|
PR EXC EXCSV SKN ABD INFRAUMBILICAL PANNICULECTOMY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 15830
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Commercial |
$1,509.38
|
| Rate for Payer: Aetna Medicare |
$1,171.46
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,126.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,126.40
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,622.02
|
| Rate for Payer: Cofinity Commercial |
$1,509.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,126.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.72
|
| Rate for Payer: Nomi Health Commercial |
$1,351.68
|
| Rate for Payer: PACE SWMI |
$1,126.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,126.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,137.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,126.40
|
| Rate for Payer: UHC Exchange |
$1,126.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,126.40
|
|
|
PR EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$826.08 |
| Max. Negotiated Rate |
$1,723.15 |
| Rate for Payer: Aetna Commercial |
$1,106.95
|
| Rate for Payer: Aetna Medicare |
$859.12
|
| Rate for Payer: BCBS Complete |
$1,060.40
|
| Rate for Payer: BCBS MAPPO |
$826.08
|
| Rate for Payer: BCN Medicare Advantage |
$826.08
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,189.56
|
| Rate for Payer: Cofinity Commercial |
$1,106.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.38
|
| Rate for Payer: Nomi Health Commercial |
$991.30
|
| Rate for Payer: PACE SWMI |
$826.08
|
| Rate for Payer: PHP Medicare Advantage |
$826.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.15
|
| Rate for Payer: Priority Health Medicare |
$834.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.08
|
| Rate for Payer: UHC Exchange |
$826.08
|
| Rate for Payer: UHC Medicare Advantage |
$826.08
|
|
|
PR EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$189.81 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Commercial |
$254.35
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: BCBS MAPPO |
$189.81
|
| Rate for Payer: BCN Medicare Advantage |
$189.81
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$273.33
|
| Rate for Payer: Cofinity Commercial |
$254.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.30
|
| Rate for Payer: Nomi Health Commercial |
$227.77
|
| Rate for Payer: PACE SWMI |
$189.81
|
| Rate for Payer: PHP Medicare Advantage |
$189.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health Medicare |
$191.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.81
|
| Rate for Payer: UHC Exchange |
$189.81
|
| Rate for Payer: UHC Medicare Advantage |
$189.81
|
|
|
PR EXC/FULGURATION URETHRAL CARUNCLE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 53265
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$267.80 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$183.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Exchange |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
|
|
PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 53260
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$250.65 |
| Rate for Payer: Aetna Commercial |
$233.24
|
| Rate for Payer: Aetna Medicare |
$181.02
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$174.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.06
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$250.65
|
| Rate for Payer: Cofinity Commercial |
$233.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.76
|
| Rate for Payer: Nomi Health Commercial |
$208.87
|
| Rate for Payer: PACE SWMI |
$174.06
|
| Rate for Payer: PHP Medicare Advantage |
$174.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Medicare |
$175.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.06
|
| Rate for Payer: UHC Exchange |
$174.06
|
| Rate for Payer: UHC Medicare Advantage |
$174.06
|
|
|
PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 50435
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$828.10 |
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Medicare |
$97.14
|
| Rate for Payer: BCBS Complete |
$509.60
|
| Rate for Payer: BCBS MAPPO |
$93.40
|
| Rate for Payer: BCN Medicare Advantage |
$93.40
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Commercial |
$125.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.07
|
| Rate for Payer: Nomi Health Commercial |
$112.08
|
| Rate for Payer: PACE SWMI |
$93.40
|
| Rate for Payer: PHP Medicare Advantage |
$93.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health Medicare |
$94.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.40
|
| Rate for Payer: UHC Exchange |
$93.40
|
| Rate for Payer: UHC Medicare Advantage |
$93.40
|
|
|
PR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 49423
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$828.10 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: BCBS Complete |
$509.60
|
| Rate for Payer: BCBS MAPPO |
$66.56
|
| Rate for Payer: BCN Medicare Advantage |
$66.56
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$95.85
|
| Rate for Payer: Cofinity Commercial |
$89.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.89
|
| Rate for Payer: Nomi Health Commercial |
$79.87
|
| Rate for Payer: PACE SWMI |
$66.56
|
| Rate for Payer: PHP Medicare Advantage |
$66.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health Medicare |
$67.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.56
|
| Rate for Payer: UHC Exchange |
$66.56
|
| Rate for Payer: UHC Medicare Advantage |
$66.56
|
|
|
PR EXC HYDROCELE SPRMATIC CORD UNI SPX
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 55500
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$540.33 |
| Rate for Payer: Aetna Commercial |
$502.81
|
| Rate for Payer: Aetna Medicare |
$390.24
|
| Rate for Payer: BCBS Complete |
$290.00
|
| Rate for Payer: BCBS MAPPO |
$375.23
|
| Rate for Payer: BCN Medicare Advantage |
$375.23
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cofinity Commercial |
$540.33
|
| Rate for Payer: Cofinity Commercial |
$502.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.99
|
| Rate for Payer: Nomi Health Commercial |
$450.28
|
| Rate for Payer: PACE SWMI |
$375.23
|
| Rate for Payer: PHP Medicare Advantage |
$375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.25
|
| Rate for Payer: Priority Health Medicare |
$378.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.23
|
| Rate for Payer: UHC Exchange |
$375.23
|
| Rate for Payer: UHC Medicare Advantage |
$375.23
|
|
|
PR EXC ILEOANAL RSVR W/ILEOSTOMY
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 45136
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$2,433.33 |
| Rate for Payer: Aetna Commercial |
$2,264.35
|
| Rate for Payer: Aetna Medicare |
$1,757.40
|
| Rate for Payer: BCBS Complete |
$1,301.60
|
| Rate for Payer: BCBS MAPPO |
$1,689.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.81
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cofinity Commercial |
$2,433.33
|
| Rate for Payer: Cofinity Commercial |
$2,264.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.30
|
| Rate for Payer: Nomi Health Commercial |
$2,027.77
|
| Rate for Payer: PACE SWMI |
$1,689.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,115.10
|
| Rate for Payer: Priority Health Medicare |
$1,706.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,689.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.81
|
| Rate for Payer: UHC Exchange |
$1,689.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.81
|
|
|
PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,392.00
|
|
|
Service Code
|
HCPCS 33120
|
| Min. Negotiated Rate |
$1,756.80 |
| Max. Negotiated Rate |
$2,888.29 |
| Rate for Payer: Aetna Commercial |
$2,687.72
|
| Rate for Payer: Aetna Medicare |
$2,085.99
|
| Rate for Payer: BCBS Complete |
$1,756.80
|
| Rate for Payer: BCBS MAPPO |
$2,005.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,005.76
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cofinity Commercial |
$2,888.29
|
| Rate for Payer: Cofinity Commercial |
$2,687.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,005.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,106.05
|
| Rate for Payer: Nomi Health Commercial |
$2,406.91
|
| Rate for Payer: PACE SWMI |
$2,005.76
|
| Rate for Payer: PHP Medicare Advantage |
$2,005.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.80
|
| Rate for Payer: Priority Health Medicare |
$2,025.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,005.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,005.76
|
| Rate for Payer: UHC Exchange |
$2,005.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,005.76
|
|
|
PR EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 19260
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$1,472.25 |
| Rate for Payer: Aetna Medicare |
$1,132.50
|
| Rate for Payer: BCBS Complete |
$906.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.25
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
HCPCS 15940
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$984.97 |
| Rate for Payer: Aetna Commercial |
$916.57
|
| Rate for Payer: Aetna Medicare |
$711.37
|
| Rate for Payer: BCBS Complete |
$499.20
|
| Rate for Payer: BCBS MAPPO |
$684.01
|
| Rate for Payer: BCN Medicare Advantage |
$684.01
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cofinity Commercial |
$984.97
|
| Rate for Payer: Cofinity Commercial |
$916.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.21
|
| Rate for Payer: Nomi Health Commercial |
$820.81
|
| Rate for Payer: PACE SWMI |
$684.01
|
| Rate for Payer: PHP Medicare Advantage |
$684.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$811.20
|
| Rate for Payer: Priority Health Medicare |
$690.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.01
|
| Rate for Payer: UHC Exchange |
$684.01
|
| Rate for Payer: UHC Medicare Advantage |
$684.01
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 15944
|
| Min. Negotiated Rate |
$646.80 |
| Max. Negotiated Rate |
$1,283.23 |
| Rate for Payer: Aetna Commercial |
$1,194.11
|
| Rate for Payer: Aetna Medicare |
$926.78
|
| Rate for Payer: BCBS Complete |
$646.80
|
| Rate for Payer: BCBS MAPPO |
$891.13
|
| Rate for Payer: BCN Medicare Advantage |
$891.13
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,194.11
|
| Rate for Payer: Cofinity Commercial |
$1,283.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$891.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$935.69
|
| Rate for Payer: Nomi Health Commercial |
$1,069.36
|
| Rate for Payer: PACE SWMI |
$891.13
|
| Rate for Payer: PHP Medicare Advantage |
$891.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.05
|
| Rate for Payer: Priority Health Medicare |
$900.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$891.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$891.13
|
| Rate for Payer: UHC Exchange |
$891.13
|
| Rate for Payer: UHC Medicare Advantage |
$891.13
|
|
|
PR EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$3,352.00
|
|
|
Service Code
|
HCPCS 15946
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$2,211.74 |
| Rate for Payer: Aetna Commercial |
$2,058.15
|
| Rate for Payer: Aetna Medicare |
$1,597.37
|
| Rate for Payer: BCBS Complete |
$1,340.80
|
| Rate for Payer: BCBS MAPPO |
$1,535.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,535.93
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cofinity Commercial |
$2,211.74
|
| Rate for Payer: Cofinity Commercial |
$2,058.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,535.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,612.73
|
| Rate for Payer: Nomi Health Commercial |
$1,843.12
|
| Rate for Payer: PACE SWMI |
$1,535.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,535.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,178.80
|
| Rate for Payer: Priority Health Medicare |
$1,551.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,535.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,535.93
|
| Rate for Payer: UHC Exchange |
$1,535.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,535.93
|
|
|
PR EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 15941
|
| Min. Negotiated Rate |
$646.40 |
| Max. Negotiated Rate |
$1,299.53 |
| Rate for Payer: Aetna Commercial |
$1,209.28
|
| Rate for Payer: Aetna Medicare |
$938.55
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$902.45
|
| Rate for Payer: BCN Medicare Advantage |
$902.45
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$1,299.53
|
| Rate for Payer: Cofinity Commercial |
$1,209.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.57
|
| Rate for Payer: Nomi Health Commercial |
$1,082.94
|
| Rate for Payer: PACE SWMI |
$902.45
|
| Rate for Payer: PHP Medicare Advantage |
$902.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$911.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.45
|
| Rate for Payer: UHC Exchange |
$902.45
|
| Rate for Payer: UHC Medicare Advantage |
$902.45
|
|
|
PR EXCISION 1ST &/CERVICAL RIB
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 21615
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$871.52 |
| Rate for Payer: Aetna Commercial |
$810.99
|
| Rate for Payer: Aetna Medicare |
$629.43
|
| Rate for Payer: BCBS Complete |
$480.80
|
| Rate for Payer: BCBS MAPPO |
$605.22
|
| Rate for Payer: BCN Medicare Advantage |
$605.22
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cofinity Commercial |
$871.52
|
| Rate for Payer: Cofinity Commercial |
$810.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.48
|
| Rate for Payer: Nomi Health Commercial |
$726.26
|
| Rate for Payer: PACE SWMI |
$605.22
|
| Rate for Payer: PHP Medicare Advantage |
$605.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health Medicare |
$611.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.22
|
| Rate for Payer: UHC Exchange |
$605.22
|
| Rate for Payer: UHC Medicare Advantage |
$605.22
|
|
|
PR EXCISION AMPULLA VATER
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 48148
|
| Min. Negotiated Rate |
$738.80 |
| Max. Negotiated Rate |
$1,750.03 |
| Rate for Payer: Aetna Commercial |
$1,628.50
|
| Rate for Payer: Aetna Medicare |
$1,263.91
|
| Rate for Payer: BCBS Complete |
$738.80
|
| Rate for Payer: BCBS MAPPO |
$1,215.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.30
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,750.03
|
| Rate for Payer: Cofinity Commercial |
$1,628.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,276.07
|
| Rate for Payer: Nomi Health Commercial |
$1,458.36
|
| Rate for Payer: PACE SWMI |
$1,215.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health Medicare |
$1,227.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,215.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.30
|
| Rate for Payer: UHC Exchange |
$1,215.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.30
|
|
|
PR EXCISION AURAL POLYP
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 69540
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: Aetna Medicare |
$125.15
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: BCBS MAPPO |
$120.34
|
| Rate for Payer: BCN Medicare Advantage |
$120.34
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$173.29
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.36
|
| Rate for Payer: Nomi Health Commercial |
$144.41
|
| Rate for Payer: PACE SWMI |
$120.34
|
| Rate for Payer: PHP Medicare Advantage |
$120.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health Medicare |
$121.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.34
|
| Rate for Payer: UHC Exchange |
$120.34
|
| Rate for Payer: UHC Medicare Advantage |
$120.34
|
|
|
PR EXCISION BARTHOLINS GLAND OR CYST
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$300.06 |
| Max. Negotiated Rate |
$603.85 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| Rate for Payer: Aetna Medicare |
$312.06
|
| Rate for Payer: BCBS Complete |
$371.60
|
| Rate for Payer: BCBS MAPPO |
$300.06
|
| Rate for Payer: BCN Medicare Advantage |
$300.06
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cofinity Commercial |
$432.09
|
| Rate for Payer: Cofinity Commercial |
$402.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.06
|
| Rate for Payer: Nomi Health Commercial |
$360.07
|
| Rate for Payer: PACE SWMI |
$300.06
|
| Rate for Payer: PHP Medicare Advantage |
$300.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.85
|
| Rate for Payer: Priority Health Medicare |
$303.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.06
|
| Rate for Payer: UHC Exchange |
$300.06
|
| Rate for Payer: UHC Medicare Advantage |
$300.06
|
|
|
PR EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 21040
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$634.40 |
| Rate for Payer: Aetna Commercial |
$461.34
|
| Rate for Payer: Aetna Medicare |
$358.05
|
| Rate for Payer: BCBS Complete |
$390.40
|
| Rate for Payer: BCBS MAPPO |
$344.28
|
| Rate for Payer: BCN Medicare Advantage |
$344.28
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cofinity Commercial |
$495.76
|
| Rate for Payer: Cofinity Commercial |
$461.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.49
|
| Rate for Payer: Nomi Health Commercial |
$413.14
|
| Rate for Payer: PACE SWMI |
$344.28
|
| Rate for Payer: PHP Medicare Advantage |
$344.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.40
|
| Rate for Payer: Priority Health Medicare |
$347.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.28
|
| Rate for Payer: UHC Exchange |
$344.28
|
| Rate for Payer: UHC Medicare Advantage |
$344.28
|
|
|
PR EXCISION BONE CYST/BENIGN TUMOR DEEP
|
Professional
|
Both
|
$1,497.00
|
|
|
Service Code
|
HCPCS 27066
|
| Min. Negotiated Rate |
$598.80 |
| Max. Negotiated Rate |
$1,138.36 |
| Rate for Payer: Aetna Commercial |
$1,059.31
|
| Rate for Payer: Aetna Medicare |
$822.15
|
| Rate for Payer: BCBS Complete |
$598.80
|
| Rate for Payer: BCBS MAPPO |
$790.53
|
| Rate for Payer: BCN Medicare Advantage |
$790.53
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cofinity Commercial |
$1,138.36
|
| Rate for Payer: Cofinity Commercial |
$1,059.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.06
|
| Rate for Payer: Nomi Health Commercial |
$948.64
|
| Rate for Payer: PACE SWMI |
$790.53
|
| Rate for Payer: PHP Medicare Advantage |
$790.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.05
|
| Rate for Payer: Priority Health Medicare |
$798.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$790.53
|
| Rate for Payer: UHC Exchange |
$790.53
|
| Rate for Payer: UHC Medicare Advantage |
$790.53
|
|
|
PR EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 27065
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$728.32 |
| Rate for Payer: Aetna Commercial |
$677.75
|
| Rate for Payer: Aetna Medicare |
$526.01
|
| Rate for Payer: BCBS Complete |
$362.00
|
| Rate for Payer: BCBS MAPPO |
$505.78
|
| Rate for Payer: BCN Medicare Advantage |
$505.78
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$728.32
|
| Rate for Payer: Cofinity Commercial |
$677.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.07
|
| Rate for Payer: Nomi Health Commercial |
$606.94
|
| Rate for Payer: PACE SWMI |
$505.78
|
| Rate for Payer: PHP Medicare Advantage |
$505.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health Medicare |
$510.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.78
|
| Rate for Payer: UHC Exchange |
$505.78
|
| Rate for Payer: UHC Medicare Advantage |
$505.78
|
|
|
PR EXCISION BONE MANDIBLE
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 21025
|
| Min. Negotiated Rate |
$635.55 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Aetna Commercial |
$851.64
|
| Rate for Payer: Aetna Medicare |
$660.97
|
| Rate for Payer: BCBS Complete |
$638.40
|
| Rate for Payer: BCBS MAPPO |
$635.55
|
| Rate for Payer: BCN Medicare Advantage |
$635.55
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cofinity Commercial |
$915.19
|
| Rate for Payer: Cofinity Commercial |
$851.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.33
|
| Rate for Payer: Nomi Health Commercial |
$762.66
|
| Rate for Payer: PACE SWMI |
$635.55
|
| Rate for Payer: PHP Medicare Advantage |
$635.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
| Rate for Payer: Priority Health Medicare |
$641.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$635.55
|
| Rate for Payer: UHC Exchange |
$635.55
|
| Rate for Payer: UHC Medicare Advantage |
$635.55
|
|
|
PR EXCISION CHALAZION MULTIPLE SAME LID
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 67801
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Aetna Commercial |
$163.98
|
| Rate for Payer: Aetna Medicare |
$127.26
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$122.37
|
| Rate for Payer: BCN Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$176.21
|
| Rate for Payer: Cofinity Commercial |
$163.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.49
|
| Rate for Payer: Nomi Health Commercial |
$146.84
|
| Rate for Payer: PACE SWMI |
$122.37
|
| Rate for Payer: PHP Medicare Advantage |
$122.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$123.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.37
|
| Rate for Payer: UHC Exchange |
$122.37
|
| Rate for Payer: UHC Medicare Advantage |
$122.37
|
|
|
PR EXCISION CHALAZION SINGLE
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 67800
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$137.16 |
| Rate for Payer: Aetna Commercial |
$127.64
|
| Rate for Payer: Aetna Medicare |
$99.06
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$95.25
|
| Rate for Payer: BCN Medicare Advantage |
$95.25
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Cofinity Commercial |
$127.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.01
|
| Rate for Payer: Nomi Health Commercial |
$114.30
|
| Rate for Payer: PACE SWMI |
$95.25
|
| Rate for Payer: PHP Medicare Advantage |
$95.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$96.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.25
|
| Rate for Payer: UHC Exchange |
$95.25
|
| Rate for Payer: UHC Medicare Advantage |
$95.25
|
|
