|
PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 28153
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$988.45 |
| Rate for Payer: Aetna Commercial |
$343.13
|
| Rate for Payer: Aetna Medicare |
$266.31
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: BCBS MAPPO |
$256.07
|
| Rate for Payer: BCBS Trust/PPO |
$988.45
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: BCN Medicare Advantage |
$256.07
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$343.13
|
| Rate for Payer: Cofinity Commercial |
$368.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.07
|
| Rate for Payer: Mclaren Medicaid |
$170.61
|
| Rate for Payer: Meridian Medicaid |
$179.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.87
|
| Rate for Payer: PACE SWMI |
$256.07
|
| Rate for Payer: PHP Medicare Advantage |
$256.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$401.37
|
| Rate for Payer: Priority Health Medicare |
$256.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.07
|
| Rate for Payer: UHC Medicare Advantage |
$263.75
|
|
|
PR RESECTION EXTERNAL CARDIAC TUMOR
|
Professional
|
Both
|
$4,553.00
|
|
|
Service Code
|
HCPCS 33130
|
| Min. Negotiated Rate |
$855.83 |
| Max. Negotiated Rate |
$3,187.10 |
| Rate for Payer: Aetna Commercial |
$1,796.44
|
| Rate for Payer: Aetna Medicare |
$1,394.26
|
| Rate for Payer: BCBS Complete |
$898.62
|
| Rate for Payer: BCBS MAPPO |
$1,340.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.28
|
| Rate for Payer: BCN Commercial |
$1,958.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,340.63
|
| Rate for Payer: Cash Price |
$3,642.40
|
| Rate for Payer: Cash Price |
$3,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,796.44
|
| Rate for Payer: Cofinity Commercial |
$1,930.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,340.63
|
| Rate for Payer: Mclaren Medicaid |
$855.83
|
| Rate for Payer: Meridian Medicaid |
$898.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,407.66
|
| Rate for Payer: PACE SWMI |
$1,340.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,340.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.09
|
| Rate for Payer: Priority Health Medicare |
$1,340.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,132.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,340.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,340.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,380.85
|
|
|
PR RESECTION HUMERAL HEAD
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 23195
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,143.34 |
| Rate for Payer: Aetna Commercial |
$982.85
|
| Rate for Payer: Aetna Medicare |
$762.81
|
| Rate for Payer: BCBS Complete |
$508.36
|
| Rate for Payer: BCBS MAPPO |
$733.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$1,094.15
|
| Rate for Payer: BCN Medicare Advantage |
$733.47
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cofinity Commercial |
$1,056.20
|
| Rate for Payer: Cofinity Commercial |
$982.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.47
|
| Rate for Payer: Mclaren Medicaid |
$484.15
|
| Rate for Payer: Meridian Medicaid |
$508.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$770.14
|
| Rate for Payer: PACE SWMI |
$733.47
|
| Rate for Payer: PHP Medicare Advantage |
$733.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,143.34
|
| Rate for Payer: Priority Health Medicare |
$733.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,143.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.47
|
| Rate for Payer: UHC Medicare Advantage |
$755.47
|
|
|
PR RESECTION/INCISION SUBVALVULAR TISSUE
|
Professional
|
Both
|
$6,098.00
|
|
|
Service Code
|
HCPCS 33415
|
| Min. Negotiated Rate |
$642.41 |
| Max. Negotiated Rate |
$4,268.60 |
| Rate for Payer: Aetna Commercial |
$2,671.95
|
| Rate for Payer: Aetna Medicare |
$2,073.75
|
| Rate for Payer: BCBS Complete |
$1,333.41
|
| Rate for Payer: BCBS MAPPO |
$1,993.99
|
| Rate for Payer: BCBS Trust/PPO |
$642.41
|
| Rate for Payer: BCN Commercial |
$2,902.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,993.99
|
| Rate for Payer: Cash Price |
$4,878.40
|
| Rate for Payer: Cash Price |
$4,878.40
|
| Rate for Payer: Cofinity Commercial |
$2,671.95
|
| Rate for Payer: Cofinity Commercial |
$2,871.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,993.99
|
| Rate for Payer: Mclaren Medicaid |
$1,269.91
|
| Rate for Payer: Meridian Medicaid |
$1,333.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,093.69
|
| Rate for Payer: PACE SWMI |
$1,993.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,993.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,269.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,268.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,159.29
|
| Rate for Payer: Priority Health Medicare |
$1,993.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,159.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,993.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,993.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,053.81
|
|
|
PR RESECTION MEDIASTINAL TUMOR
|
Professional
|
Both
|
$5,669.00
|
|
|
Service Code
|
HCPCS 39220
|
| Min. Negotiated Rate |
$718.02 |
| Max. Negotiated Rate |
$3,968.30 |
| Rate for Payer: Aetna Commercial |
$1,498.84
|
| Rate for Payer: Aetna Medicare |
$1,163.28
|
| Rate for Payer: BCBS Complete |
$753.92
|
| Rate for Payer: BCBS MAPPO |
$1,118.54
|
| Rate for Payer: BCBS Trust/PPO |
$735.39
|
| Rate for Payer: BCN Commercial |
$1,639.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,118.54
|
| Rate for Payer: Cash Price |
$4,535.20
|
| Rate for Payer: Cash Price |
$4,535.20
|
| Rate for Payer: Cofinity Commercial |
$1,610.70
|
| Rate for Payer: Cofinity Commercial |
$1,498.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,118.54
|
| Rate for Payer: Mclaren Medicaid |
$718.02
|
| Rate for Payer: Meridian Medicaid |
$753.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,174.47
|
| Rate for Payer: PACE SWMI |
$1,118.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,118.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,968.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,784.19
|
| Rate for Payer: Priority Health Medicare |
$1,118.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,784.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,118.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.10
|
|
|
PR RESECTION OF MEDIASTINAL CYST
|
Professional
|
Both
|
$4,942.00
|
|
|
Service Code
|
HCPCS 39200
|
| Min. Negotiated Rate |
$549.54 |
| Max. Negotiated Rate |
$3,459.40 |
| Rate for Payer: Aetna Commercial |
$1,149.67
|
| Rate for Payer: Aetna Medicare |
$892.28
|
| Rate for Payer: BCBS Complete |
$577.02
|
| Rate for Payer: BCBS MAPPO |
$857.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.79
|
| Rate for Payer: BCN Commercial |
$1,253.95
|
| Rate for Payer: BCN Medicare Advantage |
$857.96
|
| Rate for Payer: Cash Price |
$3,953.60
|
| Rate for Payer: Cash Price |
$3,953.60
|
| Rate for Payer: Cofinity Commercial |
$1,235.46
|
| Rate for Payer: Cofinity Commercial |
$1,149.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$857.96
|
| Rate for Payer: Mclaren Medicaid |
$549.54
|
| Rate for Payer: Meridian Medicaid |
$577.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$900.86
|
| Rate for Payer: PACE SWMI |
$857.96
|
| Rate for Payer: PHP Medicare Advantage |
$857.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,459.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,365.01
|
| Rate for Payer: Priority Health Medicare |
$857.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,365.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$857.96
|
| Rate for Payer: UHC Medicare Advantage |
$883.70
|
|
|
PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 28126
|
| Min. Negotiated Rate |
$162.09 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna Commercial |
$324.01
|
| Rate for Payer: Aetna Medicare |
$251.47
|
| Rate for Payer: BCBS Complete |
$170.19
|
| Rate for Payer: BCBS MAPPO |
$241.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.54
|
| Rate for Payer: BCN Commercial |
$566.87
|
| Rate for Payer: BCN Medicare Advantage |
$241.80
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$324.01
|
| Rate for Payer: Cofinity Commercial |
$348.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.80
|
| Rate for Payer: Mclaren Medicaid |
$162.09
|
| Rate for Payer: Meridian Medicaid |
$170.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$253.89
|
| Rate for Payer: PACE SWMI |
$241.80
|
| Rate for Payer: PHP Medicare Advantage |
$241.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.39
|
| Rate for Payer: Priority Health Medicare |
$241.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$378.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.80
|
| Rate for Payer: UHC Medicare Advantage |
$249.05
|
|
|
PR RESECTION PERICARDIAL CYST/TUMOR
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
HCPCS 33050
|
| Min. Negotiated Rate |
$636.23 |
| Max. Negotiated Rate |
$1,969.10 |
| Rate for Payer: Aetna Commercial |
$1,325.62
|
| Rate for Payer: Aetna Medicare |
$1,028.84
|
| Rate for Payer: BCBS Complete |
$668.04
|
| Rate for Payer: BCBS MAPPO |
$989.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$1,448.93
|
| Rate for Payer: BCN Medicare Advantage |
$989.27
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cofinity Commercial |
$1,325.62
|
| Rate for Payer: Cofinity Commercial |
$1,424.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$989.27
|
| Rate for Payer: Mclaren Medicaid |
$636.23
|
| Rate for Payer: Meridian Medicaid |
$668.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,038.73
|
| Rate for Payer: PACE SWMI |
$989.27
|
| Rate for Payer: PHP Medicare Advantage |
$989.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$636.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,969.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,577.26
|
| Rate for Payer: Priority Health Medicare |
$989.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,577.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$989.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$989.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.95
|
|
|
PR RESECTION RIBS EXTRAPLEURAL ALL STAGES
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 32900
|
| Min. Negotiated Rate |
$857.96 |
| Max. Negotiated Rate |
$2,157.40 |
| Rate for Payer: Aetna Commercial |
$1,883.18
|
| Rate for Payer: Aetna Medicare |
$1,461.57
|
| Rate for Payer: BCBS Complete |
$900.86
|
| Rate for Payer: BCBS MAPPO |
$1,405.36
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$2,061.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,405.36
|
| Rate for Payer: Cash Price |
$2,465.60
|
| Rate for Payer: Cash Price |
$2,465.60
|
| Rate for Payer: Cofinity Commercial |
$1,883.18
|
| Rate for Payer: Cofinity Commercial |
$2,023.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,405.36
|
| Rate for Payer: Mclaren Medicaid |
$857.96
|
| Rate for Payer: Meridian Medicaid |
$900.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,475.63
|
| Rate for Payer: PACE SWMI |
$1,405.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,405.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$857.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,157.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,953.59
|
| Rate for Payer: Priority Health Medicare |
$1,405.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,953.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,405.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,405.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,447.52
|
|
|
PR RESECTION SCROTUM
|
Professional
|
Both
|
$1,555.00
|
|
|
Service Code
|
HCPCS 55150
|
| Min. Negotiated Rate |
$315.88 |
| Max. Negotiated Rate |
$2,291.77 |
| Rate for Payer: Aetna Commercial |
$646.23
|
| Rate for Payer: Aetna Medicare |
$501.55
|
| Rate for Payer: BCBS Complete |
$331.67
|
| Rate for Payer: BCBS MAPPO |
$482.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,291.77
|
| Rate for Payer: BCN Commercial |
$715.42
|
| Rate for Payer: BCN Medicare Advantage |
$482.26
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cash Price |
$1,244.00
|
| Rate for Payer: Cofinity Commercial |
$694.45
|
| Rate for Payer: Cofinity Commercial |
$646.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.26
|
| Rate for Payer: Mclaren Medicaid |
$315.88
|
| Rate for Payer: Meridian Medicaid |
$331.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$506.37
|
| Rate for Payer: PACE SWMI |
$482.26
|
| Rate for Payer: PHP Medicare Advantage |
$482.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$791.09
|
| Rate for Payer: Priority Health Medicare |
$482.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$791.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.26
|
| Rate for Payer: UHC Medicare Advantage |
$496.73
|
|
|
PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 23440
|
| Min. Negotiated Rate |
$134.57 |
| Max. Negotiated Rate |
$1,162.75 |
| Rate for Payer: Aetna Commercial |
$1,000.67
|
| Rate for Payer: Aetna Medicare |
$776.64
|
| Rate for Payer: BCBS Complete |
$514.62
|
| Rate for Payer: BCBS MAPPO |
$746.77
|
| Rate for Payer: BCBS Trust/PPO |
$134.57
|
| Rate for Payer: BCN Commercial |
$1,112.72
|
| Rate for Payer: BCN Medicare Advantage |
$746.77
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,000.67
|
| Rate for Payer: Cofinity Commercial |
$1,075.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.77
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Meridian Medicaid |
$514.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$784.11
|
| Rate for Payer: PACE SWMI |
$746.77
|
| Rate for Payer: PHP Medicare Advantage |
$746.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,162.75
|
| Rate for Payer: Priority Health Medicare |
$746.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.77
|
| Rate for Payer: UHC Medicare Advantage |
$769.17
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 94375
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$2,149.65 |
| Rate for Payer: Aetna Commercial |
$48.56
|
| Rate for Payer: Aetna Medicare |
$37.69
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$36.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.65
|
| Rate for Payer: BCN Commercial |
$55.71
|
| Rate for Payer: BCN Medicare Advantage |
$36.24
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$48.56
|
| Rate for Payer: Cofinity Commercial |
$52.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.05
|
| Rate for Payer: PACE SWMI |
$36.24
|
| Rate for Payer: PHP Medicare Advantage |
$36.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.20
|
| Rate for Payer: Priority Health Medicare |
$36.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.24
|
| Rate for Payer: UHC Medicare Advantage |
$37.33
|
|
|
PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E
|
Professional
|
Both
|
$3,618.00
|
|
|
Service Code
|
HCPCS 90378
|
| Min. Negotiated Rate |
$1,447.20 |
| Max. Negotiated Rate |
$2,532.60 |
| Rate for Payer: Aetna Commercial |
$1,857.07
|
| Rate for Payer: BCBS Complete |
$1,447.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.79
|
| Rate for Payer: BCN Commercial |
$1,700.79
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Cash Price |
$2,894.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,532.60
|
|
|
PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 37222
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$1,131.09 |
| Rate for Payer: Aetna Commercial |
$244.04
|
| Rate for Payer: Aetna Medicare |
$189.40
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS MAPPO |
$182.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.09
|
| Rate for Payer: BCN Commercial |
$903.08
|
| Rate for Payer: BCN Medicare Advantage |
$182.12
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$244.04
|
| Rate for Payer: Cofinity Commercial |
$262.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.12
|
| Rate for Payer: Mclaren Medicaid |
$114.59
|
| Rate for Payer: Meridian Medicaid |
$120.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$191.23
|
| Rate for Payer: PACE SWMI |
$182.12
|
| Rate for Payer: PHP Medicare Advantage |
$182.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.72
|
| Rate for Payer: Priority Health Medicare |
$182.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.12
|
| Rate for Payer: UHC Medicare Advantage |
$187.58
|
|
|
PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 37220
|
| Min. Negotiated Rate |
$247.93 |
| Max. Negotiated Rate |
$3,691.47 |
| Rate for Payer: Aetna Commercial |
$526.33
|
| Rate for Payer: Aetna Medicare |
$408.49
|
| Rate for Payer: BCBS Complete |
$260.33
|
| Rate for Payer: BCBS MAPPO |
$392.78
|
| Rate for Payer: BCBS Trust/PPO |
$463.32
|
| Rate for Payer: BCN Commercial |
$3,691.47
|
| Rate for Payer: BCN Medicare Advantage |
$392.78
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$526.33
|
| Rate for Payer: Cofinity Commercial |
$565.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.78
|
| Rate for Payer: Mclaren Medicaid |
$247.93
|
| Rate for Payer: Meridian Medicaid |
$260.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$412.42
|
| Rate for Payer: PACE SWMI |
$392.78
|
| Rate for Payer: PHP Medicare Advantage |
$392.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.20
|
| Rate for Payer: Priority Health Medicare |
$392.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$619.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.78
|
| Rate for Payer: UHC Medicare Advantage |
$404.56
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
|
Professional
|
Both
|
$4,901.00
|
|
|
Service Code
|
HCPCS 24371
|
| Min. Negotiated Rate |
$413.46 |
| Max. Negotiated Rate |
$3,430.70 |
| Rate for Payer: Aetna Commercial |
$2,333.81
|
| Rate for Payer: Aetna Medicare |
$1,811.32
|
| Rate for Payer: BCBS Complete |
$1,186.91
|
| Rate for Payer: BCBS MAPPO |
$1,741.65
|
| Rate for Payer: BCBS Trust/PPO |
$413.46
|
| Rate for Payer: BCN Commercial |
$2,578.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,741.65
|
| Rate for Payer: Cash Price |
$3,920.80
|
| Rate for Payer: Cash Price |
$3,920.80
|
| Rate for Payer: Cofinity Commercial |
$2,507.98
|
| Rate for Payer: Cofinity Commercial |
$2,333.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,741.65
|
| Rate for Payer: Mclaren Medicaid |
$1,130.39
|
| Rate for Payer: Meridian Medicaid |
$1,186.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,828.73
|
| Rate for Payer: PACE SWMI |
$1,741.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,741.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,130.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,430.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,694.70
|
| Rate for Payer: Priority Health Medicare |
$1,741.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,694.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,741.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,741.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,793.90
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
|
Professional
|
Both
|
$3,706.00
|
|
|
Service Code
|
HCPCS 24370
|
| Min. Negotiated Rate |
$355.73 |
| Max. Negotiated Rate |
$2,594.20 |
| Rate for Payer: Aetna Commercial |
$2,031.04
|
| Rate for Payer: Aetna Medicare |
$1,576.33
|
| Rate for Payer: BCBS Complete |
$1,033.04
|
| Rate for Payer: BCBS MAPPO |
$1,515.70
|
| Rate for Payer: BCBS Trust/PPO |
$355.73
|
| Rate for Payer: BCN Commercial |
$2,246.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.70
|
| Rate for Payer: Cash Price |
$2,964.80
|
| Rate for Payer: Cash Price |
$2,964.80
|
| Rate for Payer: Cofinity Commercial |
$2,182.61
|
| Rate for Payer: Cofinity Commercial |
$2,031.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.70
|
| Rate for Payer: Mclaren Medicaid |
$983.85
|
| Rate for Payer: Meridian Medicaid |
$1,033.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,591.48
|
| Rate for Payer: PACE SWMI |
$1,515.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$983.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,594.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,347.96
|
| Rate for Payer: Priority Health Medicare |
$1,515.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,347.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,515.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,561.17
|
|
|
PR REVISION OF LARYNX, UNSPECIFIED
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 31588
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$1,414.00 |
| Rate for Payer: BCBS Complete |
$808.00
|
| Rate for Payer: Cash Price |
$1,616.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.00
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$517.80 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$1,061.03
|
| Rate for Payer: Aetna Medicare |
$823.48
|
| Rate for Payer: BCBS Complete |
$543.69
|
| Rate for Payer: BCBS MAPPO |
$791.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,918.45
|
| Rate for Payer: BCN Commercial |
$1,182.11
|
| Rate for Payer: BCN Medicare Advantage |
$791.81
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cofinity Commercial |
$1,061.03
|
| Rate for Payer: Cofinity Commercial |
$1,140.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$791.81
|
| Rate for Payer: Mclaren Medicaid |
$517.80
|
| Rate for Payer: Meridian Medicaid |
$543.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$831.40
|
| Rate for Payer: PACE SWMI |
$791.81
|
| Rate for Payer: PHP Medicare Advantage |
$791.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$994.30
|
| Rate for Payer: Priority Health Medicare |
$791.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$791.81
|
| Rate for Payer: UHC Medicare Advantage |
$815.56
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$431.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$881.88
|
| Rate for Payer: Aetna Medicare |
$684.44
|
| Rate for Payer: BCBS Complete |
$452.90
|
| Rate for Payer: BCBS MAPPO |
$658.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$983.22
|
| Rate for Payer: BCN Medicare Advantage |
$658.12
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cofinity Commercial |
$881.88
|
| Rate for Payer: Cofinity Commercial |
$947.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.12
|
| Rate for Payer: Mclaren Medicaid |
$431.33
|
| Rate for Payer: Meridian Medicaid |
$452.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$691.03
|
| Rate for Payer: PACE SWMI |
$658.12
|
| Rate for Payer: PHP Medicare Advantage |
$658.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.01
|
| Rate for Payer: Priority Health Medicare |
$658.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$827.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.12
|
| Rate for Payer: UHC Medicare Advantage |
$677.86
|
|
|
PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 57426
|
| Min. Negotiated Rate |
$560.83 |
| Max. Negotiated Rate |
$1,275.45 |
| Rate for Payer: Aetna Commercial |
$1,153.59
|
| Rate for Payer: Aetna Medicare |
$895.33
|
| Rate for Payer: BCBS Complete |
$588.87
|
| Rate for Payer: BCBS MAPPO |
$860.89
|
| Rate for Payer: BCBS Trust/PPO |
$628.68
|
| Rate for Payer: BCN Commercial |
$1,275.45
|
| Rate for Payer: BCN Medicare Advantage |
$860.89
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cash Price |
$1,264.00
|
| Rate for Payer: Cofinity Commercial |
$1,239.68
|
| Rate for Payer: Cofinity Commercial |
$1,153.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.89
|
| Rate for Payer: Mclaren Medicaid |
$560.83
|
| Rate for Payer: Meridian Medicaid |
$588.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$903.93
|
| Rate for Payer: PACE SWMI |
$860.89
|
| Rate for Payer: PHP Medicare Advantage |
$860.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$560.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,235.64
|
| Rate for Payer: Priority Health Medicare |
$860.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,235.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$860.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$860.89
|
| Rate for Payer: UHC Medicare Advantage |
$886.72
|
|
|
PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 64569
|
| Min. Negotiated Rate |
$484.98 |
| Max. Negotiated Rate |
$1,530.20 |
| Rate for Payer: Aetna Commercial |
$1,029.09
|
| Rate for Payer: Aetna Medicare |
$798.70
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS MAPPO |
$767.98
|
| Rate for Payer: BCBS Trust/PPO |
$484.98
|
| Rate for Payer: BCN Commercial |
$1,132.26
|
| Rate for Payer: BCN Medicare Advantage |
$767.98
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cofinity Commercial |
$1,105.89
|
| Rate for Payer: Cofinity Commercial |
$1,029.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.98
|
| Rate for Payer: Mclaren Medicaid |
$500.12
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.38
|
| Rate for Payer: PACE SWMI |
$767.98
|
| Rate for Payer: PHP Medicare Advantage |
$767.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.95
|
| Rate for Payer: Priority Health Medicare |
$767.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,311.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$767.98
|
| Rate for Payer: UHC Medicare Advantage |
$791.02
|
|
|
PR REVISION/RMVL PERIPHERAL/GASTRIC NPGR
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$123.77 |
| Max. Negotiated Rate |
$2,181.88 |
| Rate for Payer: Aetna Commercial |
$165.85
|
| Rate for Payer: Aetna Medicare |
$128.72
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS MAPPO |
$123.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.88
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: BCN Medicare Advantage |
$123.77
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cofinity Commercial |
$178.23
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.77
|
| Rate for Payer: Mclaren Medicaid |
$146.76
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.96
|
| Rate for Payer: PACE SWMI |
$123.77
|
| Rate for Payer: PHP Medicare Advantage |
$123.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.59
|
| Rate for Payer: Priority Health Medicare |
$123.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.77
|
| Rate for Payer: UHC Medicare Advantage |
$127.48
|
|
|
PR REVISION STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$3,840.00
|
|
|
Service Code
|
HCPCS 69662
|
| Min. Negotiated Rate |
$742.94 |
| Max. Negotiated Rate |
$3,121.20 |
| Rate for Payer: Aetna Commercial |
$1,523.18
|
| Rate for Payer: Aetna Medicare |
$1,182.17
|
| Rate for Payer: BCBS Complete |
$780.09
|
| Rate for Payer: BCBS MAPPO |
$1,136.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,121.20
|
| Rate for Payer: BCN Commercial |
$1,704.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.70
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cofinity Commercial |
$1,636.85
|
| Rate for Payer: Cofinity Commercial |
$1,523.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.70
|
| Rate for Payer: Mclaren Medicaid |
$742.94
|
| Rate for Payer: Meridian Medicaid |
$780.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,193.54
|
| Rate for Payer: PACE SWMI |
$1,136.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$742.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,644.46
|
| Rate for Payer: Priority Health Medicare |
$1,136.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,644.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,136.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,170.80
|
|
|
PR REVISION TRACHEOSTOMY SCAR
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
HCPCS 31830
|
| Min. Negotiated Rate |
$237.50 |
| Max. Negotiated Rate |
$982.11 |
| Rate for Payer: Aetna Commercial |
$482.39
|
| Rate for Payer: Aetna Medicare |
$374.39
|
| Rate for Payer: BCBS Complete |
$249.38
|
| Rate for Payer: BCBS MAPPO |
$359.99
|
| Rate for Payer: BCBS Trust/PPO |
$982.11
|
| Rate for Payer: BCN Commercial |
$733.51
|
| Rate for Payer: BCN Medicare Advantage |
$359.99
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cofinity Commercial |
$518.39
|
| Rate for Payer: Cofinity Commercial |
$482.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.99
|
| Rate for Payer: Mclaren Medicaid |
$237.50
|
| Rate for Payer: Meridian Medicaid |
$249.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$377.99
|
| Rate for Payer: PACE SWMI |
$359.99
|
| Rate for Payer: PHP Medicare Advantage |
$359.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.52
|
| Rate for Payer: Priority Health Medicare |
$359.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.99
|
| Rate for Payer: UHC Medicare Advantage |
$370.79
|
|
