|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$1,179.10 |
| Rate for Payer: Aetna Commercial |
$1,033.02
|
| Rate for Payer: Aetna Medicare |
$801.75
|
| Rate for Payer: BCBS Complete |
$725.60
|
| Rate for Payer: BCBS MAPPO |
$770.91
|
| Rate for Payer: BCN Medicare Advantage |
$770.91
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,110.11
|
| Rate for Payer: Cofinity Commercial |
$1,033.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.46
|
| Rate for Payer: Nomi Health Commercial |
$925.09
|
| Rate for Payer: PACE SWMI |
$770.91
|
| Rate for Payer: PHP Medicare Advantage |
$770.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health Medicare |
$778.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.91
|
| Rate for Payer: UHC Exchange |
$770.91
|
| Rate for Payer: UHC Medicare Advantage |
$770.91
|
|
|
PR REPAIR RECTOCELE SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 45560
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$954.86 |
| Rate for Payer: Aetna Commercial |
$888.55
|
| Rate for Payer: Aetna Medicare |
$689.62
|
| Rate for Payer: BCBS Complete |
$515.20
|
| Rate for Payer: BCBS MAPPO |
$663.10
|
| Rate for Payer: BCN Medicare Advantage |
$663.10
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$954.86
|
| Rate for Payer: Cofinity Commercial |
$888.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.25
|
| Rate for Payer: Nomi Health Commercial |
$795.72
|
| Rate for Payer: PACE SWMI |
$663.10
|
| Rate for Payer: PHP Medicare Advantage |
$663.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.20
|
| Rate for Payer: Priority Health Medicare |
$669.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.10
|
| Rate for Payer: UHC Exchange |
$663.10
|
| Rate for Payer: UHC Medicare Advantage |
$663.10
|
|
|
PR REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 27654
|
| Min. Negotiated Rate |
$689.76 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$924.28
|
| Rate for Payer: Aetna Medicare |
$717.35
|
| Rate for Payer: BCBS Complete |
$1,110.00
|
| Rate for Payer: BCBS MAPPO |
$689.76
|
| Rate for Payer: BCN Medicare Advantage |
$689.76
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$993.25
|
| Rate for Payer: Cofinity Commercial |
$924.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.25
|
| Rate for Payer: Nomi Health Commercial |
$827.71
|
| Rate for Payer: PACE SWMI |
$689.76
|
| Rate for Payer: PHP Medicare Advantage |
$689.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health Medicare |
$696.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$689.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.76
|
| Rate for Payer: UHC Exchange |
$689.76
|
| Rate for Payer: UHC Medicare Advantage |
$689.76
|
|
|
PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$2,993.00
|
|
|
Service Code
|
HCPCS 27698
|
| Min. Negotiated Rate |
$614.15 |
| Max. Negotiated Rate |
$1,945.45 |
| Rate for Payer: Aetna Commercial |
$822.96
|
| Rate for Payer: Aetna Medicare |
$638.72
|
| Rate for Payer: BCBS Complete |
$1,197.20
|
| Rate for Payer: BCBS MAPPO |
$614.15
|
| Rate for Payer: BCN Medicare Advantage |
$614.15
|
| Rate for Payer: Cash Price |
$2,394.40
|
| Rate for Payer: Cash Price |
$2,394.40
|
| Rate for Payer: Cofinity Commercial |
$884.38
|
| Rate for Payer: Cofinity Commercial |
$822.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$644.86
|
| Rate for Payer: Nomi Health Commercial |
$736.98
|
| Rate for Payer: PACE SWMI |
$614.15
|
| Rate for Payer: PHP Medicare Advantage |
$614.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.45
|
| Rate for Payer: Priority Health Medicare |
$620.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.15
|
| Rate for Payer: UHC Exchange |
$614.15
|
| Rate for Payer: UHC Medicare Advantage |
$614.15
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE COMPLEX
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 26562
|
| Min. Negotiated Rate |
$904.40 |
| Max. Negotiated Rate |
$1,882.90 |
| Rate for Payer: Aetna Commercial |
$1,752.14
|
| Rate for Payer: Aetna Medicare |
$1,359.87
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$1,307.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,307.57
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$1,882.90
|
| Rate for Payer: Cofinity Commercial |
$1,752.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,307.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,372.95
|
| Rate for Payer: Nomi Health Commercial |
$1,569.08
|
| Rate for Payer: PACE SWMI |
$1,307.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,307.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$1,320.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,307.57
|
| Rate for Payer: UHC Exchange |
$1,307.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,307.57
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26560
|
| Min. Negotiated Rate |
$593.48 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$795.26
|
| Rate for Payer: Aetna Medicare |
$617.22
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$593.48
|
| Rate for Payer: BCN Medicare Advantage |
$593.48
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$854.61
|
| Rate for Payer: Cofinity Commercial |
$795.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.15
|
| Rate for Payer: Nomi Health Commercial |
$712.18
|
| Rate for Payer: PACE SWMI |
$593.48
|
| Rate for Payer: PHP Medicare Advantage |
$593.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$599.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$593.48
|
| Rate for Payer: UHC Exchange |
$593.48
|
| Rate for Payer: UHC Medicare Advantage |
$593.48
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT
|
Professional
|
Both
|
$2,404.00
|
|
|
Service Code
|
HCPCS 26561
|
| Min. Negotiated Rate |
$928.15 |
| Max. Negotiated Rate |
$1,562.60 |
| Rate for Payer: Aetna Commercial |
$1,243.72
|
| Rate for Payer: Aetna Medicare |
$965.28
|
| Rate for Payer: BCBS Complete |
$961.60
|
| Rate for Payer: BCBS MAPPO |
$928.15
|
| Rate for Payer: BCN Medicare Advantage |
$928.15
|
| Rate for Payer: Cash Price |
$1,923.20
|
| Rate for Payer: Cash Price |
$1,923.20
|
| Rate for Payer: Cofinity Commercial |
$1,336.54
|
| Rate for Payer: Cofinity Commercial |
$1,243.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.56
|
| Rate for Payer: Nomi Health Commercial |
$1,113.78
|
| Rate for Payer: PACE SWMI |
$928.15
|
| Rate for Payer: PHP Medicare Advantage |
$928.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.60
|
| Rate for Payer: Priority Health Medicare |
$937.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.15
|
| Rate for Payer: UHC Exchange |
$928.15
|
| Rate for Payer: UHC Medicare Advantage |
$928.15
|
|
|
PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 28208
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$494.65 |
| Rate for Payer: Aetna Commercial |
$410.50
|
| Rate for Payer: Aetna Medicare |
$318.59
|
| Rate for Payer: BCBS Complete |
$304.40
|
| Rate for Payer: BCBS MAPPO |
$306.34
|
| Rate for Payer: BCN Medicare Advantage |
$306.34
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cofinity Commercial |
$441.13
|
| Rate for Payer: Cofinity Commercial |
$410.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.66
|
| Rate for Payer: Nomi Health Commercial |
$367.61
|
| Rate for Payer: PACE SWMI |
$306.34
|
| Rate for Payer: PHP Medicare Advantage |
$306.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.65
|
| Rate for Payer: Priority Health Medicare |
$309.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.34
|
| Rate for Payer: UHC Exchange |
$306.34
|
| Rate for Payer: UHC Medicare Advantage |
$306.34
|
|
|
PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 24341
|
| Min. Negotiated Rate |
$722.69 |
| Max. Negotiated Rate |
$1,517.75 |
| Rate for Payer: Aetna Commercial |
$968.40
|
| Rate for Payer: Aetna Medicare |
$751.60
|
| Rate for Payer: BCBS Complete |
$934.00
|
| Rate for Payer: BCBS MAPPO |
$722.69
|
| Rate for Payer: BCN Medicare Advantage |
$722.69
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cofinity Commercial |
$968.40
|
| Rate for Payer: Cofinity Commercial |
$1,040.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.82
|
| Rate for Payer: Nomi Health Commercial |
$867.23
|
| Rate for Payer: PACE SWMI |
$722.69
|
| Rate for Payer: PHP Medicare Advantage |
$722.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.75
|
| Rate for Payer: Priority Health Medicare |
$729.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.69
|
| Rate for Payer: UHC Exchange |
$722.69
|
| Rate for Payer: UHC Medicare Advantage |
$722.69
|
|
|
PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 33363
|
| Min. Negotiated Rate |
$1,029.60 |
| Max. Negotiated Rate |
$1,880.68 |
| Rate for Payer: Aetna Commercial |
$1,750.08
|
| Rate for Payer: Aetna Medicare |
$1,358.27
|
| Rate for Payer: BCBS Complete |
$1,029.60
|
| Rate for Payer: BCBS MAPPO |
$1,306.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,306.03
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cofinity Commercial |
$1,880.68
|
| Rate for Payer: Cofinity Commercial |
$1,750.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,306.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,371.33
|
| Rate for Payer: Nomi Health Commercial |
$1,567.24
|
| Rate for Payer: PACE SWMI |
$1,306.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,306.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.10
|
| Rate for Payer: Priority Health Medicare |
$1,319.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,306.03
|
| Rate for Payer: UHC Exchange |
$1,306.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,306.03
|
|
|
PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH
|
Professional
|
Both
|
$4,316.00
|
|
|
Service Code
|
HCPCS 33362
|
| Min. Negotiated Rate |
$1,260.99 |
| Max. Negotiated Rate |
$2,805.40 |
| Rate for Payer: Aetna Commercial |
$1,689.73
|
| Rate for Payer: Aetna Medicare |
$1,311.43
|
| Rate for Payer: BCBS Complete |
$1,726.40
|
| Rate for Payer: BCBS MAPPO |
$1,260.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,260.99
|
| Rate for Payer: Cash Price |
$3,452.80
|
| Rate for Payer: Cash Price |
$3,452.80
|
| Rate for Payer: Cofinity Commercial |
$1,815.83
|
| Rate for Payer: Cofinity Commercial |
$1,689.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,260.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,324.04
|
| Rate for Payer: Nomi Health Commercial |
$1,513.19
|
| Rate for Payer: PACE SWMI |
$1,260.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,260.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,805.40
|
| Rate for Payer: Priority Health Medicare |
$1,273.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,260.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,260.99
|
| Rate for Payer: UHC Exchange |
$1,260.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,260.99
|
|
|
PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH
|
Professional
|
Both
|
$5,215.00
|
|
|
Service Code
|
HCPCS 33365
|
| Min. Negotiated Rate |
$1,360.42 |
| Max. Negotiated Rate |
$3,389.75 |
| Rate for Payer: Aetna Commercial |
$1,822.96
|
| Rate for Payer: Aetna Medicare |
$1,414.84
|
| Rate for Payer: BCBS Complete |
$2,086.00
|
| Rate for Payer: BCBS MAPPO |
$1,360.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,360.42
|
| Rate for Payer: Cash Price |
$4,172.00
|
| Rate for Payer: Cash Price |
$4,172.00
|
| Rate for Payer: Cofinity Commercial |
$1,959.00
|
| Rate for Payer: Cofinity Commercial |
$1,822.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,360.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,428.44
|
| Rate for Payer: Nomi Health Commercial |
$1,632.50
|
| Rate for Payer: PACE SWMI |
$1,360.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,360.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.75
|
| Rate for Payer: Priority Health Medicare |
$1,374.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,360.42
|
| Rate for Payer: UHC Exchange |
$1,360.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,360.42
|
|
|
PR REPLACE AORTIC VALVE OPEN TRANSTHORACIC APPROACH
|
Professional
|
Both
|
$3,171.00
|
|
|
Service Code
|
HCPCS 0318T
|
| Min. Negotiated Rate |
$1,268.40 |
| Max. Negotiated Rate |
$2,061.15 |
| Rate for Payer: Aetna Medicare |
$1,585.50
|
| Rate for Payer: BCBS Complete |
$1,268.40
|
| Rate for Payer: Cash Price |
$2,536.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.15
|
|
|
PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH
|
Professional
|
Both
|
$3,945.00
|
|
|
Service Code
|
HCPCS 33361
|
| Min. Negotiated Rate |
$1,155.07 |
| Max. Negotiated Rate |
$2,564.25 |
| Rate for Payer: Aetna Commercial |
$1,547.79
|
| Rate for Payer: Aetna Medicare |
$1,201.27
|
| Rate for Payer: BCBS Complete |
$1,578.00
|
| Rate for Payer: BCBS MAPPO |
$1,155.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.07
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cofinity Commercial |
$1,663.30
|
| Rate for Payer: Cofinity Commercial |
$1,547.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,212.82
|
| Rate for Payer: Nomi Health Commercial |
$1,386.08
|
| Rate for Payer: PACE SWMI |
$1,155.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,564.25
|
| Rate for Payer: Priority Health Medicare |
$1,166.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,155.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.07
|
| Rate for Payer: UHC Exchange |
$1,155.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.07
|
|
|
PR REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH
|
Professional
|
Both
|
$2,220.00
|
|
|
Service Code
|
HCPCS 33368
|
| Min. Negotiated Rate |
$706.69 |
| Max. Negotiated Rate |
$1,443.00 |
| Rate for Payer: Aetna Commercial |
$946.96
|
| Rate for Payer: Aetna Medicare |
$734.96
|
| Rate for Payer: BCBS Complete |
$888.00
|
| Rate for Payer: BCBS MAPPO |
$706.69
|
| Rate for Payer: BCN Medicare Advantage |
$706.69
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cofinity Commercial |
$1,017.63
|
| Rate for Payer: Cofinity Commercial |
$946.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.02
|
| Rate for Payer: Nomi Health Commercial |
$848.03
|
| Rate for Payer: PACE SWMI |
$706.69
|
| Rate for Payer: PHP Medicare Advantage |
$706.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.00
|
| Rate for Payer: Priority Health Medicare |
$713.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$706.69
|
| Rate for Payer: UHC Exchange |
$706.69
|
| Rate for Payer: UHC Medicare Advantage |
$706.69
|
|
|
PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$1,365.00
|
|
|
Service Code
|
HCPCS 49451
|
| Min. Negotiated Rate |
$83.61 |
| Max. Negotiated Rate |
$887.25 |
| Rate for Payer: Aetna Commercial |
$112.04
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: BCBS Complete |
$546.00
|
| Rate for Payer: BCBS MAPPO |
$83.61
|
| Rate for Payer: BCN Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$112.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.79
|
| Rate for Payer: Nomi Health Commercial |
$100.33
|
| Rate for Payer: PACE SWMI |
$83.61
|
| Rate for Payer: PHP Medicare Advantage |
$83.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.25
|
| Rate for Payer: Priority Health Medicare |
$84.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.61
|
| Rate for Payer: UHC Exchange |
$83.61
|
| Rate for Payer: UHC Medicare Advantage |
$83.61
|
|
|
PR REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$1,209.00
|
|
|
Service Code
|
HCPCS 49450
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$785.85 |
| Rate for Payer: Aetna Commercial |
$83.67
|
| Rate for Payer: Aetna Medicare |
$64.94
|
| Rate for Payer: BCBS Complete |
$483.60
|
| Rate for Payer: BCBS MAPPO |
$62.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.44
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cofinity Commercial |
$89.91
|
| Rate for Payer: Cofinity Commercial |
$83.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.56
|
| Rate for Payer: Nomi Health Commercial |
$74.93
|
| Rate for Payer: PACE SWMI |
$62.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.85
|
| Rate for Payer: Priority Health Medicare |
$63.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.44
|
| Rate for Payer: UHC Exchange |
$62.44
|
| Rate for Payer: UHC Medicare Advantage |
$62.44
|
|
|
PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$1,493.00
|
|
|
Service Code
|
HCPCS 49452
|
| Min. Negotiated Rate |
$128.56 |
| Max. Negotiated Rate |
$970.45 |
| Rate for Payer: Aetna Commercial |
$172.27
|
| Rate for Payer: Aetna Medicare |
$133.70
|
| Rate for Payer: BCBS Complete |
$597.20
|
| Rate for Payer: BCBS MAPPO |
$128.56
|
| Rate for Payer: BCN Medicare Advantage |
$128.56
|
| Rate for Payer: Cash Price |
$1,194.40
|
| Rate for Payer: Cash Price |
$1,194.40
|
| Rate for Payer: Cofinity Commercial |
$185.13
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.99
|
| Rate for Payer: Nomi Health Commercial |
$154.27
|
| Rate for Payer: PACE SWMI |
$128.56
|
| Rate for Payer: PHP Medicare Advantage |
$128.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.45
|
| Rate for Payer: Priority Health Medicare |
$129.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.56
|
| Rate for Payer: UHC Exchange |
$128.56
|
| Rate for Payer: UHC Medicare Advantage |
$128.56
|
|
|
PR REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$5,864.00
|
|
|
Service Code
|
HCPCS 33430
|
| Min. Negotiated Rate |
$2,345.60 |
| Max. Negotiated Rate |
$3,865.61 |
| Rate for Payer: Aetna Commercial |
$3,597.16
|
| Rate for Payer: Aetna Medicare |
$2,791.83
|
| Rate for Payer: BCBS Complete |
$2,345.60
|
| Rate for Payer: BCBS MAPPO |
$2,684.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,684.45
|
| Rate for Payer: Cash Price |
$4,691.20
|
| Rate for Payer: Cash Price |
$4,691.20
|
| Rate for Payer: Cofinity Commercial |
$3,865.61
|
| Rate for Payer: Cofinity Commercial |
$3,597.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,684.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,818.67
|
| Rate for Payer: Nomi Health Commercial |
$3,221.34
|
| Rate for Payer: PACE SWMI |
$2,684.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,684.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,811.60
|
| Rate for Payer: Priority Health Medicare |
$2,711.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,684.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,684.45
|
| Rate for Payer: UHC Exchange |
$2,684.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,684.45
|
|
|
PR REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 11970
|
| Min. Negotiated Rate |
$441.60 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Aetna Commercial |
$720.57
|
| Rate for Payer: Aetna Medicare |
$559.25
|
| Rate for Payer: BCBS Complete |
$441.60
|
| Rate for Payer: BCBS MAPPO |
$537.74
|
| Rate for Payer: BCN Medicare Advantage |
$537.74
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$774.35
|
| Rate for Payer: Cofinity Commercial |
$720.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.63
|
| Rate for Payer: Nomi Health Commercial |
$645.29
|
| Rate for Payer: PACE SWMI |
$537.74
|
| Rate for Payer: PHP Medicare Advantage |
$537.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health Medicare |
$543.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$537.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.74
|
| Rate for Payer: UHC Exchange |
$537.74
|
| Rate for Payer: UHC Medicare Advantage |
$537.74
|
|
|
PR REPLACEMENT TRICUSPID VALVE W/CARD BYPASS
|
Professional
|
Both
|
$8,810.00
|
|
|
Service Code
|
HCPCS 33465
|
| Min. Negotiated Rate |
$2,636.94 |
| Max. Negotiated Rate |
$5,726.50 |
| Rate for Payer: Aetna Commercial |
$3,533.50
|
| Rate for Payer: Aetna Medicare |
$2,742.42
|
| Rate for Payer: BCBS Complete |
$3,524.00
|
| Rate for Payer: BCBS MAPPO |
$2,636.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,636.94
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$3,797.19
|
| Rate for Payer: Cofinity Commercial |
$3,533.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,636.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,768.79
|
| Rate for Payer: Nomi Health Commercial |
$3,164.33
|
| Rate for Payer: PACE SWMI |
$2,636.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,636.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health Medicare |
$2,663.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,636.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,636.94
|
| Rate for Payer: UHC Exchange |
$2,636.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,636.94
|
|
|
PR REPOSITIONING PERQ R/L VAD W/IMG GDN SEP INSJ
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
HCPCS 33993
|
| Min. Negotiated Rate |
$157.48 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$163.78
|
| Rate for Payer: BCBS Complete |
$197.60
|
| Rate for Payer: BCBS MAPPO |
$157.48
|
| Rate for Payer: BCN Medicare Advantage |
$157.48
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cofinity Commercial |
$226.77
|
| Rate for Payer: Cofinity Commercial |
$211.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.35
|
| Rate for Payer: Nomi Health Commercial |
$188.98
|
| Rate for Payer: PACE SWMI |
$157.48
|
| Rate for Payer: PHP Medicare Advantage |
$157.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.10
|
| Rate for Payer: Priority Health Medicare |
$159.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.48
|
| Rate for Payer: UHC Exchange |
$157.48
|
| Rate for Payer: UHC Medicare Advantage |
$157.48
|
|
|
PR REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 43761
|
| Min. Negotiated Rate |
$99.43 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$133.24
|
| Rate for Payer: Aetna Medicare |
$103.41
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: BCBS MAPPO |
$99.43
|
| Rate for Payer: BCN Medicare Advantage |
$99.43
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$143.18
|
| Rate for Payer: Cofinity Commercial |
$133.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.40
|
| Rate for Payer: Nomi Health Commercial |
$119.32
|
| Rate for Payer: PACE SWMI |
$99.43
|
| Rate for Payer: PHP Medicare Advantage |
$99.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health Medicare |
$100.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.43
|
| Rate for Payer: UHC Exchange |
$99.43
|
| Rate for Payer: UHC Medicare Advantage |
$99.43
|
|
|
PR REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 33273
|
| Min. Negotiated Rate |
$336.80 |
| Max. Negotiated Rate |
$549.85 |
| Rate for Payer: Aetna Commercial |
$511.67
|
| Rate for Payer: Aetna Medicare |
$397.11
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$381.84
|
| Rate for Payer: BCN Medicare Advantage |
$381.84
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$549.85
|
| Rate for Payer: Cofinity Commercial |
$511.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.93
|
| Rate for Payer: Nomi Health Commercial |
$458.21
|
| Rate for Payer: PACE SWMI |
$381.84
|
| Rate for Payer: PHP Medicare Advantage |
$381.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$385.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$381.84
|
| Rate for Payer: UHC Exchange |
$381.84
|
| Rate for Payer: UHC Medicare Advantage |
$381.84
|
|
|
PR REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 62252
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$110.79
|
| Rate for Payer: Aetna Medicare |
$85.99
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$82.68
|
| Rate for Payer: BCN Medicare Advantage |
$82.68
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$119.06
|
| Rate for Payer: Cofinity Commercial |
$110.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.81
|
| Rate for Payer: Nomi Health Commercial |
$99.22
|
| Rate for Payer: PACE SWMI |
$82.68
|
| Rate for Payer: PHP Medicare Advantage |
$82.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$83.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.68
|
| Rate for Payer: UHC Exchange |
$82.68
|
| Rate for Payer: UHC Medicare Advantage |
$82.68
|
|
