|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCN Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$100.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.98
|
| Rate for Payer: Nomi Health Commercial |
$90.26
|
| Rate for Payer: PACE SWMI |
$75.22
|
| Rate for Payer: PHP Medicare Advantage |
$75.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$75.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Exchange |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$67.08 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$48.44
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$46.58
|
| Rate for Payer: BCN Medicare Advantage |
$46.58
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.91
|
| Rate for Payer: Nomi Health Commercial |
$55.90
|
| Rate for Payer: PACE SWMI |
$46.58
|
| Rate for Payer: PHP Medicare Advantage |
$46.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$47.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.58
|
| Rate for Payer: UHC Exchange |
$46.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.58
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$208.81 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: Aetna Medicare |
$150.81
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$145.01
|
| Rate for Payer: BCN Medicare Advantage |
$145.01
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.26
|
| Rate for Payer: Nomi Health Commercial |
$174.01
|
| Rate for Payer: PACE SWMI |
$145.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$146.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.01
|
| Rate for Payer: UHC Exchange |
$145.01
|
| Rate for Payer: UHC Medicare Advantage |
$145.01
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$100.57 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$69.84
|
| Rate for Payer: BCN Medicare Advantage |
$69.84
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$93.59
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.33
|
| Rate for Payer: Nomi Health Commercial |
$83.81
|
| Rate for Payer: PACE SWMI |
$69.84
|
| Rate for Payer: PHP Medicare Advantage |
$69.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$70.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.84
|
| Rate for Payer: UHC Exchange |
$69.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.84
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$146.17 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$105.57
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$101.51
|
| Rate for Payer: BCN Medicare Advantage |
$101.51
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$146.17
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.59
|
| Rate for Payer: Nomi Health Commercial |
$121.81
|
| Rate for Payer: PACE SWMI |
$101.51
|
| Rate for Payer: PHP Medicare Advantage |
$101.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$102.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.51
|
| Rate for Payer: UHC Exchange |
$101.51
|
| Rate for Payer: UHC Medicare Advantage |
$101.51
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$38.92
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$37.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Cofinity Commercial |
$50.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.29
|
| Rate for Payer: Nomi Health Commercial |
$44.90
|
| Rate for Payer: PACE SWMI |
$37.42
|
| Rate for Payer: PHP Medicare Advantage |
$37.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$37.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.42
|
| Rate for Payer: UHC Exchange |
$37.42
|
| Rate for Payer: UHC Medicare Advantage |
$37.42
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
|
|
PR SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99225
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
PR SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99226
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
|
|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$130.44
|
| Rate for Payer: Aetna Medicare |
$101.23
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$97.34
|
| Rate for Payer: BCN Medicare Advantage |
$97.34
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$140.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$116.81
|
| Rate for Payer: PACE SWMI |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$98.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.34
|
| Rate for Payer: UHC Exchange |
$97.34
|
| Rate for Payer: UHC Medicare Advantage |
$97.34
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$113.45 |
| Max. Negotiated Rate |
$1,473.55 |
| Rate for Payer: Aetna Commercial |
$152.02
|
| Rate for Payer: Aetna Medicare |
$117.99
|
| Rate for Payer: BCBS Complete |
$906.80
|
| Rate for Payer: BCBS MAPPO |
$113.45
|
| Rate for Payer: BCN Medicare Advantage |
$113.45
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Cofinity Commercial |
$152.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.12
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: PACE SWMI |
$113.45
|
| Rate for Payer: PHP Medicare Advantage |
$113.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.55
|
| Rate for Payer: Priority Health Medicare |
$114.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.45
|
| Rate for Payer: UHC Exchange |
$113.45
|
| Rate for Payer: UHC Medicare Advantage |
$113.45
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$23.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Exchange |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
|
|
PR SCREENING PROCTOSCOPY
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS S0601
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Medicare |
$77.00
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
|
|
PR SCR MAMMO BI INCL CAD
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS G0202
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
|
|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$537.39 |
| Rate for Payer: Aetna Commercial |
$500.07
|
| Rate for Payer: Aetna Medicare |
$388.12
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$373.19
|
| Rate for Payer: BCN Medicare Advantage |
$373.19
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$500.07
|
| Rate for Payer: Cofinity Commercial |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.85
|
| Rate for Payer: Nomi Health Commercial |
$447.83
|
| Rate for Payer: PACE SWMI |
$373.19
|
| Rate for Payer: PHP Medicare Advantage |
$373.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health Medicare |
$376.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.19
|
| Rate for Payer: UHC Exchange |
$373.19
|
| Rate for Payer: UHC Medicare Advantage |
$373.19
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$948.11 |
| Rate for Payer: Aetna Commercial |
$882.27
|
| Rate for Payer: Aetna Medicare |
$684.75
|
| Rate for Payer: BCBS Complete |
$565.60
|
| Rate for Payer: BCBS MAPPO |
$658.41
|
| Rate for Payer: BCN Medicare Advantage |
$658.41
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cofinity Commercial |
$948.11
|
| Rate for Payer: Cofinity Commercial |
$882.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.33
|
| Rate for Payer: Nomi Health Commercial |
$790.09
|
| Rate for Payer: PACE SWMI |
$658.41
|
| Rate for Payer: PHP Medicare Advantage |
$658.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health Medicare |
$664.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.41
|
| Rate for Payer: UHC Exchange |
$658.41
|
| Rate for Payer: UHC Medicare Advantage |
$658.41
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$503.71 |
| Rate for Payer: Aetna Commercial |
$468.73
|
| Rate for Payer: Aetna Medicare |
$363.79
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: BCBS MAPPO |
$349.80
|
| Rate for Payer: BCN Medicare Advantage |
$349.80
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$503.71
|
| Rate for Payer: Cofinity Commercial |
$468.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.29
|
| Rate for Payer: Nomi Health Commercial |
$419.76
|
| Rate for Payer: PACE SWMI |
$349.80
|
| Rate for Payer: PHP Medicare Advantage |
$349.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health Medicare |
$353.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.80
|
| Rate for Payer: UHC Exchange |
$349.80
|
| Rate for Payer: UHC Medicare Advantage |
$349.80
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$2,346.00
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$798.93 |
| Max. Negotiated Rate |
$1,524.90 |
| Rate for Payer: Aetna Commercial |
$1,070.57
|
| Rate for Payer: Aetna Medicare |
$830.89
|
| Rate for Payer: BCBS Complete |
$938.40
|
| Rate for Payer: BCBS MAPPO |
$798.93
|
| Rate for Payer: BCN Medicare Advantage |
$798.93
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cofinity Commercial |
$1,150.46
|
| Rate for Payer: Cofinity Commercial |
$1,070.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.88
|
| Rate for Payer: Nomi Health Commercial |
$958.72
|
| Rate for Payer: PACE SWMI |
$798.93
|
| Rate for Payer: PHP Medicare Advantage |
$798.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.90
|
| Rate for Payer: Priority Health Medicare |
$806.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.93
|
| Rate for Payer: UHC Exchange |
$798.93
|
| Rate for Payer: UHC Medicare Advantage |
$798.93
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$1,792.00
|
|
|
Service Code
|
HCPCS 13160
|
| Min. Negotiated Rate |
$716.80 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: Aetna Commercial |
$1,022.26
|
| Rate for Payer: Aetna Medicare |
$793.40
|
| Rate for Payer: BCBS Complete |
$716.80
|
| Rate for Payer: BCBS MAPPO |
$762.88
|
| Rate for Payer: BCN Medicare Advantage |
$762.88
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.55
|
| Rate for Payer: Cofinity Commercial |
$1,022.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.02
|
| Rate for Payer: Nomi Health Commercial |
$915.46
|
| Rate for Payer: PACE SWMI |
$762.88
|
| Rate for Payer: PHP Medicare Advantage |
$762.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.80
|
| Rate for Payer: Priority Health Medicare |
$770.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.88
|
| Rate for Payer: UHC Exchange |
$762.88
|
| Rate for Payer: UHC Medicare Advantage |
$762.88
|
|
|
PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 21275
|
| Min. Negotiated Rate |
$805.18 |
| Max. Negotiated Rate |
$2,970.50 |
| Rate for Payer: Aetna Commercial |
$1,078.94
|
| Rate for Payer: Aetna Medicare |
$837.39
|
| Rate for Payer: BCBS Complete |
$1,828.00
|
| Rate for Payer: BCBS MAPPO |
$805.18
|
| Rate for Payer: BCN Medicare Advantage |
$805.18
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cofinity Commercial |
$1,159.46
|
| Rate for Payer: Cofinity Commercial |
$1,078.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.44
|
| Rate for Payer: Nomi Health Commercial |
$966.22
|
| Rate for Payer: PACE SWMI |
$805.18
|
| Rate for Payer: PHP Medicare Advantage |
$805.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.50
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.18
|
| Rate for Payer: UHC Exchange |
$805.18
|
| Rate for Payer: UHC Medicare Advantage |
$805.18
|
|
|
PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT
|
Professional
|
Both
|
$6,290.00
|
|
|
Service Code
|
HCPCS 61618
|
| Min. Negotiated Rate |
$1,269.44 |
| Max. Negotiated Rate |
$4,088.50 |
| Rate for Payer: Aetna Commercial |
$1,701.05
|
| Rate for Payer: Aetna Medicare |
$1,320.22
|
| Rate for Payer: BCBS Complete |
$2,516.00
|
| Rate for Payer: BCBS MAPPO |
$1,269.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,269.44
|
| Rate for Payer: Cash Price |
$5,032.00
|
| Rate for Payer: Cash Price |
$5,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,827.99
|
| Rate for Payer: Cofinity Commercial |
$1,701.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,269.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,332.91
|
| Rate for Payer: Nomi Health Commercial |
$1,523.33
|
| Rate for Payer: PACE SWMI |
$1,269.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,269.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,088.50
|
| Rate for Payer: Priority Health Medicare |
$1,282.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,269.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,269.44
|
| Rate for Payer: UHC Exchange |
$1,269.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.44
|
|
|
PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Professional
|
Both
|
$2,567.00
|
|
|
Service Code
|
HCPCS 37186
|
| Min. Negotiated Rate |
$233.80 |
| Max. Negotiated Rate |
$1,668.55 |
| Rate for Payer: Aetna Commercial |
$313.29
|
| Rate for Payer: Aetna Medicare |
$243.15
|
| Rate for Payer: BCBS Complete |
$1,026.80
|
| Rate for Payer: BCBS MAPPO |
$233.80
|
| Rate for Payer: BCN Medicare Advantage |
$233.80
|
| Rate for Payer: Cash Price |
$2,053.60
|
| Rate for Payer: Cash Price |
$2,053.60
|
| Rate for Payer: Cofinity Commercial |
$336.67
|
| Rate for Payer: Cofinity Commercial |
$313.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.49
|
| Rate for Payer: Nomi Health Commercial |
$280.56
|
| Rate for Payer: PACE SWMI |
$233.80
|
| Rate for Payer: PHP Medicare Advantage |
$233.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,668.55
|
| Rate for Payer: Priority Health Medicare |
$236.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.80
|
| Rate for Payer: UHC Exchange |
$233.80
|
| Rate for Payer: UHC Medicare Advantage |
$233.80
|
|
|
PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP
|
Professional
|
Both
|
$9,939.00
|
|
|
Service Code
|
HCPCS 61619
|
| Min. Negotiated Rate |
$1,389.53 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$1,861.97
|
| Rate for Payer: Aetna Medicare |
$1,445.11
|
| Rate for Payer: BCBS Complete |
$3,975.60
|
| Rate for Payer: BCBS MAPPO |
$1,389.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,389.53
|
| Rate for Payer: Cash Price |
$7,951.20
|
| Rate for Payer: Cash Price |
$7,951.20
|
| Rate for Payer: Cofinity Commercial |
$2,000.92
|
| Rate for Payer: Cofinity Commercial |
$1,861.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,389.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,459.01
|
| Rate for Payer: Nomi Health Commercial |
$1,667.44
|
| Rate for Payer: PACE SWMI |
$1,389.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,389.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,460.35
|
| Rate for Payer: Priority Health Medicare |
$1,403.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.53
|
| Rate for Payer: UHC Exchange |
$1,389.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.53
|
|
