|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$869.41 |
| Rate for Payer: Aetna Commercial |
$809.04
|
| Rate for Payer: Aetna Medicare |
$627.91
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$603.76
|
| Rate for Payer: BCN Medicare Advantage |
$603.76
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$869.41
|
| Rate for Payer: Cofinity Commercial |
$809.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.95
|
| Rate for Payer: Nomi Health Commercial |
$724.51
|
| Rate for Payer: PACE SWMI |
$603.76
|
| Rate for Payer: PHP Medicare Advantage |
$603.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$609.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$603.76
|
| Rate for Payer: UHC Exchange |
$603.76
|
| Rate for Payer: UHC Medicare Advantage |
$603.76
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$2,861.00
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$1,142.04 |
| Max. Negotiated Rate |
$1,859.65 |
| Rate for Payer: Aetna Commercial |
$1,530.33
|
| Rate for Payer: Aetna Medicare |
$1,187.72
|
| Rate for Payer: BCBS Complete |
$1,144.40
|
| Rate for Payer: BCBS MAPPO |
$1,142.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.04
|
| Rate for Payer: Cash Price |
$2,288.80
|
| Rate for Payer: Cash Price |
$2,288.80
|
| Rate for Payer: Cofinity Commercial |
$1,644.54
|
| Rate for Payer: Cofinity Commercial |
$1,530.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.14
|
| Rate for Payer: Nomi Health Commercial |
$1,370.45
|
| Rate for Payer: PACE SWMI |
$1,142.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,859.65
|
| Rate for Payer: Priority Health Medicare |
$1,153.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,142.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.04
|
| Rate for Payer: UHC Exchange |
$1,142.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.04
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF
|
Professional
|
Both
|
$2,619.00
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$1,047.60 |
| Max. Negotiated Rate |
$1,719.01 |
| Rate for Payer: Aetna Commercial |
$1,599.64
|
| Rate for Payer: Aetna Medicare |
$1,241.51
|
| Rate for Payer: BCBS Complete |
$1,047.60
|
| Rate for Payer: BCBS MAPPO |
$1,193.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.76
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cofinity Commercial |
$1,719.01
|
| Rate for Payer: Cofinity Commercial |
$1,599.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.45
|
| Rate for Payer: Nomi Health Commercial |
$1,432.51
|
| Rate for Payer: PACE SWMI |
$1,193.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.35
|
| Rate for Payer: Priority Health Medicare |
$1,205.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,193.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.76
|
| Rate for Payer: UHC Exchange |
$1,193.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.76
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$2,362.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$944.80 |
| Max. Negotiated Rate |
$1,650.10 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Aetna Medicare |
$1,191.74
|
| Rate for Payer: BCBS Complete |
$944.80
|
| Rate for Payer: BCBS MAPPO |
$1,145.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,145.90
|
| Rate for Payer: Cash Price |
$1,889.60
|
| Rate for Payer: Cash Price |
$1,889.60
|
| Rate for Payer: Cofinity Commercial |
$1,650.10
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,145.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,203.19
|
| Rate for Payer: Nomi Health Commercial |
$1,375.08
|
| Rate for Payer: PACE SWMI |
$1,145.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,145.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.30
|
| Rate for Payer: Priority Health Medicare |
$1,157.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,145.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,145.90
|
| Rate for Payer: UHC Exchange |
$1,145.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,145.90
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$5,384.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$1,591.27 |
| Max. Negotiated Rate |
$3,499.60 |
| Rate for Payer: Aetna Commercial |
$2,132.30
|
| Rate for Payer: Aetna Medicare |
$1,654.92
|
| Rate for Payer: BCBS Complete |
$2,153.60
|
| Rate for Payer: BCBS MAPPO |
$1,591.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.27
|
| Rate for Payer: Cash Price |
$4,307.20
|
| Rate for Payer: Cash Price |
$4,307.20
|
| Rate for Payer: Cofinity Commercial |
$2,291.43
|
| Rate for Payer: Cofinity Commercial |
$2,132.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,670.83
|
| Rate for Payer: Nomi Health Commercial |
$1,909.52
|
| Rate for Payer: PACE SWMI |
$1,591.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,499.60
|
| Rate for Payer: Priority Health Medicare |
$1,607.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,591.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.27
|
| Rate for Payer: UHC Exchange |
$1,591.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,591.27
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$964.69 |
| Max. Negotiated Rate |
$1,681.55 |
| Rate for Payer: Aetna Commercial |
$1,292.68
|
| Rate for Payer: Aetna Medicare |
$1,003.28
|
| Rate for Payer: BCBS Complete |
$1,034.80
|
| Rate for Payer: BCBS MAPPO |
$964.69
|
| Rate for Payer: BCN Medicare Advantage |
$964.69
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cofinity Commercial |
$1,389.15
|
| Rate for Payer: Cofinity Commercial |
$1,292.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.92
|
| Rate for Payer: Nomi Health Commercial |
$1,157.63
|
| Rate for Payer: PACE SWMI |
$964.69
|
| Rate for Payer: PHP Medicare Advantage |
$964.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health Medicare |
$974.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$964.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.69
|
| Rate for Payer: UHC Exchange |
$964.69
|
| Rate for Payer: UHC Medicare Advantage |
$964.69
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$495.20 |
| Max. Negotiated Rate |
$828.58 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare |
$598.42
|
| Rate for Payer: BCBS Complete |
$495.20
|
| Rate for Payer: BCBS MAPPO |
$575.40
|
| Rate for Payer: BCN Medicare Advantage |
$575.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$828.58
|
| Rate for Payer: Cofinity Commercial |
$771.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.17
|
| Rate for Payer: Nomi Health Commercial |
$690.48
|
| Rate for Payer: PACE SWMI |
$575.40
|
| Rate for Payer: PHP Medicare Advantage |
$575.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.70
|
| Rate for Payer: Priority Health Medicare |
$581.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.40
|
| Rate for Payer: UHC Exchange |
$575.40
|
| Rate for Payer: UHC Medicare Advantage |
$575.40
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,128.00
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$2,683.20 |
| Rate for Payer: Aetna Commercial |
$1,166.62
|
| Rate for Payer: Aetna Medicare |
$905.43
|
| Rate for Payer: BCBS Complete |
$1,651.20
|
| Rate for Payer: BCBS MAPPO |
$870.61
|
| Rate for Payer: BCN Medicare Advantage |
$870.61
|
| Rate for Payer: Cash Price |
$3,302.40
|
| Rate for Payer: Cash Price |
$3,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,253.68
|
| Rate for Payer: Cofinity Commercial |
$1,166.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.14
|
| Rate for Payer: Nomi Health Commercial |
$1,044.73
|
| Rate for Payer: PACE SWMI |
$870.61
|
| Rate for Payer: PHP Medicare Advantage |
$870.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,683.20
|
| Rate for Payer: Priority Health Medicare |
$879.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.61
|
| Rate for Payer: UHC Exchange |
$870.61
|
| Rate for Payer: UHC Medicare Advantage |
$870.61
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$4,817.00
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$431.97 |
| Max. Negotiated Rate |
$3,131.05 |
| Rate for Payer: Aetna Commercial |
$578.84
|
| Rate for Payer: Aetna Medicare |
$449.25
|
| Rate for Payer: BCBS Complete |
$1,926.80
|
| Rate for Payer: BCBS MAPPO |
$431.97
|
| Rate for Payer: BCN Medicare Advantage |
$431.97
|
| Rate for Payer: Cash Price |
$3,853.60
|
| Rate for Payer: Cash Price |
$3,853.60
|
| Rate for Payer: Cofinity Commercial |
$622.04
|
| Rate for Payer: Cofinity Commercial |
$578.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$453.57
|
| Rate for Payer: Nomi Health Commercial |
$518.36
|
| Rate for Payer: PACE SWMI |
$431.97
|
| Rate for Payer: PHP Medicare Advantage |
$431.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,131.05
|
| Rate for Payer: Priority Health Medicare |
$436.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.97
|
| Rate for Payer: UHC Exchange |
$431.97
|
| Rate for Payer: UHC Medicare Advantage |
$431.97
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$1,273.87 |
| Rate for Payer: Aetna Commercial |
$1,185.40
|
| Rate for Payer: Aetna Medicare |
$920.02
|
| Rate for Payer: BCBS Complete |
$730.00
|
| Rate for Payer: BCBS MAPPO |
$884.63
|
| Rate for Payer: BCN Medicare Advantage |
$884.63
|
| Rate for Payer: Cash Price |
$1,460.00
|
| Rate for Payer: Cash Price |
$1,460.00
|
| Rate for Payer: Cofinity Commercial |
$1,273.87
|
| Rate for Payer: Cofinity Commercial |
$1,185.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.86
|
| Rate for Payer: Nomi Health Commercial |
$1,061.56
|
| Rate for Payer: PACE SWMI |
$884.63
|
| Rate for Payer: PHP Medicare Advantage |
$884.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.25
|
| Rate for Payer: Priority Health Medicare |
$893.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$884.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.63
|
| Rate for Payer: UHC Exchange |
$884.63
|
| Rate for Payer: UHC Medicare Advantage |
$884.63
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$2,119.00
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$1,412.88 |
| Rate for Payer: Aetna Commercial |
$1,314.77
|
| Rate for Payer: Aetna Medicare |
$1,020.42
|
| Rate for Payer: BCBS Complete |
$847.60
|
| Rate for Payer: BCBS MAPPO |
$981.17
|
| Rate for Payer: BCN Medicare Advantage |
$981.17
|
| Rate for Payer: Cash Price |
$1,695.20
|
| Rate for Payer: Cash Price |
$1,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,412.88
|
| Rate for Payer: Cofinity Commercial |
$1,314.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.23
|
| Rate for Payer: Nomi Health Commercial |
$1,177.40
|
| Rate for Payer: PACE SWMI |
$981.17
|
| Rate for Payer: PHP Medicare Advantage |
$981.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,377.35
|
| Rate for Payer: Priority Health Medicare |
$990.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$981.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.17
|
| Rate for Payer: UHC Exchange |
$981.17
|
| Rate for Payer: UHC Medicare Advantage |
$981.17
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,374.62 |
| Rate for Payer: Aetna Commercial |
$1,279.16
|
| Rate for Payer: Aetna Medicare |
$992.78
|
| Rate for Payer: BCBS Complete |
$834.80
|
| Rate for Payer: BCBS MAPPO |
$954.60
|
| Rate for Payer: BCN Medicare Advantage |
$954.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,374.62
|
| Rate for Payer: Cofinity Commercial |
$1,279.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$954.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,002.33
|
| Rate for Payer: Nomi Health Commercial |
$1,145.52
|
| Rate for Payer: PACE SWMI |
$954.60
|
| Rate for Payer: PHP Medicare Advantage |
$954.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health Medicare |
$964.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$954.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$954.60
|
| Rate for Payer: UHC Exchange |
$954.60
|
| Rate for Payer: UHC Medicare Advantage |
$954.60
|
|
|
PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
HCPCS 69604
|
| Min. Negotiated Rate |
$895.60 |
| Max. Negotiated Rate |
$1,497.47 |
| Rate for Payer: Aetna Commercial |
$1,393.48
|
| Rate for Payer: Aetna Medicare |
$1,081.51
|
| Rate for Payer: BCBS Complete |
$895.60
|
| Rate for Payer: BCBS MAPPO |
$1,039.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,039.91
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cofinity Commercial |
$1,497.47
|
| Rate for Payer: Cofinity Commercial |
$1,393.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,039.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,091.91
|
| Rate for Payer: Nomi Health Commercial |
$1,247.89
|
| Rate for Payer: PACE SWMI |
$1,039.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,039.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.35
|
| Rate for Payer: Priority Health Medicare |
$1,050.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,039.91
|
| Rate for Payer: UHC Exchange |
$1,039.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,039.91
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$1,040.26 |
| Rate for Payer: Aetna Commercial |
$968.02
|
| Rate for Payer: Aetna Medicare |
$751.30
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: BCBS MAPPO |
$722.40
|
| Rate for Payer: BCN Medicare Advantage |
$722.40
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Commercial |
$968.02
|
| Rate for Payer: Cofinity Commercial |
$1,040.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.52
|
| Rate for Payer: Nomi Health Commercial |
$866.88
|
| Rate for Payer: PACE SWMI |
$722.40
|
| Rate for Payer: PHP Medicare Advantage |
$722.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
| Rate for Payer: Priority Health Medicare |
$729.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.40
|
| Rate for Payer: UHC Exchange |
$722.40
|
| Rate for Payer: UHC Medicare Advantage |
$722.40
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$771.31 |
| Max. Negotiated Rate |
$1,516.45 |
| Rate for Payer: Aetna Commercial |
$1,033.56
|
| Rate for Payer: Aetna Medicare |
$802.16
|
| Rate for Payer: BCBS Complete |
$933.20
|
| Rate for Payer: BCBS MAPPO |
$771.31
|
| Rate for Payer: BCN Medicare Advantage |
$771.31
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,110.69
|
| Rate for Payer: Cofinity Commercial |
$1,033.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.88
|
| Rate for Payer: Nomi Health Commercial |
$925.57
|
| Rate for Payer: PACE SWMI |
$771.31
|
| Rate for Payer: PHP Medicare Advantage |
$771.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: Priority Health Medicare |
$779.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.31
|
| Rate for Payer: UHC Exchange |
$771.31
|
| Rate for Payer: UHC Medicare Advantage |
$771.31
|
|
|
PR REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
HCPCS 63688
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$1,182.35 |
| Rate for Payer: Aetna Commercial |
$387.23
|
| Rate for Payer: Aetna Medicare |
$300.54
|
| Rate for Payer: BCBS Complete |
$727.60
|
| Rate for Payer: BCBS MAPPO |
$288.98
|
| Rate for Payer: BCN Medicare Advantage |
$288.98
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cofinity Commercial |
$416.13
|
| Rate for Payer: Cofinity Commercial |
$387.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.43
|
| Rate for Payer: Nomi Health Commercial |
$346.78
|
| Rate for Payer: PACE SWMI |
$288.98
|
| Rate for Payer: PHP Medicare Advantage |
$288.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.35
|
| Rate for Payer: Priority Health Medicare |
$291.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.98
|
| Rate for Payer: UHC Exchange |
$288.98
|
| Rate for Payer: UHC Medicare Advantage |
$288.98
|
|
|
PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS
|
Professional
|
Both
|
$3,184.00
|
|
|
Service Code
|
HCPCS 61880
|
| Min. Negotiated Rate |
$579.59 |
| Max. Negotiated Rate |
$2,069.60 |
| Rate for Payer: Aetna Commercial |
$776.65
|
| Rate for Payer: Aetna Medicare |
$602.77
|
| Rate for Payer: BCBS Complete |
$1,273.60
|
| Rate for Payer: BCBS MAPPO |
$579.59
|
| Rate for Payer: BCN Medicare Advantage |
$579.59
|
| Rate for Payer: Cash Price |
$2,547.20
|
| Rate for Payer: Cash Price |
$2,547.20
|
| Rate for Payer: Cofinity Commercial |
$834.61
|
| Rate for Payer: Cofinity Commercial |
$776.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$608.57
|
| Rate for Payer: Nomi Health Commercial |
$695.51
|
| Rate for Payer: PACE SWMI |
$579.59
|
| Rate for Payer: PHP Medicare Advantage |
$579.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,069.60
|
| Rate for Payer: Priority Health Medicare |
$585.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$579.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$579.59
|
| Rate for Payer: UHC Exchange |
$579.59
|
| Rate for Payer: UHC Medicare Advantage |
$579.59
|
|
|
PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
HCPCS 61888
|
| Min. Negotiated Rate |
$392.23 |
| Max. Negotiated Rate |
$681.20 |
| Rate for Payer: Aetna Commercial |
$525.59
|
| Rate for Payer: Aetna Medicare |
$407.92
|
| Rate for Payer: BCBS Complete |
$419.20
|
| Rate for Payer: BCBS MAPPO |
$392.23
|
| Rate for Payer: BCN Medicare Advantage |
$392.23
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cofinity Commercial |
$564.81
|
| Rate for Payer: Cofinity Commercial |
$525.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.84
|
| Rate for Payer: Nomi Health Commercial |
$470.68
|
| Rate for Payer: PACE SWMI |
$392.23
|
| Rate for Payer: PHP Medicare Advantage |
$392.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.20
|
| Rate for Payer: Priority Health Medicare |
$396.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.23
|
| Rate for Payer: UHC Exchange |
$392.23
|
| Rate for Payer: UHC Medicare Advantage |
$392.23
|
|
|
PR REVJ/RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 64585
|
| Min. Negotiated Rate |
$136.72 |
| Max. Negotiated Rate |
$869.70 |
| Rate for Payer: Aetna Commercial |
$183.20
|
| Rate for Payer: Aetna Medicare |
$142.19
|
| Rate for Payer: BCBS Complete |
$535.20
|
| Rate for Payer: BCBS MAPPO |
$136.72
|
| Rate for Payer: BCN Medicare Advantage |
$136.72
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$183.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.56
|
| Rate for Payer: Nomi Health Commercial |
$164.06
|
| Rate for Payer: PACE SWMI |
$136.72
|
| Rate for Payer: PHP Medicare Advantage |
$136.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.70
|
| Rate for Payer: Priority Health Medicare |
$138.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.72
|
| Rate for Payer: UHC Exchange |
$136.72
|
| Rate for Payer: UHC Medicare Advantage |
$136.72
|
|
|
PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 57295
|
| Min. Negotiated Rate |
$478.91 |
| Max. Negotiated Rate |
$923.00 |
| Rate for Payer: Aetna Commercial |
$641.74
|
| Rate for Payer: Aetna Medicare |
$498.07
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$478.91
|
| Rate for Payer: BCN Medicare Advantage |
$478.91
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$689.63
|
| Rate for Payer: Cofinity Commercial |
$641.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.86
|
| Rate for Payer: Nomi Health Commercial |
$574.69
|
| Rate for Payer: PACE SWMI |
$478.91
|
| Rate for Payer: PHP Medicare Advantage |
$478.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$483.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$478.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.91
|
| Rate for Payer: UHC Exchange |
$478.91
|
| Rate for Payer: UHC Medicare Advantage |
$478.91
|
|
|
PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 64583
|
| Min. Negotiated Rate |
$701.60 |
| Max. Negotiated Rate |
$1,191.25 |
| Rate for Payer: Aetna Commercial |
$1,108.53
|
| Rate for Payer: Aetna Medicare |
$860.35
|
| Rate for Payer: BCBS Complete |
$701.60
|
| Rate for Payer: BCBS MAPPO |
$827.26
|
| Rate for Payer: BCN Medicare Advantage |
$827.26
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cofinity Commercial |
$1,191.25
|
| Rate for Payer: Cofinity Commercial |
$1,108.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.62
|
| Rate for Payer: Nomi Health Commercial |
$992.71
|
| Rate for Payer: PACE SWMI |
$827.26
|
| Rate for Payer: PHP Medicare Advantage |
$827.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.10
|
| Rate for Payer: Priority Health Medicare |
$835.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.26
|
| Rate for Payer: UHC Exchange |
$827.26
|
| Rate for Payer: UHC Medicare Advantage |
$827.26
|
|
|
PR REVJ/RPLMNT CH WAL RESPIR ELTRD & CONJ PULSE GEN
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 0467T
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$4,568.00
|
|
|
Service Code
|
HCPCS 27486
|
| Min. Negotiated Rate |
$1,352.57 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$1,812.44
|
| Rate for Payer: Aetna Medicare |
$1,406.67
|
| Rate for Payer: BCBS Complete |
$1,827.20
|
| Rate for Payer: BCBS MAPPO |
$1,352.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,352.57
|
| Rate for Payer: Cash Price |
$3,654.40
|
| Rate for Payer: Cash Price |
$3,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,947.70
|
| Rate for Payer: Cofinity Commercial |
$1,812.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,352.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.20
|
| Rate for Payer: Nomi Health Commercial |
$1,623.08
|
| Rate for Payer: PACE SWMI |
$1,352.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,352.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,969.20
|
| Rate for Payer: Priority Health Medicare |
$1,366.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,352.57
|
| Rate for Payer: UHC Exchange |
$1,352.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,352.57
|
|
|
PR REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,038.00
|
|
|
Service Code
|
HCPCS 27137
|
| Min. Negotiated Rate |
$1,215.20 |
| Max. Negotiated Rate |
$2,032.10 |
| Rate for Payer: Aetna Commercial |
$1,890.98
|
| Rate for Payer: Aetna Medicare |
$1,467.63
|
| Rate for Payer: BCBS Complete |
$1,215.20
|
| Rate for Payer: BCBS MAPPO |
$1,411.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.18
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$1,890.98
|
| Rate for Payer: Cofinity Commercial |
$2,032.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,481.74
|
| Rate for Payer: Nomi Health Commercial |
$1,693.42
|
| Rate for Payer: PACE SWMI |
$1,411.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.70
|
| Rate for Payer: Priority Health Medicare |
$1,425.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,411.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.18
|
| Rate for Payer: UHC Exchange |
$1,411.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.18
|
|
|
PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,958.00
|
|
|
Service Code
|
HCPCS 27134
|
| Min. Negotiated Rate |
$1,583.20 |
| Max. Negotiated Rate |
$2,639.04 |
| Rate for Payer: Aetna Commercial |
$2,455.78
|
| Rate for Payer: Aetna Medicare |
$1,905.98
|
| Rate for Payer: BCBS Complete |
$1,583.20
|
| Rate for Payer: BCBS MAPPO |
$1,832.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,832.67
|
| Rate for Payer: Cash Price |
$3,166.40
|
| Rate for Payer: Cash Price |
$3,166.40
|
| Rate for Payer: Cofinity Commercial |
$2,639.04
|
| Rate for Payer: Cofinity Commercial |
$2,455.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,832.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,924.30
|
| Rate for Payer: Nomi Health Commercial |
$2,199.20
|
| Rate for Payer: PACE SWMI |
$1,832.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,832.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,572.70
|
| Rate for Payer: Priority Health Medicare |
$1,851.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,832.67
|
| Rate for Payer: UHC Exchange |
$1,832.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,832.67
|
|
