|
PR REVIS PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
HCPCS 49426
|
| Min. Negotiated Rate |
$430.90 |
| Max. Negotiated Rate |
$1,414.00 |
| Rate for Payer: Aetna Commercial |
$893.61
|
| Rate for Payer: Aetna Medicare |
$693.54
|
| Rate for Payer: BCBS Complete |
$452.44
|
| Rate for Payer: BCBS MAPPO |
$666.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.94
|
| Rate for Payer: BCN Commercial |
$982.73
|
| Rate for Payer: BCN Medicare Advantage |
$666.87
|
| Rate for Payer: Cash Price |
$1,616.00
|
| Rate for Payer: Cash Price |
$1,616.00
|
| Rate for Payer: Cofinity Commercial |
$893.61
|
| Rate for Payer: Cofinity Commercial |
$960.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$666.87
|
| Rate for Payer: Mclaren Medicaid |
$430.90
|
| Rate for Payer: Meridian Medicaid |
$452.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$700.21
|
| Rate for Payer: PACE SWMI |
$666.87
|
| Rate for Payer: PHP Medicare Advantage |
$666.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,182.41
|
| Rate for Payer: Priority Health Medicare |
$666.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,182.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$666.87
|
| Rate for Payer: UHC Medicare Advantage |
$686.88
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$4,110.00
|
|
|
Service Code
|
HCPCS 23474
|
| Min. Negotiated Rate |
$341.30 |
| Max. Negotiated Rate |
$2,877.00 |
| Rate for Payer: Aetna Commercial |
$2,296.01
|
| Rate for Payer: Aetna Medicare |
$1,781.98
|
| Rate for Payer: BCBS Complete |
$1,165.67
|
| Rate for Payer: BCBS MAPPO |
$1,713.44
|
| Rate for Payer: BCBS Trust/PPO |
$341.30
|
| Rate for Payer: BCN Commercial |
$2,535.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,713.44
|
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Cofinity Commercial |
$2,467.35
|
| Rate for Payer: Cofinity Commercial |
$2,296.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,713.44
|
| Rate for Payer: Mclaren Medicaid |
$1,110.16
|
| Rate for Payer: Meridian Medicaid |
$1,165.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,799.11
|
| Rate for Payer: PACE SWMI |
$1,713.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,713.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,110.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,877.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,649.77
|
| Rate for Payer: Priority Health Medicare |
$1,713.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,649.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,713.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,764.84
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$3,516.00
|
|
|
Service Code
|
HCPCS 23473
|
| Min. Negotiated Rate |
$225.83 |
| Max. Negotiated Rate |
$2,461.20 |
| Rate for Payer: Aetna Commercial |
$2,125.68
|
| Rate for Payer: Aetna Medicare |
$1,649.78
|
| Rate for Payer: BCBS Complete |
$1,080.01
|
| Rate for Payer: BCBS MAPPO |
$1,586.33
|
| Rate for Payer: BCBS Trust/PPO |
$225.83
|
| Rate for Payer: BCN Commercial |
$2,349.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.33
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cofinity Commercial |
$2,125.68
|
| Rate for Payer: Cofinity Commercial |
$2,284.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.33
|
| Rate for Payer: Mclaren Medicaid |
$1,028.58
|
| Rate for Payer: Meridian Medicaid |
$1,080.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,665.65
|
| Rate for Payer: PACE SWMI |
$1,586.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,028.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,461.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,454.70
|
| Rate for Payer: Priority Health Medicare |
$1,586.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,454.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,586.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,633.92
|
|
|
PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 25449
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$3,253.04 |
| Rate for Payer: Aetna Commercial |
$1,364.99
|
| Rate for Payer: Aetna Medicare |
$1,059.40
|
| Rate for Payer: BCBS Complete |
$698.46
|
| Rate for Payer: BCBS MAPPO |
$1,018.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.04
|
| Rate for Payer: BCN Commercial |
$1,516.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.65
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cofinity Commercial |
$1,364.99
|
| Rate for Payer: Cofinity Commercial |
$1,466.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.65
|
| Rate for Payer: Mclaren Medicaid |
$665.20
|
| Rate for Payer: Meridian Medicaid |
$698.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,069.58
|
| Rate for Payer: PACE SWMI |
$1,018.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,429.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.55
|
| Rate for Payer: Priority Health Medicare |
$1,018.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,584.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,018.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,049.21
|
|
|
PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 44345
|
| Min. Negotiated Rate |
$670.52 |
| Max. Negotiated Rate |
$1,841.54 |
| Rate for Payer: Aetna Commercial |
$1,392.65
|
| Rate for Payer: Aetna Medicare |
$1,080.86
|
| Rate for Payer: BCBS Complete |
$704.05
|
| Rate for Payer: BCBS MAPPO |
$1,039.29
|
| Rate for Payer: BCBS Trust/PPO |
$697.88
|
| Rate for Payer: BCN Commercial |
$1,530.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,039.29
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cofinity Commercial |
$1,392.65
|
| Rate for Payer: Cofinity Commercial |
$1,496.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,039.29
|
| Rate for Payer: Mclaren Medicaid |
$670.52
|
| Rate for Payer: Meridian Medicaid |
$704.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,091.25
|
| Rate for Payer: PACE SWMI |
$1,039.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,039.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,841.54
|
| Rate for Payer: Priority Health Medicare |
$1,039.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,841.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,039.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,070.47
|
|
|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$249.89 |
| Max. Negotiated Rate |
$1,104.80 |
| Rate for Payer: Aetna Commercial |
$829.93
|
| Rate for Payer: Aetna Medicare |
$644.12
|
| Rate for Payer: BCBS Complete |
$424.94
|
| Rate for Payer: BCBS MAPPO |
$619.35
|
| Rate for Payer: BCBS Trust/PPO |
$249.89
|
| Rate for Payer: BCN Commercial |
$918.23
|
| Rate for Payer: BCN Medicare Advantage |
$619.35
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cofinity Commercial |
$891.86
|
| Rate for Payer: Cofinity Commercial |
$829.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.35
|
| Rate for Payer: Mclaren Medicaid |
$404.70
|
| Rate for Payer: Meridian Medicaid |
$424.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$650.32
|
| Rate for Payer: PACE SWMI |
$619.35
|
| Rate for Payer: PHP Medicare Advantage |
$619.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.80
|
| Rate for Payer: Priority Health Medicare |
$619.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$619.35
|
| Rate for Payer: UHC Medicare Advantage |
$637.93
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$754.02 |
| Max. Negotiated Rate |
$2,070.26 |
| Rate for Payer: Aetna Commercial |
$1,567.34
|
| Rate for Payer: Aetna Medicare |
$1,216.45
|
| Rate for Payer: BCBS Complete |
$791.72
|
| Rate for Payer: BCBS MAPPO |
$1,169.66
|
| Rate for Payer: BCBS Trust/PPO |
$785.58
|
| Rate for Payer: BCN Commercial |
$1,720.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,169.66
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$1,684.31
|
| Rate for Payer: Cofinity Commercial |
$1,567.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,169.66
|
| Rate for Payer: Mclaren Medicaid |
$754.02
|
| Rate for Payer: Meridian Medicaid |
$791.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,228.14
|
| Rate for Payer: PACE SWMI |
$1,169.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,169.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$754.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,070.26
|
| Rate for Payer: Priority Health Medicare |
$1,169.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,070.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,169.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,204.75
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF
|
Professional
|
Both
|
$2,568.00
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$772.98 |
| Max. Negotiated Rate |
$1,921.96 |
| Rate for Payer: Aetna Commercial |
$1,639.03
|
| Rate for Payer: Aetna Medicare |
$1,272.09
|
| Rate for Payer: BCBS Complete |
$811.63
|
| Rate for Payer: BCBS MAPPO |
$1,223.16
|
| Rate for Payer: BCBS Trust/PPO |
$926.64
|
| Rate for Payer: BCN Commercial |
$1,765.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,223.16
|
| Rate for Payer: Cash Price |
$2,054.40
|
| Rate for Payer: Cash Price |
$2,054.40
|
| Rate for Payer: Cofinity Commercial |
$1,761.35
|
| Rate for Payer: Cofinity Commercial |
$1,639.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,223.16
|
| Rate for Payer: Mclaren Medicaid |
$772.98
|
| Rate for Payer: Meridian Medicaid |
$811.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,284.32
|
| Rate for Payer: PACE SWMI |
$1,223.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,223.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,921.96
|
| Rate for Payer: Priority Health Medicare |
$1,223.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,921.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,223.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,223.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,259.85
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$1,858.66 |
| Rate for Payer: Aetna Commercial |
$1,580.89
|
| Rate for Payer: Aetna Medicare |
$1,226.96
|
| Rate for Payer: BCBS Complete |
$782.78
|
| Rate for Payer: BCBS MAPPO |
$1,179.77
|
| Rate for Payer: BCBS Trust/PPO |
$876.98
|
| Rate for Payer: BCN Commercial |
$1,707.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,179.77
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cofinity Commercial |
$1,698.87
|
| Rate for Payer: Cofinity Commercial |
$1,580.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,179.77
|
| Rate for Payer: Mclaren Medicaid |
$745.50
|
| Rate for Payer: Meridian Medicaid |
$782.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,238.76
|
| Rate for Payer: PACE SWMI |
$1,179.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,179.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,621.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,858.66
|
| Rate for Payer: Priority Health Medicare |
$1,179.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,858.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,179.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,179.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.16
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$5,278.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$163.77 |
| Max. Negotiated Rate |
$3,694.60 |
| Rate for Payer: Aetna Commercial |
$2,182.20
|
| Rate for Payer: Aetna Medicare |
$1,693.65
|
| Rate for Payer: BCBS Complete |
$1,096.11
|
| Rate for Payer: BCBS MAPPO |
$1,628.51
|
| Rate for Payer: BCBS Trust/PPO |
$163.77
|
| Rate for Payer: BCN Commercial |
$2,385.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,628.51
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cofinity Commercial |
$2,345.05
|
| Rate for Payer: Cofinity Commercial |
$2,182.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,628.51
|
| Rate for Payer: Mclaren Medicaid |
$1,043.91
|
| Rate for Payer: Meridian Medicaid |
$1,096.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,709.94
|
| Rate for Payer: PACE SWMI |
$1,628.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,628.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,043.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,694.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,869.89
|
| Rate for Payer: Priority Health Medicare |
$1,628.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,869.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,628.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,628.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,677.37
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,536.00
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$249.89 |
| Max. Negotiated Rate |
$1,775.20 |
| Rate for Payer: Aetna Commercial |
$1,329.87
|
| Rate for Payer: Aetna Medicare |
$1,032.14
|
| Rate for Payer: BCBS Complete |
$672.74
|
| Rate for Payer: BCBS MAPPO |
$992.44
|
| Rate for Payer: BCBS Trust/PPO |
$249.89
|
| Rate for Payer: BCN Commercial |
$1,462.12
|
| Rate for Payer: BCN Medicare Advantage |
$992.44
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Cofinity Commercial |
$1,429.11
|
| Rate for Payer: Cofinity Commercial |
$1,329.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.44
|
| Rate for Payer: Mclaren Medicaid |
$640.70
|
| Rate for Payer: Meridian Medicaid |
$672.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,042.06
|
| Rate for Payer: PACE SWMI |
$992.44
|
| Rate for Payer: PHP Medicare Advantage |
$992.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.22
|
| Rate for Payer: Priority Health Medicare |
$992.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,759.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$992.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,022.21
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$1,047.18 |
| Rate for Payer: Aetna Commercial |
$789.18
|
| Rate for Payer: Aetna Medicare |
$612.50
|
| Rate for Payer: BCBS Complete |
$402.12
|
| Rate for Payer: BCBS MAPPO |
$588.94
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: BCN Medicare Advantage |
$588.94
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cofinity Commercial |
$789.18
|
| Rate for Payer: Cofinity Commercial |
$848.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.94
|
| Rate for Payer: Mclaren Medicaid |
$382.97
|
| Rate for Payer: Meridian Medicaid |
$402.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.39
|
| Rate for Payer: PACE SWMI |
$588.94
|
| Rate for Payer: PHP Medicare Advantage |
$588.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.18
|
| Rate for Payer: Priority Health Medicare |
$588.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,047.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.94
|
| Rate for Payer: UHC Medicare Advantage |
$606.61
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,047.00
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$2,832.90 |
| Rate for Payer: Aetna Commercial |
$1,182.16
|
| Rate for Payer: Aetna Medicare |
$917.50
|
| Rate for Payer: BCBS Complete |
$604.98
|
| Rate for Payer: BCBS MAPPO |
$882.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$1,305.75
|
| Rate for Payer: BCN Medicare Advantage |
$882.21
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cofinity Commercial |
$1,270.38
|
| Rate for Payer: Cofinity Commercial |
$1,182.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.21
|
| Rate for Payer: Mclaren Medicaid |
$576.17
|
| Rate for Payer: Meridian Medicaid |
$604.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$926.32
|
| Rate for Payer: PACE SWMI |
$882.21
|
| Rate for Payer: PHP Medicare Advantage |
$882.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,832.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.96
|
| Rate for Payer: Priority Health Medicare |
$882.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,512.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.21
|
| Rate for Payer: UHC Medicare Advantage |
$908.68
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$4,723.00
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$3,306.10 |
| Rate for Payer: Aetna Commercial |
$594.30
|
| Rate for Payer: Aetna Medicare |
$461.25
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$443.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.26
|
| Rate for Payer: BCN Commercial |
$1,321.38
|
| Rate for Payer: BCN Medicare Advantage |
$443.51
|
| Rate for Payer: Cash Price |
$3,778.40
|
| Rate for Payer: Cash Price |
$3,778.40
|
| Rate for Payer: Cofinity Commercial |
$594.30
|
| Rate for Payer: Cofinity Commercial |
$638.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.51
|
| Rate for Payer: Mclaren Medicaid |
$288.83
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$465.69
|
| Rate for Payer: PACE SWMI |
$443.51
|
| Rate for Payer: PHP Medicare Advantage |
$443.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,306.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$759.31
|
| Rate for Payer: Priority Health Medicare |
$443.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$759.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.51
|
| Rate for Payer: UHC Medicare Advantage |
$456.82
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$1,789.00
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$574.89 |
| Max. Negotiated Rate |
$1,898.71 |
| Rate for Payer: Aetna Commercial |
$1,216.01
|
| Rate for Payer: Aetna Medicare |
$943.77
|
| Rate for Payer: BCBS Complete |
$603.63
|
| Rate for Payer: BCBS MAPPO |
$907.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.71
|
| Rate for Payer: BCN Commercial |
$1,316.01
|
| Rate for Payer: BCN Medicare Advantage |
$907.47
|
| Rate for Payer: Cash Price |
$1,431.20
|
| Rate for Payer: Cash Price |
$1,431.20
|
| Rate for Payer: Cofinity Commercial |
$1,216.01
|
| Rate for Payer: Cofinity Commercial |
$1,306.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.47
|
| Rate for Payer: Mclaren Medicaid |
$574.89
|
| Rate for Payer: Meridian Medicaid |
$603.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$952.84
|
| Rate for Payer: PACE SWMI |
$907.47
|
| Rate for Payer: PHP Medicare Advantage |
$907.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,432.56
|
| Rate for Payer: Priority Health Medicare |
$907.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,432.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$907.47
|
| Rate for Payer: UHC Medicare Advantage |
$934.69
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$2,077.00
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$642.62 |
| Max. Negotiated Rate |
$1,789.35 |
| Rate for Payer: Aetna Commercial |
$1,349.66
|
| Rate for Payer: Aetna Medicare |
$1,047.50
|
| Rate for Payer: BCBS Complete |
$674.75
|
| Rate for Payer: BCBS MAPPO |
$1,007.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.35
|
| Rate for Payer: BCN Commercial |
$1,460.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.21
|
| Rate for Payer: Cash Price |
$1,661.60
|
| Rate for Payer: Cash Price |
$1,661.60
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$1,450.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.21
|
| Rate for Payer: Mclaren Medicaid |
$642.62
|
| Rate for Payer: Meridian Medicaid |
$674.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,057.57
|
| Rate for Payer: PACE SWMI |
$1,007.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,590.02
|
| Rate for Payer: Priority Health Medicare |
$1,007.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,590.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.43
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$653.91 |
| Max. Negotiated Rate |
$2,276.44 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Medicare |
$1,041.00
|
| Rate for Payer: BCBS Complete |
$686.61
|
| Rate for Payer: BCBS MAPPO |
$1,000.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.44
|
| Rate for Payer: BCN Commercial |
$1,503.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.96
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cofinity Commercial |
$1,441.38
|
| Rate for Payer: Cofinity Commercial |
$1,341.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.96
|
| Rate for Payer: Mclaren Medicaid |
$653.91
|
| Rate for Payer: Meridian Medicaid |
$686.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,051.01
|
| Rate for Payer: PACE SWMI |
$1,000.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$653.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,450.21
|
| Rate for Payer: Priority Health Medicare |
$1,000.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,450.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,000.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,030.99
|
|
|
PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY
|
Professional
|
Both
|
$2,195.00
|
|
|
Service Code
|
HCPCS 69604
|
| Min. Negotiated Rate |
$714.62 |
| Max. Negotiated Rate |
$1,642.45 |
| Rate for Payer: Aetna Commercial |
$1,462.88
|
| Rate for Payer: Aetna Medicare |
$1,135.37
|
| Rate for Payer: BCBS Complete |
$750.35
|
| Rate for Payer: BCBS MAPPO |
$1,091.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.15
|
| Rate for Payer: BCN Commercial |
$1,642.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cofinity Commercial |
$1,462.88
|
| Rate for Payer: Cofinity Commercial |
$1,572.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.70
|
| Rate for Payer: Mclaren Medicaid |
$714.62
|
| Rate for Payer: Meridian Medicaid |
$750.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,146.28
|
| Rate for Payer: PACE SWMI |
$1,091.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$714.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.58
|
| Rate for Payer: Priority Health Medicare |
$1,091.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,584.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,091.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,091.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,124.45
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,757.65 |
| Rate for Payer: Aetna Commercial |
$994.29
|
| Rate for Payer: Aetna Medicare |
$771.69
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS MAPPO |
$742.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.65
|
| Rate for Payer: BCN Commercial |
$1,081.45
|
| Rate for Payer: BCN Medicare Advantage |
$742.01
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,068.49
|
| Rate for Payer: Cofinity Commercial |
$994.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$742.01
|
| Rate for Payer: Mclaren Medicaid |
$473.50
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$779.11
|
| Rate for Payer: PACE SWMI |
$742.01
|
| Rate for Payer: PHP Medicare Advantage |
$742.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,177.22
|
| Rate for Payer: Priority Health Medicare |
$742.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,177.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$742.01
|
| Rate for Payer: UHC Medicare Advantage |
$764.27
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$505.02 |
| Max. Negotiated Rate |
$1,600.90 |
| Rate for Payer: Aetna Commercial |
$1,062.82
|
| Rate for Payer: Aetna Medicare |
$824.88
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS MAPPO |
$793.15
|
| Rate for Payer: BCBS Trust/PPO |
$902.86
|
| Rate for Payer: BCN Commercial |
$1,155.23
|
| Rate for Payer: BCN Medicare Advantage |
$793.15
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.14
|
| Rate for Payer: Cofinity Commercial |
$1,062.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.15
|
| Rate for Payer: Mclaren Medicaid |
$505.02
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$832.81
|
| Rate for Payer: PACE SWMI |
$793.15
|
| Rate for Payer: PHP Medicare Advantage |
$793.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,600.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,257.54
|
| Rate for Payer: Priority Health Medicare |
$793.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,257.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.15
|
| Rate for Payer: UHC Medicare Advantage |
$816.94
|
|
|
PR REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 63688
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$1,248.10 |
| Rate for Payer: Aetna Commercial |
$494.06
|
| Rate for Payer: Aetna Medicare |
$383.45
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS MAPPO |
$368.70
|
| Rate for Payer: BCBS Trust/PPO |
$917.66
|
| Rate for Payer: BCN Commercial |
$547.80
|
| Rate for Payer: BCN Medicare Advantage |
$368.70
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cofinity Commercial |
$530.93
|
| Rate for Payer: Cofinity Commercial |
$494.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.70
|
| Rate for Payer: Mclaren Medicaid |
$193.62
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$387.14
|
| Rate for Payer: PACE SWMI |
$368.70
|
| Rate for Payer: PHP Medicare Advantage |
$368.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.74
|
| Rate for Payer: Priority Health Medicare |
$368.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$634.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$368.70
|
| Rate for Payer: UHC Medicare Advantage |
$379.76
|
|
|
PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS
|
Professional
|
Both
|
$3,122.00
|
|
|
Service Code
|
HCPCS 61880
|
| Min. Negotiated Rate |
$384.25 |
| Max. Negotiated Rate |
$2,185.40 |
| Rate for Payer: Aetna Commercial |
$786.73
|
| Rate for Payer: Aetna Medicare |
$610.59
|
| Rate for Payer: BCBS Complete |
$403.46
|
| Rate for Payer: BCBS MAPPO |
$587.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.32
|
| Rate for Payer: BCN Commercial |
$871.31
|
| Rate for Payer: BCN Medicare Advantage |
$587.11
|
| Rate for Payer: Cash Price |
$2,497.60
|
| Rate for Payer: Cash Price |
$2,497.60
|
| Rate for Payer: Cofinity Commercial |
$845.44
|
| Rate for Payer: Cofinity Commercial |
$786.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.11
|
| Rate for Payer: Mclaren Medicaid |
$384.25
|
| Rate for Payer: Meridian Medicaid |
$403.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$616.47
|
| Rate for Payer: PACE SWMI |
$587.11
|
| Rate for Payer: PHP Medicare Advantage |
$587.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,185.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.58
|
| Rate for Payer: Priority Health Medicare |
$587.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,009.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.11
|
| Rate for Payer: UHC Medicare Advantage |
$604.72
|
|
|
PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR
|
Professional
|
Both
|
$1,027.00
|
|
|
Service Code
|
HCPCS 61888
|
| Min. Negotiated Rate |
$259.22 |
| Max. Negotiated Rate |
$1,422.71 |
| Rate for Payer: Aetna Commercial |
$535.73
|
| Rate for Payer: Aetna Medicare |
$415.79
|
| Rate for Payer: BCBS Complete |
$272.18
|
| Rate for Payer: BCBS MAPPO |
$399.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$818.26
|
| Rate for Payer: BCN Medicare Advantage |
$399.80
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cofinity Commercial |
$535.73
|
| Rate for Payer: Cofinity Commercial |
$575.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.80
|
| Rate for Payer: Mclaren Medicaid |
$259.22
|
| Rate for Payer: Meridian Medicaid |
$272.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.79
|
| Rate for Payer: PACE SWMI |
$399.80
|
| Rate for Payer: PHP Medicare Advantage |
$399.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.43
|
| Rate for Payer: Priority Health Medicare |
$399.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.80
|
| Rate for Payer: UHC Medicare Advantage |
$411.79
|
|
|
PR REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 64585
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$918.40 |
| Rate for Payer: Aetna Commercial |
$186.93
|
| Rate for Payer: Aetna Medicare |
$145.08
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.50
|
| Rate for Payer: BCBS Trust/PPO |
$390.41
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$139.50
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.50
|
| Rate for Payer: Mclaren Medicaid |
$92.23
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.48
|
| Rate for Payer: PACE SWMI |
$139.50
|
| Rate for Payer: PHP Medicare Advantage |
$139.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.21
|
| Rate for Payer: Priority Health Medicare |
$139.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.50
|
| Rate for Payer: UHC Medicare Advantage |
$143.68
|
|
|
PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 57295
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$1,461.28 |
| Rate for Payer: Aetna Commercial |
$663.85
|
| Rate for Payer: Aetna Medicare |
$515.23
|
| Rate for Payer: BCBS Complete |
$339.06
|
| Rate for Payer: BCBS MAPPO |
$495.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.28
|
| Rate for Payer: BCN Commercial |
$1,021.64
|
| Rate for Payer: BCN Medicare Advantage |
$495.41
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cofinity Commercial |
$663.85
|
| Rate for Payer: Cofinity Commercial |
$713.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.41
|
| Rate for Payer: Mclaren Medicaid |
$322.91
|
| Rate for Payer: Meridian Medicaid |
$339.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$520.18
|
| Rate for Payer: PACE SWMI |
$495.41
|
| Rate for Payer: PHP Medicare Advantage |
$495.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$713.45
|
| Rate for Payer: Priority Health Medicare |
$495.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.41
|
| Rate for Payer: UHC Medicare Advantage |
$510.27
|
|
