|
PR RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 50555
|
| Min. Negotiated Rate |
$214.07 |
| Max. Negotiated Rate |
$4,030.40 |
| Rate for Payer: Aetna Commercial |
$444.21
|
| Rate for Payer: Aetna Medicare |
$344.76
|
| Rate for Payer: BCBS Complete |
$224.77
|
| Rate for Payer: BCBS MAPPO |
$331.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,030.40
|
| Rate for Payer: BCN Commercial |
$595.70
|
| Rate for Payer: BCN Medicare Advantage |
$331.50
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$477.36
|
| Rate for Payer: Cofinity Commercial |
$444.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.50
|
| Rate for Payer: Mclaren Medicaid |
$214.07
|
| Rate for Payer: Meridian Medicaid |
$224.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.08
|
| Rate for Payer: PACE SWMI |
$331.50
|
| Rate for Payer: PHP Medicare Advantage |
$331.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.20
|
| Rate for Payer: Priority Health Medicare |
$331.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$331.50
|
| Rate for Payer: UHC Medicare Advantage |
$341.44
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 50557
|
| Min. Negotiated Rate |
$216.83 |
| Max. Negotiated Rate |
$4,171.46 |
| Rate for Payer: Aetna Commercial |
$450.03
|
| Rate for Payer: Aetna Medicare |
$349.27
|
| Rate for Payer: BCBS Complete |
$227.67
|
| Rate for Payer: BCBS MAPPO |
$335.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,171.46
|
| Rate for Payer: BCN Commercial |
$606.45
|
| Rate for Payer: BCN Medicare Advantage |
$335.84
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cofinity Commercial |
$450.03
|
| Rate for Payer: Cofinity Commercial |
$483.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.84
|
| Rate for Payer: Mclaren Medicaid |
$216.83
|
| Rate for Payer: Meridian Medicaid |
$227.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$352.63
|
| Rate for Payer: PACE SWMI |
$335.84
|
| Rate for Payer: PHP Medicare Advantage |
$335.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.22
|
| Rate for Payer: Priority Health Medicare |
$335.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.84
|
| Rate for Payer: UHC Medicare Advantage |
$345.92
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 50561
|
| Min. Negotiated Rate |
$247.72 |
| Max. Negotiated Rate |
$687.57 |
| Rate for Payer: Aetna Commercial |
$513.18
|
| Rate for Payer: Aetna Medicare |
$398.29
|
| Rate for Payer: BCBS Complete |
$260.11
|
| Rate for Payer: BCBS MAPPO |
$382.97
|
| Rate for Payer: BCBS Trust/PPO |
$287.92
|
| Rate for Payer: BCN Commercial |
$687.57
|
| Rate for Payer: BCN Medicare Advantage |
$382.97
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cofinity Commercial |
$551.48
|
| Rate for Payer: Cofinity Commercial |
$513.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.97
|
| Rate for Payer: Mclaren Medicaid |
$247.72
|
| Rate for Payer: Meridian Medicaid |
$260.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.12
|
| Rate for Payer: PACE SWMI |
$382.97
|
| Rate for Payer: PHP Medicare Advantage |
$382.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$621.41
|
| Rate for Payer: Priority Health Medicare |
$382.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.97
|
| Rate for Payer: UHC Medicare Advantage |
$394.46
|
|
|
PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 50553
|
| Min. Negotiated Rate |
$197.24 |
| Max. Negotiated Rate |
$3,834.93 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna Medicare |
$318.00
|
| Rate for Payer: BCBS Complete |
$207.10
|
| Rate for Payer: BCBS MAPPO |
$305.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,834.93
|
| Rate for Payer: BCN Commercial |
$560.51
|
| Rate for Payer: BCN Medicare Advantage |
$305.77
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cofinity Commercial |
$440.31
|
| Rate for Payer: Cofinity Commercial |
$409.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.77
|
| Rate for Payer: Mclaren Medicaid |
$197.24
|
| Rate for Payer: Meridian Medicaid |
$207.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$321.06
|
| Rate for Payer: PACE SWMI |
$305.77
|
| Rate for Payer: PHP Medicare Advantage |
$305.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.58
|
| Rate for Payer: Priority Health Medicare |
$305.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$496.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.77
|
| Rate for Payer: UHC Medicare Advantage |
$314.94
|
|
|
PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 50570
|
| Min. Negotiated Rate |
$308.21 |
| Max. Negotiated Rate |
$773.26 |
| Rate for Payer: Aetna Commercial |
$638.95
|
| Rate for Payer: Aetna Medicare |
$495.90
|
| Rate for Payer: BCBS Complete |
$323.62
|
| Rate for Payer: BCBS MAPPO |
$476.83
|
| Rate for Payer: BCBS Trust/PPO |
$634.49
|
| Rate for Payer: BCN Commercial |
$699.30
|
| Rate for Payer: BCN Medicare Advantage |
$476.83
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$686.64
|
| Rate for Payer: Cofinity Commercial |
$638.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.83
|
| Rate for Payer: Mclaren Medicaid |
$308.21
|
| Rate for Payer: Meridian Medicaid |
$323.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.67
|
| Rate for Payer: PACE SWMI |
$476.83
|
| Rate for Payer: PHP Medicare Advantage |
$476.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$773.26
|
| Rate for Payer: Priority Health Medicare |
$476.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.83
|
| Rate for Payer: UHC Medicare Advantage |
$491.13
|
|
|
PR REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 49002
|
| Min. Negotiated Rate |
$611.24 |
| Max. Negotiated Rate |
$1,827.41 |
| Rate for Payer: Aetna Commercial |
$1,387.89
|
| Rate for Payer: Aetna Medicare |
$1,077.17
|
| Rate for Payer: BCBS Complete |
$698.68
|
| Rate for Payer: BCBS MAPPO |
$1,035.74
|
| Rate for Payer: BCBS Trust/PPO |
$611.24
|
| Rate for Payer: BCN Commercial |
$1,518.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.74
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,387.89
|
| Rate for Payer: Cofinity Commercial |
$1,491.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.74
|
| Rate for Payer: Mclaren Medicaid |
$665.41
|
| Rate for Payer: Meridian Medicaid |
$698.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,087.53
|
| Rate for Payer: PACE SWMI |
$1,035.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,459.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,827.41
|
| Rate for Payer: Priority Health Medicare |
$1,035.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,827.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,035.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,035.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,066.81
|
|
|
PR REPAIR ANAL FISTULA W/FIBRIN GLUE
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 46706
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$316.32 |
| Rate for Payer: Aetna Commercial |
$236.91
|
| Rate for Payer: Aetna Medicare |
$183.87
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS MAPPO |
$176.80
|
| Rate for Payer: BCBS Trust/PPO |
$169.58
|
| Rate for Payer: BCN Commercial |
$262.91
|
| Rate for Payer: BCN Medicare Advantage |
$176.80
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$254.59
|
| Rate for Payer: Cofinity Commercial |
$236.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.80
|
| Rate for Payer: Mclaren Medicaid |
$116.09
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.64
|
| Rate for Payer: PACE SWMI |
$176.80
|
| Rate for Payer: PHP Medicare Advantage |
$176.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.32
|
| Rate for Payer: Priority Health Medicare |
$176.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.80
|
| Rate for Payer: UHC Medicare Advantage |
$182.10
|
|
|
PR REPAIR ANORECTAL FISTULA PLUG
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 46707
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$891.96 |
| Rate for Payer: Aetna Commercial |
$665.35
|
| Rate for Payer: Aetna Medicare |
$516.39
|
| Rate for Payer: BCBS Complete |
$341.29
|
| Rate for Payer: BCBS MAPPO |
$496.53
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: BCN Medicare Advantage |
$496.53
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$665.35
|
| Rate for Payer: Cofinity Commercial |
$715.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.53
|
| Rate for Payer: Mclaren Medicaid |
$325.04
|
| Rate for Payer: Meridian Medicaid |
$341.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.36
|
| Rate for Payer: PACE SWMI |
$496.53
|
| Rate for Payer: PHP Medicare Advantage |
$496.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$891.96
|
| Rate for Payer: Priority Health Medicare |
$496.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.53
|
| Rate for Payer: UHC Medicare Advantage |
$511.43
|
|
|
PR REPAIR BIFID EARLOBES - BILATERAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00535
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
|
|
PR REPAIR BIFID EARLOBES - UNILATERAL
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00534
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
PR REPAIR BLOOD VESSEL DIRECT HAND FINGER
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 35207
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$1,208.08 |
| Rate for Payer: Aetna Commercial |
$998.81
|
| Rate for Payer: Aetna Medicare |
$775.20
|
| Rate for Payer: BCBS Complete |
$508.81
|
| Rate for Payer: BCBS MAPPO |
$745.38
|
| Rate for Payer: BCBS Trust/PPO |
$292.68
|
| Rate for Payer: BCN Commercial |
$1,109.79
|
| Rate for Payer: BCN Medicare Advantage |
$745.38
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$998.81
|
| Rate for Payer: Cofinity Commercial |
$1,073.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.38
|
| Rate for Payer: Mclaren Medicaid |
$484.58
|
| Rate for Payer: Meridian Medicaid |
$508.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$782.65
|
| Rate for Payer: PACE SWMI |
$745.38
|
| Rate for Payer: PHP Medicare Advantage |
$745.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.08
|
| Rate for Payer: Priority Health Medicare |
$745.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,208.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$745.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.38
|
| Rate for Payer: UHC Medicare Advantage |
$767.74
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,157.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$586.18 |
| Max. Negotiated Rate |
$2,909.90 |
| Rate for Payer: Aetna Commercial |
$1,233.36
|
| Rate for Payer: Aetna Medicare |
$957.24
|
| Rate for Payer: BCBS Complete |
$615.49
|
| Rate for Payer: BCBS MAPPO |
$920.42
|
| Rate for Payer: BCBS Trust/PPO |
$871.17
|
| Rate for Payer: BCN Commercial |
$1,340.94
|
| Rate for Payer: BCN Medicare Advantage |
$920.42
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cofinity Commercial |
$1,325.40
|
| Rate for Payer: Cofinity Commercial |
$1,233.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$920.42
|
| Rate for Payer: Mclaren Medicaid |
$586.18
|
| Rate for Payer: Meridian Medicaid |
$615.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$966.44
|
| Rate for Payer: PACE SWMI |
$920.42
|
| Rate for Payer: PHP Medicare Advantage |
$920.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,909.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,459.68
|
| Rate for Payer: Priority Health Medicare |
$920.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,459.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$920.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$920.42
|
| Rate for Payer: UHC Medicare Advantage |
$948.03
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$2,735.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$497.99 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,035.77
|
| Rate for Payer: Aetna Medicare |
$803.88
|
| Rate for Payer: BCBS Complete |
$522.89
|
| Rate for Payer: BCBS MAPPO |
$772.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.46
|
| Rate for Payer: BCN Commercial |
$1,129.33
|
| Rate for Payer: BCN Medicare Advantage |
$772.96
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.06
|
| Rate for Payer: Cofinity Commercial |
$1,035.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.96
|
| Rate for Payer: Mclaren Medicaid |
$497.99
|
| Rate for Payer: Meridian Medicaid |
$522.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$811.61
|
| Rate for Payer: PACE SWMI |
$772.96
|
| Rate for Payer: PHP Medicare Advantage |
$772.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,229.35
|
| Rate for Payer: Priority Health Medicare |
$772.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.96
|
| Rate for Payer: UHC Medicare Advantage |
$796.15
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,764.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$808.30 |
| Max. Negotiated Rate |
$2,736.93 |
| Rate for Payer: Aetna Commercial |
$2,315.01
|
| Rate for Payer: Aetna Medicare |
$1,796.72
|
| Rate for Payer: BCBS Complete |
$1,146.21
|
| Rate for Payer: BCBS MAPPO |
$1,727.62
|
| Rate for Payer: BCBS Trust/PPO |
$808.30
|
| Rate for Payer: BCN Commercial |
$2,514.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,727.62
|
| Rate for Payer: Cash Price |
$3,011.20
|
| Rate for Payer: Cash Price |
$3,011.20
|
| Rate for Payer: Cofinity Commercial |
$2,315.01
|
| Rate for Payer: Cofinity Commercial |
$2,487.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,727.62
|
| Rate for Payer: Mclaren Medicaid |
$1,091.63
|
| Rate for Payer: Meridian Medicaid |
$1,146.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,814.00
|
| Rate for Payer: PACE SWMI |
$1,727.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,727.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,091.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,634.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,736.93
|
| Rate for Payer: Priority Health Medicare |
$1,727.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,736.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,727.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,779.45
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,485.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$3,139.50 |
| Rate for Payer: Aetna Commercial |
$1,346.20
|
| Rate for Payer: Aetna Medicare |
$1,044.82
|
| Rate for Payer: BCBS Complete |
$664.02
|
| Rate for Payer: BCBS MAPPO |
$1,004.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.92
|
| Rate for Payer: BCN Commercial |
$1,459.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,004.63
|
| Rate for Payer: Cash Price |
$3,588.00
|
| Rate for Payer: Cash Price |
$3,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,446.67
|
| Rate for Payer: Cofinity Commercial |
$1,346.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,004.63
|
| Rate for Payer: Mclaren Medicaid |
$632.40
|
| Rate for Payer: Meridian Medicaid |
$664.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,054.86
|
| Rate for Payer: PACE SWMI |
$1,004.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,004.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$632.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,139.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,588.42
|
| Rate for Payer: Priority Health Medicare |
$1,004.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,588.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,004.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,034.77
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$613.23 |
| Max. Negotiated Rate |
$3,220.00 |
| Rate for Payer: Aetna Commercial |
$1,294.95
|
| Rate for Payer: Aetna Medicare |
$1,005.04
|
| Rate for Payer: BCBS Complete |
$643.89
|
| Rate for Payer: BCBS MAPPO |
$966.38
|
| Rate for Payer: BCBS Trust/PPO |
$773.96
|
| Rate for Payer: BCN Commercial |
$1,398.59
|
| Rate for Payer: BCN Medicare Advantage |
$966.38
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$1,391.59
|
| Rate for Payer: Cofinity Commercial |
$1,294.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.38
|
| Rate for Payer: Mclaren Medicaid |
$613.23
|
| Rate for Payer: Meridian Medicaid |
$643.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,014.70
|
| Rate for Payer: PACE SWMI |
$966.38
|
| Rate for Payer: PHP Medicare Advantage |
$966.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$613.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.46
|
| Rate for Payer: Priority Health Medicare |
$966.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,522.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.38
|
| Rate for Payer: UHC Medicare Advantage |
$995.37
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,859.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$788.95 |
| Max. Negotiated Rate |
$2,591.31 |
| Rate for Payer: Aetna Commercial |
$1,646.83
|
| Rate for Payer: Aetna Medicare |
$1,278.14
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$1,228.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.31
|
| Rate for Payer: BCN Commercial |
$1,810.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,228.98
|
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Cofinity Commercial |
$1,769.73
|
| Rate for Payer: Cofinity Commercial |
$1,646.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,228.98
|
| Rate for Payer: Mclaren Medicaid |
$788.95
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,290.43
|
| Rate for Payer: PACE SWMI |
$1,228.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,228.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,970.37
|
| Rate for Payer: Priority Health Medicare |
$1,228.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,970.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,228.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,228.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,265.85
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,625.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$627.07 |
| Max. Negotiated Rate |
$2,563.84 |
| Rate for Payer: Aetna Commercial |
$1,312.97
|
| Rate for Payer: Aetna Medicare |
$1,019.02
|
| Rate for Payer: BCBS Complete |
$658.42
|
| Rate for Payer: BCBS MAPPO |
$979.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.84
|
| Rate for Payer: BCN Commercial |
$1,427.91
|
| Rate for Payer: BCN Medicare Advantage |
$979.83
|
| Rate for Payer: Cash Price |
$2,900.00
|
| Rate for Payer: Cash Price |
$2,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,312.97
|
| Rate for Payer: Cofinity Commercial |
$1,410.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.83
|
| Rate for Payer: Mclaren Medicaid |
$627.07
|
| Rate for Payer: Meridian Medicaid |
$658.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,028.82
|
| Rate for Payer: PACE SWMI |
$979.83
|
| Rate for Payer: PHP Medicare Advantage |
$979.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,537.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,554.37
|
| Rate for Payer: Priority Health Medicare |
$979.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,554.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,009.22
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$944.61 |
| Rate for Payer: Aetna Commercial |
$647.19
|
| Rate for Payer: Aetna Medicare |
$502.30
|
| Rate for Payer: BCBS Complete |
$335.93
|
| Rate for Payer: BCBS MAPPO |
$482.98
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$944.61
|
| Rate for Payer: BCN Medicare Advantage |
$482.98
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cofinity Commercial |
$695.49
|
| Rate for Payer: Cofinity Commercial |
$647.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.98
|
| Rate for Payer: Mclaren Medicaid |
$319.93
|
| Rate for Payer: Meridian Medicaid |
$335.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$507.13
|
| Rate for Payer: PACE SWMI |
$482.98
|
| Rate for Payer: PHP Medicare Advantage |
$482.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.52
|
| Rate for Payer: Priority Health Medicare |
$482.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$870.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.98
|
| Rate for Payer: UHC Medicare Advantage |
$497.47
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,535.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$786.64 |
| Max. Negotiated Rate |
$6,356.36 |
| Rate for Payer: Aetna Commercial |
$5,387.04
|
| Rate for Payer: Aetna Medicare |
$4,180.99
|
| Rate for Payer: BCBS Complete |
$2,687.82
|
| Rate for Payer: BCBS MAPPO |
$4,020.18
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$5,839.21
|
| Rate for Payer: BCN Medicare Advantage |
$4,020.18
|
| Rate for Payer: Cash Price |
$6,028.00
|
| Rate for Payer: Cash Price |
$6,028.00
|
| Rate for Payer: Cofinity Commercial |
$5,789.06
|
| Rate for Payer: Cofinity Commercial |
$5,387.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,020.18
|
| Rate for Payer: Mclaren Medicaid |
$2,559.83
|
| Rate for Payer: Meridian Medicaid |
$2,687.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,221.19
|
| Rate for Payer: PACE SWMI |
$4,020.18
|
| Rate for Payer: PHP Medicare Advantage |
$4,020.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,356.36
|
| Rate for Payer: Priority Health Medicare |
$4,020.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,356.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,020.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,020.18
|
| Rate for Payer: UHC Medicare Advantage |
$4,140.79
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,507.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,529.34 |
| Max. Negotiated Rate |
$3,794.45 |
| Rate for Payer: Aetna Commercial |
$3,210.93
|
| Rate for Payer: Aetna Medicare |
$2,492.07
|
| Rate for Payer: BCBS Complete |
$1,605.81
|
| Rate for Payer: BCBS MAPPO |
$2,396.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.84
|
| Rate for Payer: BCN Commercial |
$3,485.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,396.22
|
| Rate for Payer: Cash Price |
$3,605.60
|
| Rate for Payer: Cash Price |
$3,605.60
|
| Rate for Payer: Cofinity Commercial |
$3,210.93
|
| Rate for Payer: Cofinity Commercial |
$3,450.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,396.22
|
| Rate for Payer: Mclaren Medicaid |
$1,529.34
|
| Rate for Payer: Meridian Medicaid |
$1,605.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,516.03
|
| Rate for Payer: PACE SWMI |
$2,396.22
|
| Rate for Payer: PHP Medicare Advantage |
$2,396.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,529.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,154.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,794.45
|
| Rate for Payer: Priority Health Medicare |
$2,396.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,794.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,396.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,396.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,468.11
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$476.27 |
| Max. Negotiated Rate |
$1,096.60 |
| Rate for Payer: Aetna Commercial |
$968.77
|
| Rate for Payer: Aetna Medicare |
$751.88
|
| Rate for Payer: BCBS Complete |
$500.08
|
| Rate for Payer: BCBS MAPPO |
$722.96
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$1,096.60
|
| Rate for Payer: BCN Medicare Advantage |
$722.96
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$968.77
|
| Rate for Payer: Cofinity Commercial |
$1,041.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.96
|
| Rate for Payer: Mclaren Medicaid |
$476.27
|
| Rate for Payer: Meridian Medicaid |
$500.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$759.11
|
| Rate for Payer: PACE SWMI |
$722.96
|
| Rate for Payer: PHP Medicare Advantage |
$722.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,039.07
|
| Rate for Payer: Priority Health Medicare |
$722.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,039.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.96
|
| Rate for Payer: UHC Medicare Advantage |
$744.65
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$1,139.30 |
| Rate for Payer: Aetna Commercial |
$362.87
|
| Rate for Payer: Aetna Medicare |
$281.63
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS MAPPO |
$270.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.30
|
| Rate for Payer: BCN Commercial |
$622.09
|
| Rate for Payer: BCN Medicare Advantage |
$270.80
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cofinity Commercial |
$389.95
|
| Rate for Payer: Cofinity Commercial |
$362.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.80
|
| Rate for Payer: Mclaren Medicaid |
$176.36
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.34
|
| Rate for Payer: PACE SWMI |
$270.80
|
| Rate for Payer: PHP Medicare Advantage |
$270.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.11
|
| Rate for Payer: Priority Health Medicare |
$270.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.80
|
| Rate for Payer: UHC Medicare Advantage |
$278.92
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,208.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$2,272.50 |
| Rate for Payer: Aetna Commercial |
$437.64
|
| Rate for Payer: Aetna Medicare |
$339.66
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$326.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.50
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: BCN Medicare Advantage |
$326.60
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Cofinity Commercial |
$437.64
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.60
|
| Rate for Payer: Mclaren Medicaid |
$212.57
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.93
|
| Rate for Payer: PACE SWMI |
$326.60
|
| Rate for Payer: PHP Medicare Advantage |
$326.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.57
|
| Rate for Payer: Priority Health Medicare |
$326.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.60
|
| Rate for Payer: UHC Medicare Advantage |
$336.40
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$314.56
|
| Rate for Payer: Aetna Medicare |
$244.14
|
| Rate for Payer: BCBS Complete |
$161.25
|
| Rate for Payer: BCBS MAPPO |
$234.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$570.29
|
| Rate for Payer: BCN Medicare Advantage |
$234.75
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$338.04
|
| Rate for Payer: Cofinity Commercial |
$314.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.75
|
| Rate for Payer: Mclaren Medicaid |
$153.57
|
| Rate for Payer: Meridian Medicaid |
$161.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.49
|
| Rate for Payer: PACE SWMI |
$234.75
|
| Rate for Payer: PHP Medicare Advantage |
$234.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.30
|
| Rate for Payer: Priority Health Medicare |
$234.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.75
|
| Rate for Payer: UHC Medicare Advantage |
$241.79
|
|
