|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Aetna Commercial |
$23.96
|
| Rate for Payer: Aetna Medicare |
$18.60
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$17.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.88
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$25.75
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.77
|
| Rate for Payer: Nomi Health Commercial |
$21.46
|
| Rate for Payer: PACE SWMI |
$17.88
|
| Rate for Payer: PHP Medicare Advantage |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.88
|
| Rate for Payer: UHC Exchange |
$17.88
|
| Rate for Payer: UHC Medicare Advantage |
$17.88
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$25.26
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$18.85
|
| Rate for Payer: BCN Medicare Advantage |
$18.85
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$27.14
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.79
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: PACE SWMI |
$18.85
|
| Rate for Payer: PHP Medicare Advantage |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.85
|
| Rate for Payer: UHC Exchange |
$18.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.85
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Aetna Commercial |
$14.22
|
| Rate for Payer: Aetna Medicare |
$11.03
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$10.61
|
| Rate for Payer: BCN Medicare Advantage |
$10.61
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.14
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: PACE SWMI |
$10.61
|
| Rate for Payer: PHP Medicare Advantage |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$10.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.61
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Medicare Advantage |
$10.61
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$26.08
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS MAPPO |
$25.08
|
| Rate for Payer: BCN Medicare Advantage |
$25.08
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.33
|
| Rate for Payer: Nomi Health Commercial |
$30.10
|
| Rate for Payer: PACE SWMI |
$25.08
|
| Rate for Payer: PHP Medicare Advantage |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.75
|
| Rate for Payer: Priority Health Medicare |
$25.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.08
|
| Rate for Payer: UHC Exchange |
$25.08
|
| Rate for Payer: UHC Medicare Advantage |
$25.08
|
|
|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$7,034.00
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$1,376.14 |
| Max. Negotiated Rate |
$4,572.10 |
| Rate for Payer: Aetna Commercial |
$1,844.03
|
| Rate for Payer: Aetna Medicare |
$1,431.19
|
| Rate for Payer: BCBS Complete |
$2,813.60
|
| Rate for Payer: BCBS MAPPO |
$1,376.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,376.14
|
| Rate for Payer: Cash Price |
$5,627.20
|
| Rate for Payer: Cash Price |
$5,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,981.64
|
| Rate for Payer: Cofinity Commercial |
$1,844.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,376.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,444.95
|
| Rate for Payer: Nomi Health Commercial |
$1,651.37
|
| Rate for Payer: PACE SWMI |
$1,376.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,376.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,572.10
|
| Rate for Payer: Priority Health Medicare |
$1,389.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,376.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,376.14
|
| Rate for Payer: UHC Exchange |
$1,376.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,376.14
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$312.60
|
| Rate for Payer: Aetna Medicare |
$242.61
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$233.28
|
| Rate for Payer: BCN Medicare Advantage |
$233.28
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$335.92
|
| Rate for Payer: Cofinity Commercial |
$312.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.94
|
| Rate for Payer: Nomi Health Commercial |
$279.94
|
| Rate for Payer: PACE SWMI |
$233.28
|
| Rate for Payer: PHP Medicare Advantage |
$233.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$235.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.28
|
| Rate for Payer: UHC Exchange |
$233.28
|
| Rate for Payer: UHC Medicare Advantage |
$233.28
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$165.66 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$221.98
|
| Rate for Payer: Aetna Medicare |
$172.29
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$165.66
|
| Rate for Payer: BCN Medicare Advantage |
$165.66
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$238.55
|
| Rate for Payer: Cofinity Commercial |
$221.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.94
|
| Rate for Payer: Nomi Health Commercial |
$198.79
|
| Rate for Payer: PACE SWMI |
$165.66
|
| Rate for Payer: PHP Medicare Advantage |
$165.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$167.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.66
|
| Rate for Payer: UHC Exchange |
$165.66
|
| Rate for Payer: UHC Medicare Advantage |
$165.66
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$400.93
|
| Rate for Payer: Aetna Medicare |
$311.17
|
| Rate for Payer: BCBS Complete |
$3,326.40
|
| Rate for Payer: BCBS MAPPO |
$299.20
|
| Rate for Payer: BCN Medicare Advantage |
$299.20
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cofinity Commercial |
$430.85
|
| Rate for Payer: Cofinity Commercial |
$400.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.16
|
| Rate for Payer: Nomi Health Commercial |
$359.04
|
| Rate for Payer: PACE SWMI |
$299.20
|
| Rate for Payer: PHP Medicare Advantage |
$299.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health Medicare |
$302.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.20
|
| Rate for Payer: UHC Exchange |
$299.20
|
| Rate for Payer: UHC Medicare Advantage |
$299.20
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$290.67
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: BCBS Complete |
$3,326.40
|
| Rate for Payer: BCBS MAPPO |
$216.92
|
| Rate for Payer: BCN Medicare Advantage |
$216.92
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cofinity Commercial |
$312.36
|
| Rate for Payer: Cofinity Commercial |
$290.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.77
|
| Rate for Payer: Nomi Health Commercial |
$260.30
|
| Rate for Payer: PACE SWMI |
$216.92
|
| Rate for Payer: PHP Medicare Advantage |
$216.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health Medicare |
$219.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.92
|
| Rate for Payer: UHC Exchange |
$216.92
|
| Rate for Payer: UHC Medicare Advantage |
$216.92
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Medicare |
$55.18
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$53.06
|
| Rate for Payer: BCN Medicare Advantage |
$53.06
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$71.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.71
|
| Rate for Payer: Nomi Health Commercial |
$63.67
|
| Rate for Payer: PACE SWMI |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$53.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.06
|
| Rate for Payer: UHC Exchange |
$53.06
|
| Rate for Payer: UHC Medicare Advantage |
$53.06
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: Aetna Commercial |
$150.39
|
| Rate for Payer: Aetna Medicare |
$116.72
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS MAPPO |
$112.23
|
| Rate for Payer: BCN Medicare Advantage |
$112.23
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Commercial |
$150.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.84
|
| Rate for Payer: Nomi Health Commercial |
$134.68
|
| Rate for Payer: PACE SWMI |
$112.23
|
| Rate for Payer: PHP Medicare Advantage |
$112.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$113.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.23
|
| Rate for Payer: UHC Exchange |
$112.23
|
| Rate for Payer: UHC Medicare Advantage |
$112.23
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$196.40 |
| Max. Negotiated Rate |
$319.15 |
| Rate for Payer: Aetna Commercial |
$286.87
|
| Rate for Payer: Aetna Medicare |
$222.64
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS MAPPO |
$214.08
|
| Rate for Payer: BCN Medicare Advantage |
$214.08
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$308.28
|
| Rate for Payer: Cofinity Commercial |
$286.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.78
|
| Rate for Payer: Nomi Health Commercial |
$256.90
|
| Rate for Payer: PACE SWMI |
$214.08
|
| Rate for Payer: PHP Medicare Advantage |
$214.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health Medicare |
$216.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.08
|
| Rate for Payer: UHC Exchange |
$214.08
|
| Rate for Payer: UHC Medicare Advantage |
$214.08
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$72.19
|
| Rate for Payer: Aetna Medicare |
$56.02
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$53.87
|
| Rate for Payer: BCN Medicare Advantage |
$53.87
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$77.57
|
| Rate for Payer: Cofinity Commercial |
$72.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$64.64
|
| Rate for Payer: PACE SWMI |
$53.87
|
| Rate for Payer: PHP Medicare Advantage |
$53.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$54.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.87
|
| Rate for Payer: UHC Exchange |
$53.87
|
| Rate for Payer: UHC Medicare Advantage |
$53.87
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$183.95 |
| Rate for Payer: Aetna Commercial |
$119.66
|
| Rate for Payer: Aetna Medicare |
$92.87
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: BCBS MAPPO |
$89.30
|
| Rate for Payer: BCN Medicare Advantage |
$89.30
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$128.59
|
| Rate for Payer: Cofinity Commercial |
$119.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.77
|
| Rate for Payer: Nomi Health Commercial |
$107.16
|
| Rate for Payer: PACE SWMI |
$89.30
|
| Rate for Payer: PHP Medicare Advantage |
$89.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health Medicare |
$90.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.30
|
| Rate for Payer: UHC Exchange |
$89.30
|
| Rate for Payer: UHC Medicare Advantage |
$89.30
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$23.75
|
| Rate for Payer: BCN Medicare Advantage |
$23.75
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$34.20
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.94
|
| Rate for Payer: Nomi Health Commercial |
$28.50
|
| Rate for Payer: PACE SWMI |
$23.75
|
| Rate for Payer: PHP Medicare Advantage |
$23.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.75
|
| Rate for Payer: UHC Exchange |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$23.75
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$502.66 |
| Rate for Payer: Aetna Commercial |
$467.75
|
| Rate for Payer: Aetna Medicare |
$363.03
|
| Rate for Payer: BCBS Complete |
$293.60
|
| Rate for Payer: BCBS MAPPO |
$349.07
|
| Rate for Payer: BCN Medicare Advantage |
$349.07
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$467.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.52
|
| Rate for Payer: Nomi Health Commercial |
$418.88
|
| Rate for Payer: PACE SWMI |
$349.07
|
| Rate for Payer: PHP Medicare Advantage |
$349.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health Medicare |
$352.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.07
|
| Rate for Payer: UHC Exchange |
$349.07
|
| Rate for Payer: UHC Medicare Advantage |
$349.07
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$744.25 |
| Rate for Payer: Aetna Commercial |
$228.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$170.61
|
| Rate for Payer: BCN Medicare Advantage |
$170.61
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$245.68
|
| Rate for Payer: Cofinity Commercial |
$228.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.14
|
| Rate for Payer: Nomi Health Commercial |
$204.73
|
| Rate for Payer: PACE SWMI |
$170.61
|
| Rate for Payer: PHP Medicare Advantage |
$170.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$172.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.61
|
| Rate for Payer: UHC Exchange |
$170.61
|
| Rate for Payer: UHC Medicare Advantage |
$170.61
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Aetna Medicare |
$39.43
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$37.91
|
| Rate for Payer: BCN Medicare Advantage |
$37.91
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$54.59
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.81
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: PACE SWMI |
$37.91
|
| Rate for Payer: PHP Medicare Advantage |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$38.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.91
|
| Rate for Payer: UHC Exchange |
$37.91
|
| Rate for Payer: UHC Medicare Advantage |
$37.91
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$523.87 |
| Rate for Payer: Aetna Commercial |
$487.49
|
| Rate for Payer: Aetna Medicare |
$378.35
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS MAPPO |
$363.80
|
| Rate for Payer: BCN Medicare Advantage |
$363.80
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$523.87
|
| Rate for Payer: Cofinity Commercial |
$487.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.99
|
| Rate for Payer: Nomi Health Commercial |
$436.56
|
| Rate for Payer: PACE SWMI |
$363.80
|
| Rate for Payer: PHP Medicare Advantage |
$363.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Medicare |
$367.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.80
|
| Rate for Payer: UHC Exchange |
$363.80
|
| Rate for Payer: UHC Medicare Advantage |
$363.80
|
|
|
PR SUBSEQUENT INJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00672
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$113.46 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$152.04
|
| Rate for Payer: Aetna Medicare |
$118.00
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$113.46
|
| Rate for Payer: BCN Medicare Advantage |
$113.46
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$152.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.13
|
| Rate for Payer: Nomi Health Commercial |
$136.15
|
| Rate for Payer: PACE SWMI |
$113.46
|
| Rate for Payer: PHP Medicare Advantage |
$113.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$114.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.46
|
| Rate for Payer: UHC Exchange |
$113.46
|
| Rate for Payer: UHC Medicare Advantage |
$113.46
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: Aetna Medicare |
$129.96
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$124.96
|
| Rate for Payer: BCN Medicare Advantage |
$124.96
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$179.94
|
| Rate for Payer: Cofinity Commercial |
$167.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.21
|
| Rate for Payer: Nomi Health Commercial |
$149.95
|
| Rate for Payer: PACE SWMI |
$124.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$126.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.96
|
| Rate for Payer: UHC Exchange |
$124.96
|
| Rate for Payer: UHC Medicare Advantage |
$124.96
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$146.52
|
| Rate for Payer: Aetna Medicare |
$113.71
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$109.34
|
| Rate for Payer: BCN Medicare Advantage |
$109.34
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$146.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.81
|
| Rate for Payer: Nomi Health Commercial |
$131.21
|
| Rate for Payer: PACE SWMI |
$109.34
|
| Rate for Payer: PHP Medicare Advantage |
$109.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$110.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.34
|
| Rate for Payer: UHC Exchange |
$109.34
|
| Rate for Payer: UHC Medicare Advantage |
$109.34
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$320.79 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$429.86
|
| Rate for Payer: Aetna Medicare |
$333.62
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$320.79
|
| Rate for Payer: BCN Medicare Advantage |
$320.79
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$461.94
|
| Rate for Payer: Cofinity Commercial |
$429.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.83
|
| Rate for Payer: Nomi Health Commercial |
$384.95
|
| Rate for Payer: PACE SWMI |
$320.79
|
| Rate for Payer: PHP Medicare Advantage |
$320.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$324.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.79
|
| Rate for Payer: UHC Exchange |
$320.79
|
| Rate for Payer: UHC Medicare Advantage |
$320.79
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$289.20 |
| Max. Negotiated Rate |
$546.15 |
| Rate for Payer: Aetna Commercial |
$508.22
|
| Rate for Payer: Aetna Medicare |
$394.44
|
| Rate for Payer: BCBS Complete |
$289.20
|
| Rate for Payer: BCBS MAPPO |
$379.27
|
| Rate for Payer: BCN Medicare Advantage |
$379.27
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$546.15
|
| Rate for Payer: Cofinity Commercial |
$508.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.23
|
| Rate for Payer: Nomi Health Commercial |
$455.12
|
| Rate for Payer: PACE SWMI |
$379.27
|
| Rate for Payer: PHP Medicare Advantage |
$379.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$383.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.27
|
| Rate for Payer: UHC Exchange |
$379.27
|
| Rate for Payer: UHC Medicare Advantage |
$379.27
|
|
