UHC Exchange |
$611.42
|
| Rate for Payer: UHC Medicare Advantage |
$611.42
|
|
|
PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 54435
|
| Min. Negotiated Rate |
$301.20 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$531.54
|
| Rate for Payer: Aetna Medicare |
$412.54
|
| Rate for Payer: BCBS Complete |
$301.20
|
| Rate for Payer: BCBS MAPPO |
$396.67
|
| Rate for Payer: BCN Medicare Advantage |
$396.67
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$531.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.50
|
| Rate for Payer: Nomi Health Commercial |
$476.00
|
| Rate for Payer: PACE SWMI |
$396.67
|
| Rate for Payer: PHP Medicare Advantage |
$396.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.45
|
| Rate for Payer: Priority Health Medicare |
$400.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.67
|
| Rate for Payer: UHC Exchange |
$396.67
|
| Rate for Payer: UHC Medicare Advantage |
$396.67
|
|
|
PR CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 54420
|
| Min. Negotiated Rate |
$539.20 |
| Max. Negotiated Rate |
$967.13 |
| Rate for Payer: Aetna Commercial |
$899.97
|
| Rate for Payer: Aetna Medicare |
$698.48
|
| Rate for Payer: BCBS Complete |
$539.20
|
| Rate for Payer: BCBS MAPPO |
$671.62
|
| Rate for Payer: BCN Medicare Advantage |
$671.62
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$967.13
|
| Rate for Payer: Cofinity Commercial |
$899.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.20
|
| Rate for Payer: Nomi Health Commercial |
$805.94
|
| Rate for Payer: PACE SWMI |
$671.62
|
| Rate for Payer: PHP Medicare Advantage |
$671.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health Medicare |
$678.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$671.62
|
| Rate for Payer: UHC Exchange |
$671.62
|
| Rate for Payer: UHC Medicare Advantage |
$671.62
|
|
|
PR CORRECT BUNION,SIMPLE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 28290
|
| Min. Negotiated Rate |
$553.60 |
| Max. Negotiated Rate |
$899.60 |
| Rate for Payer: Aetna Medicare |
$692.00
|
| Rate for Payer: BCBS Complete |
$553.60
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.60
|
|
|
PR CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 28286
|
| Min. Negotiated Rate |
$282.63 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Medicare |
$293.94
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$282.63
|
| Rate for Payer: BCN Medicare Advantage |
$282.63
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$406.99
|
| Rate for Payer: Cofinity Commercial |
$378.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.76
|
| Rate for Payer: Nomi Health Commercial |
$339.16
|
| Rate for Payer: PACE SWMI |
$282.63
|
| Rate for Payer: PHP Medicare Advantage |
$282.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$285.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.63
|
| Rate for Payer: UHC Exchange |
$282.63
|
| Rate for Payer: UHC Medicare Advantage |
$282.63
|
|
|
PR CORRECTION HAMMERTOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$371.34 |
| Max. Negotiated Rate |
$621.40 |
| Rate for Payer: Aetna Commercial |
$497.60
|
| Rate for Payer: Aetna Medicare |
$386.19
|
| Rate for Payer: BCBS Complete |
$382.40
|
| Rate for Payer: BCBS MAPPO |
$371.34
|
| Rate for Payer: BCN Medicare Advantage |
$371.34
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$534.73
|
| Rate for Payer: Cofinity Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.91
|
| Rate for Payer: Nomi Health Commercial |
$445.61
|
| Rate for Payer: PACE SWMI |
$371.34
|
| Rate for Payer: PHP Medicare Advantage |
$371.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health Medicare |
$375.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.34
|
| Rate for Payer: UHC Exchange |
$371.34
|
| Rate for Payer: UHC Medicare Advantage |
$371.34
|
|
|
PR CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 19355
|
| Min. Negotiated Rate |
$591.15 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$792.14
|
| Rate for Payer: Aetna Medicare |
$614.80
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$591.15
|
| Rate for Payer: BCN Medicare Advantage |
$591.15
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$851.26
|
| Rate for Payer: Cofinity Commercial |
$792.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.71
|
| Rate for Payer: Nomi Health Commercial |
$709.38
|
| Rate for Payer: PACE SWMI |
$591.15
|
| Rate for Payer: PHP Medicare Advantage |
$591.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$597.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.15
|
| Rate for Payer: UHC Exchange |
$591.15
|
| Rate for Payer: UHC Medicare Advantage |
$591.15
|
|
|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$21.36
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$20.54
|
| Rate for Payer: BCN Medicare Advantage |
$20.54
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$24.65
|
| Rate for Payer: PACE SWMI |
$20.54
|
| Rate for Payer: PHP Medicare Advantage |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$20.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.54
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$20.54
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$493.38 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$661.13
|
| Rate for Payer: Aetna Medicare |
$513.12
|
| Rate for Payer: BCBS Complete |
$896.40
|
| Rate for Payer: BCBS MAPPO |
$493.38
|
| Rate for Payer: BCN Medicare Advantage |
$493.38
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cofinity Commercial |
$710.47
|
| Rate for Payer: Cofinity Commercial |
$661.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$518.05
|
| Rate for Payer: Nomi Health Commercial |
$592.06
|
| Rate for Payer: PACE SWMI |
$493.38
|
| Rate for Payer: PHP Medicare Advantage |
$493.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health Medicare |
$498.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.38
|
| Rate for Payer: UHC Exchange |
$493.38
|
| Rate for Payer: UHC Medicare Advantage |
$493.38
|
|
