|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,079.00 |
| Rate for Payer: Aetna Commercial |
$724.54
|
| Rate for Payer: Aetna Medicare |
$562.33
|
| Rate for Payer: BCBS Complete |
$387.37
|
| Rate for Payer: BCBS MAPPO |
$540.70
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,079.00
|
| Rate for Payer: BCN Medicare Advantage |
$540.70
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$778.61
|
| Rate for Payer: Cofinity Commercial |
$724.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.70
|
| Rate for Payer: Mclaren Medicaid |
$368.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.74
|
| Rate for Payer: Meridian Medicaid |
$387.37
|
| Rate for Payer: Nomi Health Commercial |
$648.84
|
| Rate for Payer: PACE SWMI |
$540.70
|
| Rate for Payer: PHP Medicare Advantage |
$540.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.25
|
| Rate for Payer: Priority Health HMO/PPO |
$877.28
|
| Rate for Payer: Priority Health Medicare |
$546.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.70
|
| Rate for Payer: UHC Exchange |
$540.70
|
| Rate for Payer: UHC Medicare Advantage |
$540.70
|
| Rate for Payer: UHCCP Medicaid |
$368.92
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$873.76 |
| Rate for Payer: Aetna Commercial |
$642.37
|
| Rate for Payer: Aetna Medicare |
$498.56
|
| Rate for Payer: BCBS Complete |
$341.51
|
| Rate for Payer: BCBS MAPPO |
$479.38
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$873.76
|
| Rate for Payer: BCN Medicare Advantage |
$479.38
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$690.31
|
| Rate for Payer: Cofinity Commercial |
$642.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.38
|
| Rate for Payer: Mclaren Medicaid |
$325.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.35
|
| Rate for Payer: Meridian Medicaid |
$341.51
|
| Rate for Payer: Nomi Health Commercial |
$575.26
|
| Rate for Payer: PACE SWMI |
$479.38
|
| Rate for Payer: PHP Medicare Advantage |
$479.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health HMO/PPO |
$682.24
|
| Rate for Payer: Priority Health Medicare |
$484.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$682.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.38
|
| Rate for Payer: UHC Exchange |
$479.38
|
| Rate for Payer: UHC Medicare Advantage |
$479.38
|
| Rate for Payer: UHCCP Medicaid |
$325.25
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$332.49 |
| Max. Negotiated Rate |
$889.40 |
| Rate for Payer: Aetna Commercial |
$656.55
|
| Rate for Payer: Aetna Medicare |
$509.56
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS MAPPO |
$489.96
|
| Rate for Payer: BCBS Trust/PPO |
$529.69
|
| Rate for Payer: BCN Commercial |
$889.40
|
| Rate for Payer: BCN Medicare Advantage |
$489.96
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cofinity Commercial |
$705.54
|
| Rate for Payer: Cofinity Commercial |
$656.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.96
|
| Rate for Payer: Mclaren Medicaid |
$332.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.46
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Nomi Health Commercial |
$587.95
|
| Rate for Payer: PACE SWMI |
$489.96
|
| Rate for Payer: PHP Medicare Advantage |
$489.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.05
|
| Rate for Payer: Priority Health HMO/PPO |
$697.14
|
| Rate for Payer: Priority Health Medicare |
$494.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$697.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.96
|
| Rate for Payer: UHC Exchange |
$489.96
|
| Rate for Payer: UHC Medicare Advantage |
$489.96
|
| Rate for Payer: UHCCP Medicaid |
$332.49
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$273.17 |
| Rate for Payer: Aetna Commercial |
$185.62
|
| Rate for Payer: Aetna Medicare |
$144.06
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$138.52
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$138.52
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$199.47
|
| Rate for Payer: Cofinity Commercial |
$185.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.52
|
| Rate for Payer: Mclaren Medicaid |
$92.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.45
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Nomi Health Commercial |
$166.22
|
| Rate for Payer: PACE SWMI |
$138.52
|
| Rate for Payer: PHP Medicare Advantage |
$138.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health HMO/PPO |
$192.34
|
| Rate for Payer: Priority Health Medicare |
$139.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.52
|
| Rate for Payer: UHC Exchange |
$138.52
|
| Rate for Payer: UHC Medicare Advantage |
$138.52
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$191.61
|
| Rate for Payer: Aetna Medicare |
$148.71
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$142.99
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$279.04
|
| Rate for Payer: BCN Medicare Advantage |
$142.99
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$205.91
|
| Rate for Payer: Cofinity Commercial |
$191.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.99
|
| Rate for Payer: Mclaren Medicaid |
$95.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.14
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Nomi Health Commercial |
$171.59
|
| Rate for Payer: PACE SWMI |
$142.99
|
| Rate for Payer: PHP Medicare Advantage |
$142.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO |
$199.12
|
| Rate for Payer: Priority Health Medicare |
$144.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.99
|
| Rate for Payer: UHC Exchange |
$142.99
|
| Rate for Payer: UHC Medicare Advantage |
$142.99
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$310.77 |
| Max. Negotiated Rate |
$703.20 |
| Rate for Payer: Aetna Commercial |
$615.96
|
| Rate for Payer: Aetna Medicare |
$478.06
|
| Rate for Payer: BCBS Complete |
$326.31
|
| Rate for Payer: BCBS MAPPO |
$459.67
|
| Rate for Payer: BCBS Trust/PPO |
$543.75
|
| Rate for Payer: BCN Commercial |
$703.20
|
| Rate for Payer: BCN Medicare Advantage |
$459.67
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$661.92
|
| Rate for Payer: Cofinity Commercial |
$615.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.67
|
| Rate for Payer: Mclaren Medicaid |
$310.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.65
|
| Rate for Payer: Meridian Medicaid |
$326.31
|
| Rate for Payer: Nomi Health Commercial |
$551.60
|
| Rate for Payer: PACE SWMI |
$459.67
|
| Rate for Payer: PHP Medicare Advantage |
$459.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health HMO/PPO |
$653.79
|
| Rate for Payer: Priority Health Medicare |
$464.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.67
|
| Rate for Payer: UHC Exchange |
$459.67
|
| Rate for Payer: UHC Medicare Advantage |
$459.67
|
| Rate for Payer: UHCCP Medicaid |
$310.77
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$402.14 |
| Max. Negotiated Rate |
$1,116.23 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Aetna Medicare |
$625.05
|
| Rate for Payer: BCBS Complete |
$422.25
|
| Rate for Payer: BCBS MAPPO |
$601.01
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$910.89
|
| Rate for Payer: BCN Medicare Advantage |
$601.01
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$805.35
|
| Rate for Payer: Cofinity Commercial |
$865.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.01
|
| Rate for Payer: Mclaren Medicaid |
$402.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$631.06
|
| Rate for Payer: Meridian Medicaid |
$422.25
|
| Rate for Payer: Nomi Health Commercial |
$721.21
|
| Rate for Payer: PACE SWMI |
$601.01
|
| Rate for Payer: PHP Medicare Advantage |
$601.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,116.23
|
| Rate for Payer: Priority Health Medicare |
$607.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$601.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.01
|
| Rate for Payer: UHC Exchange |
$601.01
|
| Rate for Payer: UHC Medicare Advantage |
$601.01
|
| Rate for Payer: UHCCP Medicaid |
$402.14
|
|
|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$3,048.82 |
| Rate for Payer: Aetna Commercial |
$14.43
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$10.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,048.82
|
| Rate for Payer: BCN Commercial |
$18.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.31
|
| Rate for Payer: Nomi Health Commercial |
$12.92
|
| Rate for Payer: PACE SWMI |
$10.77
|
| Rate for Payer: PHP Medicare Advantage |
$10.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO |
$15.10
|
| Rate for Payer: Priority Health Medicare |
$10.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.77
|
| Rate for Payer: UHC Exchange |
$10.77
|
| Rate for Payer: UHC Medicare Advantage |
$10.77
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$1,235.69 |
| Rate for Payer: Aetna Commercial |
$32.35
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.69
|
| Rate for Payer: BCN Commercial |
$31.02
|
| Rate for Payer: BCN Medicare Advantage |
$24.14
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$34.76
|
| Rate for Payer: Cofinity Commercial |
$32.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.14
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.35
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Nomi Health Commercial |
$28.97
|
| Rate for Payer: PACE SWMI |
$24.14
|
| Rate for Payer: PHP Medicare Advantage |
$24.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO |
$33.48
|
| Rate for Payer: Priority Health Medicare |
$24.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.14
|
| Rate for Payer: UHC Exchange |
$24.14
|
| Rate for Payer: UHC Medicare Advantage |
$24.14
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,608.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$790.34 |
| Max. Negotiated Rate |
$2,593.40 |
| Rate for Payer: Aetna Commercial |
$1,891.48
|
| Rate for Payer: Aetna Medicare |
$1,468.01
|
| Rate for Payer: BCBS Complete |
$978.92
|
| Rate for Payer: BCBS MAPPO |
$1,411.55
|
| Rate for Payer: BCBS Trust/PPO |
$790.34
|
| Rate for Payer: BCN Commercial |
$2,109.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.55
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cofinity Commercial |
$2,032.63
|
| Rate for Payer: Cofinity Commercial |
$1,891.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.55
|
| Rate for Payer: Mclaren Medicaid |
$932.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,482.13
|
| Rate for Payer: Meridian Medicaid |
$978.92
|
| Rate for Payer: Nomi Health Commercial |
$1,693.86
|
| Rate for Payer: PACE SWMI |
$1,411.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$932.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,695.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2,593.40
|
| Rate for Payer: Priority Health Medicare |
$1,425.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,593.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,411.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.55
|
| Rate for Payer: UHC Exchange |
$1,411.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.55
|
| Rate for Payer: UHCCP Medicaid |
$932.30
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,761.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$3,633.26 |
| Rate for Payer: Aetna Commercial |
$2,652.74
|
| Rate for Payer: Aetna Medicare |
$2,058.85
|
| Rate for Payer: BCBS Complete |
$1,369.63
|
| Rate for Payer: BCBS MAPPO |
$1,979.66
|
| Rate for Payer: BCBS Trust/PPO |
$979.00
|
| Rate for Payer: BCN Commercial |
$2,963.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,979.66
|
| Rate for Payer: Cash Price |
$3,008.80
|
| Rate for Payer: Cash Price |
$3,008.80
|
| Rate for Payer: Cofinity Commercial |
$2,850.71
|
| Rate for Payer: Cofinity Commercial |
$2,652.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,979.66
|
| Rate for Payer: Mclaren Medicaid |
$1,304.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,078.64
|
| Rate for Payer: Meridian Medicaid |
$1,369.63
|
| Rate for Payer: Nomi Health Commercial |
$2,375.59
|
| Rate for Payer: PACE SWMI |
$1,979.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,979.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,304.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,444.65
|
| Rate for Payer: Priority Health HMO/PPO |
$3,633.26
|
| Rate for Payer: Priority Health Medicare |
$1,999.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,633.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,979.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,979.66
|
| Rate for Payer: UHC Exchange |
$1,979.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,979.66
|
| Rate for Payer: UHCCP Medicaid |
$1,304.41
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$1,233.70 |
| Max. Negotiated Rate |
$3,437.58 |
| Rate for Payer: Aetna Commercial |
$2,507.69
|
| Rate for Payer: Aetna Medicare |
$1,946.27
|
| Rate for Payer: BCBS Complete |
$1,295.38
|
| Rate for Payer: BCBS MAPPO |
$1,871.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.24
|
| Rate for Payer: BCN Commercial |
$2,799.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,871.41
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$2,694.83
|
| Rate for Payer: Cofinity Commercial |
$2,507.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,871.41
|
| Rate for Payer: Mclaren Medicaid |
$1,233.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,964.98
|
| Rate for Payer: Meridian Medicaid |
$1,295.38
|
| Rate for Payer: Nomi Health Commercial |
$2,245.69
|
| Rate for Payer: PACE SWMI |
$1,871.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,871.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,233.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3,437.58
|
| Rate for Payer: Priority Health Medicare |
$1,890.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,871.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,871.41
|
| Rate for Payer: UHC Exchange |
$1,871.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,871.41
|
| Rate for Payer: UHCCP Medicaid |
$1,233.70
|
|
|
PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY
|
Professional
|
Both
|
$6,616.00
|
|
|
Service Code
|
HCPCS 43620
|
| Min. Negotiated Rate |
$734.87 |
| Max. Negotiated Rate |
$4,300.40 |
| Rate for Payer: Aetna Commercial |
$2,583.96
|
| Rate for Payer: Aetna Medicare |
$2,005.46
|
| Rate for Payer: BCBS Complete |
$1,333.41
|
| Rate for Payer: BCBS MAPPO |
$1,928.33
|
| Rate for Payer: BCBS Trust/PPO |
$734.87
|
| Rate for Payer: BCN Commercial |
$2,887.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,928.33
|
| Rate for Payer: Cash Price |
$5,292.80
|
| Rate for Payer: Cash Price |
$5,292.80
|
| Rate for Payer: Cofinity Commercial |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$2,583.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,928.33
|
| Rate for Payer: Mclaren Medicaid |
$1,269.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,024.75
|
| Rate for Payer: Meridian Medicaid |
$1,333.41
|
| Rate for Payer: Nomi Health Commercial |
$2,314.00
|
| Rate for Payer: PACE SWMI |
$1,928.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,928.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,269.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,300.40
|
| Rate for Payer: Priority Health HMO/PPO |
$3,539.60
|
| Rate for Payer: Priority Health Medicare |
$1,947.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,539.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,928.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,928.33
|
| Rate for Payer: UHC Exchange |
$1,928.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,928.33
|
| Rate for Payer: UHCCP Medicaid |
$1,269.91
|
|
|
PR HAIR REDUC 1/2 LEGS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00060
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR HAIR REDUC ABD TRAIL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00052
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HAIR REDUC BACK
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00054
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR HAIR REDUC BIKINI LN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00055
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HAIR REDUC BRAZ
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00056
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR HAIR REDUC BROW/NOSE/EARS/TOE/HND
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00061
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR HAIR REDUC CHIN/NECK
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00057
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HAIR REDUC FL FACE/SCALP/FL ABD
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 00058
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
|
|
PR HAIR REDUC FL LEGS
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00059
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00053
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
PR HAIR REDUC LIP
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00062
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR HAIR REDUC LIP & CHIN
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00063
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
