|
PR RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP
|
Professional
|
Both
|
$6,519.00
|
|
|
Service Code
|
HCPCS 35241
|
| Min. Negotiated Rate |
$1,371.97 |
| Max. Negotiated Rate |
$4,237.35 |
| Rate for Payer: Aetna Commercial |
$1,838.44
|
| Rate for Payer: Aetna Medicare |
$1,426.85
|
| Rate for Payer: BCBS Complete |
$2,607.60
|
| Rate for Payer: BCBS MAPPO |
$1,371.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,371.97
|
| Rate for Payer: Cash Price |
$5,215.20
|
| Rate for Payer: Cash Price |
$5,215.20
|
| Rate for Payer: Cofinity Commercial |
$1,975.64
|
| Rate for Payer: Cofinity Commercial |
$1,838.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,371.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,440.57
|
| Rate for Payer: Nomi Health Commercial |
$1,646.36
|
| Rate for Payer: PACE SWMI |
$1,371.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,371.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,237.35
|
| Rate for Payer: Priority Health Medicare |
$1,385.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,371.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,371.97
|
| Rate for Payer: UHC Exchange |
$1,371.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,371.97
|
|
|
PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP
|
Professional
|
Both
|
$6,744.00
|
|
|
Service Code
|
HCPCS 35271
|
| Min. Negotiated Rate |
$1,323.88 |
| Max. Negotiated Rate |
$4,383.60 |
| Rate for Payer: Aetna Commercial |
$1,774.00
|
| Rate for Payer: Aetna Medicare |
$1,376.84
|
| Rate for Payer: BCBS Complete |
$2,697.60
|
| Rate for Payer: BCBS MAPPO |
$1,323.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,323.88
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cash Price |
$5,395.20
|
| Rate for Payer: Cofinity Commercial |
$1,906.39
|
| Rate for Payer: Cofinity Commercial |
$1,774.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,323.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,390.07
|
| Rate for Payer: Nomi Health Commercial |
$1,588.66
|
| Rate for Payer: PACE SWMI |
$1,323.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,383.60
|
| Rate for Payer: Priority Health Medicare |
$1,337.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,323.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,323.88
|
| Rate for Payer: UHC Exchange |
$1,323.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,323.88
|
|
|
PR RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 35266
|
| Min. Negotiated Rate |
$717.20 |
| Max. Negotiated Rate |
$1,195.50 |
| Rate for Payer: Aetna Commercial |
$1,112.48
|
| Rate for Payer: Aetna Medicare |
$863.42
|
| Rate for Payer: BCBS Complete |
$717.20
|
| Rate for Payer: BCBS MAPPO |
$830.21
|
| Rate for Payer: BCN Medicare Advantage |
$830.21
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cofinity Commercial |
$1,195.50
|
| Rate for Payer: Cofinity Commercial |
$1,112.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$871.72
|
| Rate for Payer: Nomi Health Commercial |
$996.25
|
| Rate for Payer: PACE SWMI |
$830.21
|
| Rate for Payer: PHP Medicare Advantage |
$830.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.45
|
| Rate for Payer: Priority Health Medicare |
$838.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.21
|
| Rate for Payer: UHC Exchange |
$830.21
|
| Rate for Payer: UHC Medicare Advantage |
$830.21
|
|
|
PR RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY
|
Professional
|
Both
|
$3,792.00
|
|
|
Service Code
|
HCPCS 35286
|
| Min. Negotiated Rate |
$888.62 |
| Max. Negotiated Rate |
$2,464.80 |
| Rate for Payer: Aetna Commercial |
$1,190.75
|
| Rate for Payer: Aetna Medicare |
$924.16
|
| Rate for Payer: BCBS Complete |
$1,516.80
|
| Rate for Payer: BCBS MAPPO |
$888.62
|
| Rate for Payer: BCN Medicare Advantage |
$888.62
|
| Rate for Payer: Cash Price |
$3,033.60
|
| Rate for Payer: Cash Price |
$3,033.60
|
| Rate for Payer: Cofinity Commercial |
$1,279.61
|
| Rate for Payer: Cofinity Commercial |
$1,190.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.05
|
| Rate for Payer: Nomi Health Commercial |
$1,066.34
|
| Rate for Payer: PACE SWMI |
$888.62
|
| Rate for Payer: PHP Medicare Advantage |
$888.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,464.80
|
| Rate for Payer: Priority Health Medicare |
$897.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$888.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$888.62
|
| Rate for Payer: UHC Exchange |
$888.62
|
| Rate for Payer: UHC Medicare Advantage |
$888.62
|
|
|
PR RPR CLOACAL ANOMALY SACROPERINEAL
|
Professional
|
Both
|
$6,583.00
|
|
|
Service Code
|
HCPCS 46744
|
| Min. Negotiated Rate |
$2,633.20 |
| Max. Negotiated Rate |
$4,946.50 |
| Rate for Payer: Aetna Commercial |
$4,602.99
|
| Rate for Payer: Aetna Medicare |
$3,572.47
|
| Rate for Payer: BCBS Complete |
$2,633.20
|
| Rate for Payer: BCBS MAPPO |
$3,435.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,435.07
|
| Rate for Payer: Cash Price |
$5,266.40
|
| Rate for Payer: Cash Price |
$5,266.40
|
| Rate for Payer: Cofinity Commercial |
$4,946.50
|
| Rate for Payer: Cofinity Commercial |
$4,602.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,435.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,606.82
|
| Rate for Payer: Nomi Health Commercial |
$4,122.08
|
| Rate for Payer: PACE SWMI |
$3,435.07
|
| Rate for Payer: PHP Medicare Advantage |
$3,435.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,278.95
|
| Rate for Payer: Priority Health Medicare |
$3,469.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,435.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,435.07
|
| Rate for Payer: UHC Exchange |
$3,435.07
|
| Rate for Payer: UHC Medicare Advantage |
$3,435.07
|
|
|
PR RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26540
|
| Min. Negotiated Rate |
$655.19 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$877.95
|
| Rate for Payer: Aetna Medicare |
$681.40
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$655.19
|
| Rate for Payer: BCN Medicare Advantage |
$655.19
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$943.47
|
| Rate for Payer: Cofinity Commercial |
$877.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.95
|
| Rate for Payer: Nomi Health Commercial |
$786.23
|
| Rate for Payer: PACE SWMI |
$655.19
|
| Rate for Payer: PHP Medicare Advantage |
$655.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$661.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$655.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$655.19
|
| Rate for Payer: UHC Exchange |
$655.19
|
| Rate for Payer: UHC Medicare Advantage |
$655.19
|
|
|
PR RPR COMPONENT INFLATABLE PENILE PROSTHESIS
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 54408
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,089.48 |
| Rate for Payer: Aetna Commercial |
$1,013.82
|
| Rate for Payer: Aetna Medicare |
$786.84
|
| Rate for Payer: BCBS Complete |
$602.00
|
| Rate for Payer: BCBS MAPPO |
$756.58
|
| Rate for Payer: BCN Medicare Advantage |
$756.58
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cofinity Commercial |
$1,089.48
|
| Rate for Payer: Cofinity Commercial |
$1,013.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.41
|
| Rate for Payer: Nomi Health Commercial |
$907.90
|
| Rate for Payer: PACE SWMI |
$756.58
|
| Rate for Payer: PHP Medicare Advantage |
$756.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health Medicare |
$764.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.58
|
| Rate for Payer: UHC Exchange |
$756.58
|
| Rate for Payer: UHC Medicare Advantage |
$756.58
|
|
|
PR RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS
|
Professional
|
Both
|
$5,809.00
|
|
|
Service Code
|
HCPCS 33500
|
| Min. Negotiated Rate |
$1,492.25 |
| Max. Negotiated Rate |
$3,775.85 |
| Rate for Payer: Aetna Commercial |
$1,999.62
|
| Rate for Payer: Aetna Medicare |
$1,551.94
|
| Rate for Payer: BCBS Complete |
$2,323.60
|
| Rate for Payer: BCBS MAPPO |
$1,492.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,492.25
|
| Rate for Payer: Cash Price |
$4,647.20
|
| Rate for Payer: Cash Price |
$4,647.20
|
| Rate for Payer: Cofinity Commercial |
$2,148.84
|
| Rate for Payer: Cofinity Commercial |
$1,999.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,492.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,566.86
|
| Rate for Payer: Nomi Health Commercial |
$1,790.70
|
| Rate for Payer: PACE SWMI |
$1,492.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,492.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,775.85
|
| Rate for Payer: Priority Health Medicare |
$1,507.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,492.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,492.25
|
| Rate for Payer: UHC Exchange |
$1,492.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,492.25
|
|
|
PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 36576
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$553.80 |
| Rate for Payer: Aetna Commercial |
$232.58
|
| Rate for Payer: Aetna Medicare |
$180.51
|
| Rate for Payer: BCBS Complete |
$340.80
|
| Rate for Payer: BCBS MAPPO |
$173.57
|
| Rate for Payer: BCN Medicare Advantage |
$173.57
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$249.94
|
| Rate for Payer: Cofinity Commercial |
$232.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.25
|
| Rate for Payer: Nomi Health Commercial |
$208.28
|
| Rate for Payer: PACE SWMI |
$173.57
|
| Rate for Payer: PHP Medicare Advantage |
$173.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.80
|
| Rate for Payer: Priority Health Medicare |
$175.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.57
|
| Rate for Payer: UHC Exchange |
$173.57
|
| Rate for Payer: UHC Medicare Advantage |
$173.57
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT
|
Professional
|
Both
|
$5,993.00
|
|
|
Service Code
|
HCPCS 39540
|
| Min. Negotiated Rate |
$835.58 |
| Max. Negotiated Rate |
$3,895.45 |
| Rate for Payer: Aetna Commercial |
$1,119.68
|
| Rate for Payer: Aetna Medicare |
$869.00
|
| Rate for Payer: BCBS Complete |
$2,397.20
|
| Rate for Payer: BCBS MAPPO |
$835.58
|
| Rate for Payer: BCN Medicare Advantage |
$835.58
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cofinity Commercial |
$1,203.24
|
| Rate for Payer: Cofinity Commercial |
$1,119.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.36
|
| Rate for Payer: Nomi Health Commercial |
$1,002.70
|
| Rate for Payer: PACE SWMI |
$835.58
|
| Rate for Payer: PHP Medicare Advantage |
$835.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,895.45
|
| Rate for Payer: Priority Health Medicare |
$843.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.58
|
| Rate for Payer: UHC Exchange |
$835.58
|
| Rate for Payer: UHC Medicare Advantage |
$835.58
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 39541
|
| Min. Negotiated Rate |
$684.80 |
| Max. Negotiated Rate |
$1,306.90 |
| Rate for Payer: Aetna Commercial |
$1,216.14
|
| Rate for Payer: Aetna Medicare |
$943.87
|
| Rate for Payer: BCBS Complete |
$684.80
|
| Rate for Payer: BCBS MAPPO |
$907.57
|
| Rate for Payer: BCN Medicare Advantage |
$907.57
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$1,306.90
|
| Rate for Payer: Cofinity Commercial |
$1,216.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$952.95
|
| Rate for Payer: Nomi Health Commercial |
$1,089.08
|
| Rate for Payer: PACE SWMI |
$907.57
|
| Rate for Payer: PHP Medicare Advantage |
$907.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health Medicare |
$916.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$907.57
|
| Rate for Payer: UHC Exchange |
$907.57
|
| Rate for Payer: UHC Medicare Advantage |
$907.57
|
|
|
PR RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27675
|
| Min. Negotiated Rate |
$477.80 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$640.25
|
| Rate for Payer: Aetna Medicare |
$496.91
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$477.80
|
| Rate for Payer: BCN Medicare Advantage |
$477.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$688.03
|
| Rate for Payer: Cofinity Commercial |
$640.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.69
|
| Rate for Payer: Nomi Health Commercial |
$573.36
|
| Rate for Payer: PACE SWMI |
$477.80
|
| Rate for Payer: PHP Medicare Advantage |
$477.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$482.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.80
|
| Rate for Payer: UHC Exchange |
$477.80
|
| Rate for Payer: UHC Medicare Advantage |
$477.80
|
|
|
PR RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 63707
|
| Min. Negotiated Rate |
$771.20 |
| Max. Negotiated Rate |
$1,336.94 |
| Rate for Payer: Aetna Commercial |
$1,244.10
|
| Rate for Payer: Aetna Medicare |
$965.57
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$928.43
|
| Rate for Payer: BCN Medicare Advantage |
$928.43
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,336.94
|
| Rate for Payer: Cofinity Commercial |
$1,244.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.85
|
| Rate for Payer: Nomi Health Commercial |
$1,114.12
|
| Rate for Payer: PACE SWMI |
$928.43
|
| Rate for Payer: PHP Medicare Advantage |
$928.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health Medicare |
$937.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.43
|
| Rate for Payer: UHC Exchange |
$928.43
|
| Rate for Payer: UHC Medicare Advantage |
$928.43
|
|
|
PR RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM
|
Professional
|
Both
|
$6,028.00
|
|
|
Service Code
|
HCPCS 63709
|
| Min. Negotiated Rate |
$1,092.82 |
| Max. Negotiated Rate |
$3,918.20 |
| Rate for Payer: Aetna Commercial |
$1,464.38
|
| Rate for Payer: Aetna Medicare |
$1,136.53
|
| Rate for Payer: BCBS Complete |
$2,411.20
|
| Rate for Payer: BCBS MAPPO |
$1,092.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,092.82
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,573.66
|
| Rate for Payer: Cofinity Commercial |
$1,464.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,092.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,147.46
|
| Rate for Payer: Nomi Health Commercial |
$1,311.38
|
| Rate for Payer: PACE SWMI |
$1,092.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,092.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.20
|
| Rate for Payer: Priority Health Medicare |
$1,103.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,092.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,092.82
|
| Rate for Payer: UHC Exchange |
$1,092.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,092.82
|
|
|
PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY
|
Professional
|
Both
|
$5,844.00
|
|
|
Service Code
|
HCPCS 62120
|
| Min. Negotiated Rate |
$2,018.41 |
| Max. Negotiated Rate |
$3,798.60 |
| Rate for Payer: Aetna Commercial |
$2,704.67
|
| Rate for Payer: Aetna Medicare |
$2,099.15
|
| Rate for Payer: BCBS Complete |
$2,337.60
|
| Rate for Payer: BCBS MAPPO |
$2,018.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,018.41
|
| Rate for Payer: Cash Price |
$4,675.20
|
| Rate for Payer: Cash Price |
$4,675.20
|
| Rate for Payer: Cofinity Commercial |
$2,906.51
|
| Rate for Payer: Cofinity Commercial |
$2,704.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,018.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,119.33
|
| Rate for Payer: Nomi Health Commercial |
$2,422.09
|
| Rate for Payer: PACE SWMI |
$2,018.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,018.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,798.60
|
| Rate for Payer: Priority Health Medicare |
$2,038.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,018.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,018.41
|
| Rate for Payer: UHC Exchange |
$2,018.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,018.41
|
|
|
PR RPR EPIGASTRIC HERNIA INCARCERATED
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 49572
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$967.20 |
| Rate for Payer: Aetna Medicare |
$744.00
|
| Rate for Payer: BCBS Complete |
$595.20
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.20
|
|
|
PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 49570
|
| Min. Negotiated Rate |
$468.40 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Aetna Medicare |
$585.50
|
| Rate for Payer: BCBS Complete |
$468.40
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$493.34 |
| Rate for Payer: Aetna Commercial |
$459.08
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS MAPPO |
$342.60
|
| Rate for Payer: BCN Medicare Advantage |
$342.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$459.08
|
| Rate for Payer: Cofinity Commercial |
$493.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.73
|
| Rate for Payer: Nomi Health Commercial |
$411.12
|
| Rate for Payer: PACE SWMI |
$342.60
|
| Rate for Payer: PHP Medicare Advantage |
$342.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health Medicare |
$346.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.60
|
| Rate for Payer: UHC Exchange |
$342.60
|
| Rate for Payer: UHC Medicare Advantage |
$342.60
|
|
|
PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 27665
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$575.77 |
| Rate for Payer: Aetna Commercial |
$535.79
|
| Rate for Payer: Aetna Medicare |
$415.83
|
| Rate for Payer: BCBS Complete |
$343.60
|
| Rate for Payer: BCBS MAPPO |
$399.84
|
| Rate for Payer: BCN Medicare Advantage |
$399.84
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$575.77
|
| Rate for Payer: Cofinity Commercial |
$535.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$419.83
|
| Rate for Payer: Nomi Health Commercial |
$479.81
|
| Rate for Payer: PACE SWMI |
$399.84
|
| Rate for Payer: PHP Medicare Advantage |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.35
|
| Rate for Payer: Priority Health Medicare |
$403.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.84
|
| Rate for Payer: UHC Exchange |
$399.84
|
| Rate for Payer: UHC Medicare Advantage |
$399.84
|
|
|
PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 27659
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$707.20 |
| Rate for Payer: Aetna Commercial |
$608.25
|
| Rate for Payer: Aetna Medicare |
$472.08
|
| Rate for Payer: BCBS Complete |
$435.20
|
| Rate for Payer: BCBS MAPPO |
$453.92
|
| Rate for Payer: BCN Medicare Advantage |
$453.92
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$653.64
|
| Rate for Payer: Cofinity Commercial |
$608.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$476.62
|
| Rate for Payer: Nomi Health Commercial |
$544.70
|
| Rate for Payer: PACE SWMI |
$453.92
|
| Rate for Payer: PHP Medicare Advantage |
$453.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.20
|
| Rate for Payer: Priority Health Medicare |
$458.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.92
|
| Rate for Payer: UHC Exchange |
$453.92
|
| Rate for Payer: UHC Medicare Advantage |
$453.92
|
|
|
PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$5,557.00
|
|
|
Service Code
|
HCPCS 46740
|
| Min. Negotiated Rate |
$2,105.37 |
| Max. Negotiated Rate |
$3,612.05 |
| Rate for Payer: Aetna Commercial |
$2,821.20
|
| Rate for Payer: Aetna Medicare |
$2,189.58
|
| Rate for Payer: BCBS Complete |
$2,222.80
|
| Rate for Payer: BCBS MAPPO |
$2,105.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,105.37
|
| Rate for Payer: Cash Price |
$4,445.60
|
| Rate for Payer: Cash Price |
$4,445.60
|
| Rate for Payer: Cofinity Commercial |
$3,031.73
|
| Rate for Payer: Cofinity Commercial |
$2,821.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,105.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,210.64
|
| Rate for Payer: Nomi Health Commercial |
$2,526.44
|
| Rate for Payer: PACE SWMI |
$2,105.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,105.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,612.05
|
| Rate for Payer: Priority Health Medicare |
$2,126.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,105.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,105.37
|
| Rate for Payer: UHC Exchange |
$2,105.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,105.37
|
|
|
PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL
|
Professional
|
Both
|
$5,147.00
|
|
|
Service Code
|
HCPCS 46742
|
| Min. Negotiated Rate |
$2,058.80 |
| Max. Negotiated Rate |
$3,502.37 |
| Rate for Payer: Aetna Commercial |
$3,259.15
|
| Rate for Payer: Aetna Medicare |
$2,529.49
|
| Rate for Payer: BCBS Complete |
$2,058.80
|
| Rate for Payer: BCBS MAPPO |
$2,432.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,432.20
|
| Rate for Payer: Cash Price |
$4,117.60
|
| Rate for Payer: Cash Price |
$4,117.60
|
| Rate for Payer: Cofinity Commercial |
$3,502.37
|
| Rate for Payer: Cofinity Commercial |
$3,259.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,432.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,553.81
|
| Rate for Payer: Nomi Health Commercial |
$2,918.64
|
| Rate for Payer: PACE SWMI |
$2,432.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,432.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,345.55
|
| Rate for Payer: Priority Health Medicare |
$2,456.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,432.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,432.20
|
| Rate for Payer: UHC Exchange |
$2,432.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,432.20
|
|
|
PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$3,879.00
|
|
|
Service Code
|
HCPCS 46730
|
| Min. Negotiated Rate |
$1,551.60 |
| Max. Negotiated Rate |
$2,777.59 |
| Rate for Payer: Aetna Commercial |
$2,584.70
|
| Rate for Payer: Aetna Medicare |
$2,006.04
|
| Rate for Payer: BCBS Complete |
$1,551.60
|
| Rate for Payer: BCBS MAPPO |
$1,928.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,928.88
|
| Rate for Payer: Cash Price |
$3,103.20
|
| Rate for Payer: Cash Price |
$3,103.20
|
| Rate for Payer: Cofinity Commercial |
$2,777.59
|
| Rate for Payer: Cofinity Commercial |
$2,584.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,928.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,025.32
|
| Rate for Payer: Nomi Health Commercial |
$2,314.66
|
| Rate for Payer: PACE SWMI |
$1,928.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,928.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.35
|
| Rate for Payer: Priority Health Medicare |
$1,948.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,928.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,928.88
|
| Rate for Payer: UHC Exchange |
$1,928.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,928.88
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 54340
|
| Min. Negotiated Rate |
$544.04 |
| Max. Negotiated Rate |
$1,290.25 |
| Rate for Payer: Aetna Commercial |
$729.01
|
| Rate for Payer: Aetna Medicare |
$565.80
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$544.04
|
| Rate for Payer: BCN Medicare Advantage |
$544.04
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$783.42
|
| Rate for Payer: Cofinity Commercial |
$729.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.24
|
| Rate for Payer: Nomi Health Commercial |
$652.85
|
| Rate for Payer: PACE SWMI |
$544.04
|
| Rate for Payer: PHP Medicare Advantage |
$544.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$549.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$544.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$544.04
|
| Rate for Payer: UHC Exchange |
$544.04
|
| Rate for Payer: UHC Medicare Advantage |
$544.04
|
|
|
PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR
|
Professional
|
Both
|
$7,548.00
|
|
|
Service Code
|
HCPCS 33660
|
| Min. Negotiated Rate |
$1,685.84 |
| Max. Negotiated Rate |
$4,906.20 |
| Rate for Payer: Aetna Commercial |
$2,259.03
|
| Rate for Payer: Aetna Medicare |
$1,753.27
|
| Rate for Payer: BCBS Complete |
$3,019.20
|
| Rate for Payer: BCBS MAPPO |
$1,685.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,685.84
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cofinity Commercial |
$2,427.61
|
| Rate for Payer: Cofinity Commercial |
$2,259.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,685.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.13
|
| Rate for Payer: Nomi Health Commercial |
$2,023.01
|
| Rate for Payer: PACE SWMI |
$1,685.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,685.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,906.20
|
| Rate for Payer: Priority Health Medicare |
$1,702.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,685.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,685.84
|
| Rate for Payer: UHC Exchange |
$1,685.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,685.84
|
|
