|
PR TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 64760
|
| Min. Negotiated Rate |
$424.40 |
| Max. Negotiated Rate |
$728.86 |
| Rate for Payer: Aetna Commercial |
$678.24
|
| Rate for Payer: Aetna Medicare |
$526.40
|
| Rate for Payer: BCBS Complete |
$424.40
|
| Rate for Payer: BCBS MAPPO |
$506.15
|
| Rate for Payer: BCN Medicare Advantage |
$506.15
|
| Rate for Payer: Cash Price |
$848.80
|
| Rate for Payer: Cash Price |
$848.80
|
| Rate for Payer: Cofinity Commercial |
$728.86
|
| Rate for Payer: Cofinity Commercial |
$678.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.46
|
| Rate for Payer: Nomi Health Commercial |
$607.38
|
| Rate for Payer: PACE SWMI |
$506.15
|
| Rate for Payer: PHP Medicare Advantage |
$506.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.65
|
| Rate for Payer: Priority Health Medicare |
$511.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.15
|
| Rate for Payer: UHC Exchange |
$506.15
|
| Rate for Payer: UHC Medicare Advantage |
$506.15
|
|
|
PR TRANSFER ADDUCTOR ISCHIUM
|
Professional
|
Both
|
$2,657.00
|
|
|
Service Code
|
HCPCS 27098
|
| Min. Negotiated Rate |
$673.33 |
| Max. Negotiated Rate |
$1,727.05 |
| Rate for Payer: Aetna Commercial |
$902.26
|
| Rate for Payer: Aetna Medicare |
$700.26
|
| Rate for Payer: BCBS Complete |
$1,062.80
|
| Rate for Payer: BCBS MAPPO |
$673.33
|
| Rate for Payer: BCN Medicare Advantage |
$673.33
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cofinity Commercial |
$969.60
|
| Rate for Payer: Cofinity Commercial |
$902.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$673.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$707.00
|
| Rate for Payer: Nomi Health Commercial |
$808.00
|
| Rate for Payer: PACE SWMI |
$673.33
|
| Rate for Payer: PHP Medicare Advantage |
$673.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,727.05
|
| Rate for Payer: Priority Health Medicare |
$680.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$673.33
|
| Rate for Payer: UHC Exchange |
$673.33
|
| Rate for Payer: UHC Medicare Advantage |
$673.33
|
|
|
PR TRANSFER ANY PEDICLE FLAP ANY LOCATION
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 15650
|
| Min. Negotiated Rate |
$294.80 |
| Max. Negotiated Rate |
$553.18 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna Medicare |
$399.52
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS MAPPO |
$384.15
|
| Rate for Payer: BCN Medicare Advantage |
$384.15
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$553.18
|
| Rate for Payer: Cofinity Commercial |
$514.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.36
|
| Rate for Payer: Nomi Health Commercial |
$460.98
|
| Rate for Payer: PACE SWMI |
$384.15
|
| Rate for Payer: PHP Medicare Advantage |
$384.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health Medicare |
$387.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.15
|
| Rate for Payer: UHC Exchange |
$384.15
|
| Rate for Payer: UHC Medicare Advantage |
$384.15
|
|
|
PR TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 27110
|
| Min. Negotiated Rate |
$936.20 |
| Max. Negotiated Rate |
$4,516.85 |
| Rate for Payer: Aetna Commercial |
$1,254.51
|
| Rate for Payer: Aetna Medicare |
$973.65
|
| Rate for Payer: BCBS Complete |
$2,779.60
|
| Rate for Payer: BCBS MAPPO |
$936.20
|
| Rate for Payer: BCN Medicare Advantage |
$936.20
|
| Rate for Payer: Cash Price |
$5,559.20
|
| Rate for Payer: Cash Price |
$5,559.20
|
| Rate for Payer: Cofinity Commercial |
$1,348.13
|
| Rate for Payer: Cofinity Commercial |
$1,254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.01
|
| Rate for Payer: Nomi Health Commercial |
$1,123.44
|
| Rate for Payer: PACE SWMI |
$936.20
|
| Rate for Payer: PHP Medicare Advantage |
$936.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,516.85
|
| Rate for Payer: Priority Health Medicare |
$945.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$936.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$936.20
|
| Rate for Payer: UHC Exchange |
$936.20
|
| Rate for Payer: UHC Medicare Advantage |
$936.20
|
|
|
PR TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
HCPCS 26485
|
| Min. Negotiated Rate |
$780.70 |
| Max. Negotiated Rate |
$1,732.90 |
| Rate for Payer: Aetna Commercial |
$1,046.14
|
| Rate for Payer: Aetna Medicare |
$811.93
|
| Rate for Payer: BCBS Complete |
$1,066.40
|
| Rate for Payer: BCBS MAPPO |
$780.70
|
| Rate for Payer: BCN Medicare Advantage |
$780.70
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cofinity Commercial |
$1,124.21
|
| Rate for Payer: Cofinity Commercial |
$1,046.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.74
|
| Rate for Payer: Nomi Health Commercial |
$936.84
|
| Rate for Payer: PACE SWMI |
$780.70
|
| Rate for Payer: PHP Medicare Advantage |
$780.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.90
|
| Rate for Payer: Priority Health Medicare |
$788.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$780.70
|
| Rate for Payer: UHC Exchange |
$780.70
|
| Rate for Payer: UHC Medicare Advantage |
$780.70
|
|
|
PR TRANSFUSION BLOOD/BLOOD COMPONENTS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 36430
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$55.11 |
| Rate for Payer: Aetna Commercial |
$51.28
|
| Rate for Payer: Aetna Medicare |
$39.80
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS MAPPO |
$38.27
|
| Rate for Payer: BCN Medicare Advantage |
$38.27
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.18
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PACE SWMI |
$38.27
|
| Rate for Payer: PHP Medicare Advantage |
$38.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health Medicare |
$38.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.27
|
| Rate for Payer: UHC Exchange |
$38.27
|
| Rate for Payer: UHC Medicare Advantage |
$38.27
|
|
|
PR TRANSFUSION INTRAUTERINE FETAL
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 36460
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$920.40 |
| Rate for Payer: Aetna Commercial |
$441.93
|
| Rate for Payer: Aetna Medicare |
$342.99
|
| Rate for Payer: BCBS Complete |
$566.40
|
| Rate for Payer: BCBS MAPPO |
$329.80
|
| Rate for Payer: BCN Medicare Advantage |
$329.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$474.91
|
| Rate for Payer: Cofinity Commercial |
$441.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.29
|
| Rate for Payer: Nomi Health Commercial |
$395.76
|
| Rate for Payer: PACE SWMI |
$329.80
|
| Rate for Payer: PHP Medicare Advantage |
$329.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$920.40
|
| Rate for Payer: Priority Health Medicare |
$333.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.80
|
| Rate for Payer: UHC Exchange |
$329.80
|
| Rate for Payer: UHC Medicare Advantage |
$329.80
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 99496
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$240.05
|
| Rate for Payer: Aetna Medicare |
$186.31
|
| Rate for Payer: BCBS Complete |
$141.60
|
| Rate for Payer: BCBS MAPPO |
$179.14
|
| Rate for Payer: BCN Medicare Advantage |
$179.14
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cofinity Commercial |
$257.96
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$214.97
|
| Rate for Payer: PACE SWMI |
$179.14
|
| Rate for Payer: PHP Medicare Advantage |
$179.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.10
|
| Rate for Payer: Priority Health Medicare |
$180.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.14
|
| Rate for Payer: UHC Exchange |
$179.14
|
| Rate for Payer: UHC Medicare Advantage |
$179.14
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 99495
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Aetna Commercial |
$176.52
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$131.73
|
| Rate for Payer: BCN Medicare Advantage |
$131.73
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$189.69
|
| Rate for Payer: Cofinity Commercial |
$176.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.32
|
| Rate for Payer: Nomi Health Commercial |
$158.08
|
| Rate for Payer: PACE SWMI |
$131.73
|
| Rate for Payer: PHP Medicare Advantage |
$131.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$133.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.73
|
| Rate for Payer: UHC Exchange |
$131.73
|
| Rate for Payer: UHC Medicare Advantage |
$131.73
|
|
|
PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 75962
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
|
|
PR TRANSMASTOID ANTROTOMY
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 69501
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$1,157.00 |
| Rate for Payer: Aetna Commercial |
$893.78
|
| Rate for Payer: Aetna Medicare |
$693.68
|
| Rate for Payer: BCBS Complete |
$712.00
|
| Rate for Payer: BCBS MAPPO |
$667.00
|
| Rate for Payer: BCN Medicare Advantage |
$667.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$960.48
|
| Rate for Payer: Cofinity Commercial |
$893.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$700.35
|
| Rate for Payer: Nomi Health Commercial |
$800.40
|
| Rate for Payer: PACE SWMI |
$667.00
|
| Rate for Payer: PHP Medicare Advantage |
$667.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.00
|
| Rate for Payer: Priority Health Medicare |
$673.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$667.00
|
| Rate for Payer: UHC Exchange |
$667.00
|
| Rate for Payer: UHC Medicare Advantage |
$667.00
|
|
|
PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 25931
|
| Min. Negotiated Rate |
$748.69 |
| Max. Negotiated Rate |
$1,471.60 |
| Rate for Payer: Aetna Commercial |
$1,003.24
|
| Rate for Payer: Aetna Medicare |
$778.64
|
| Rate for Payer: BCBS Complete |
$905.60
|
| Rate for Payer: BCBS MAPPO |
$748.69
|
| Rate for Payer: BCN Medicare Advantage |
$748.69
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,003.24
|
| Rate for Payer: Cofinity Commercial |
$1,078.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.12
|
| Rate for Payer: Nomi Health Commercial |
$898.43
|
| Rate for Payer: PACE SWMI |
$748.69
|
| Rate for Payer: PHP Medicare Advantage |
$748.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health Medicare |
$756.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$748.69
|
| Rate for Payer: UHC Exchange |
$748.69
|
| Rate for Payer: UHC Medicare Advantage |
$748.69
|
|
|
PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 25929
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$836.11 |
| Rate for Payer: Aetna Commercial |
$778.04
|
| Rate for Payer: Aetna Medicare |
$603.86
|
| Rate for Payer: BCBS Complete |
$426.80
|
| Rate for Payer: BCBS MAPPO |
$580.63
|
| Rate for Payer: BCN Medicare Advantage |
$580.63
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Cofinity Commercial |
$778.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.66
|
| Rate for Payer: Nomi Health Commercial |
$696.76
|
| Rate for Payer: PACE SWMI |
$580.63
|
| Rate for Payer: PHP Medicare Advantage |
$580.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health Medicare |
$586.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.63
|
| Rate for Payer: UHC Exchange |
$580.63
|
| Rate for Payer: UHC Medicare Advantage |
$580.63
|
|
|
PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 33141
|
| Min. Negotiated Rate |
$126.99 |
| Max. Negotiated Rate |
$377.65 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$132.07
|
| Rate for Payer: BCBS Complete |
$232.40
|
| Rate for Payer: BCBS MAPPO |
$126.99
|
| Rate for Payer: BCN Medicare Advantage |
$126.99
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.34
|
| Rate for Payer: Nomi Health Commercial |
$152.39
|
| Rate for Payer: PACE SWMI |
$126.99
|
| Rate for Payer: PHP Medicare Advantage |
$126.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.65
|
| Rate for Payer: Priority Health Medicare |
$128.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.99
|
| Rate for Payer: UHC Exchange |
$126.99
|
| Rate for Payer: UHC Medicare Advantage |
$126.99
|
|
|
PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
HCPCS 63057
|
| Min. Negotiated Rate |
$315.91 |
| Max. Negotiated Rate |
$1,608.10 |
| Rate for Payer: Aetna Commercial |
$423.32
|
| Rate for Payer: Aetna Medicare |
$328.55
|
| Rate for Payer: BCBS Complete |
$989.60
|
| Rate for Payer: BCBS MAPPO |
$315.91
|
| Rate for Payer: BCN Medicare Advantage |
$315.91
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cofinity Commercial |
$454.91
|
| Rate for Payer: Cofinity Commercial |
$423.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.71
|
| Rate for Payer: Nomi Health Commercial |
$379.09
|
| Rate for Payer: PACE SWMI |
$315.91
|
| Rate for Payer: PHP Medicare Advantage |
$315.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.10
|
| Rate for Payer: Priority Health Medicare |
$319.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.91
|
| Rate for Payer: UHC Exchange |
$315.91
|
| Rate for Payer: UHC Medicare Advantage |
$315.91
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR
|
Professional
|
Both
|
$7,074.00
|
|
|
Service Code
|
HCPCS 63056
|
| Min. Negotiated Rate |
$1,458.87 |
| Max. Negotiated Rate |
$4,598.10 |
| Rate for Payer: Aetna Commercial |
$1,954.89
|
| Rate for Payer: Aetna Medicare |
$1,517.22
|
| Rate for Payer: BCBS Complete |
$2,829.60
|
| Rate for Payer: BCBS MAPPO |
$1,458.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,458.87
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cofinity Commercial |
$2,100.77
|
| Rate for Payer: Cofinity Commercial |
$1,954.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,458.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,531.81
|
| Rate for Payer: Nomi Health Commercial |
$1,750.64
|
| Rate for Payer: PACE SWMI |
$1,458.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,458.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,598.10
|
| Rate for Payer: Priority Health Medicare |
$1,473.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,458.87
|
| Rate for Payer: UHC Exchange |
$1,458.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,458.87
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC
|
Professional
|
Both
|
$7,455.00
|
|
|
Service Code
|
HCPCS 63055
|
| Min. Negotiated Rate |
$1,601.56 |
| Max. Negotiated Rate |
$4,845.75 |
| Rate for Payer: Aetna Commercial |
$2,146.09
|
| Rate for Payer: Aetna Medicare |
$1,665.62
|
| Rate for Payer: BCBS Complete |
$2,982.00
|
| Rate for Payer: BCBS MAPPO |
$1,601.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,601.56
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,306.25
|
| Rate for Payer: Cofinity Commercial |
$2,146.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,601.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.64
|
| Rate for Payer: Nomi Health Commercial |
$1,921.87
|
| Rate for Payer: PACE SWMI |
$1,601.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,601.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.75
|
| Rate for Payer: Priority Health Medicare |
$1,617.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,601.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.56
|
| Rate for Payer: UHC Exchange |
$1,601.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,601.56
|
|
|
PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX
|
Professional
|
Both
|
$6,685.00
|
|
|
Service Code
|
HCPCS 55874
|
| Min. Negotiated Rate |
$155.95 |
| Max. Negotiated Rate |
$4,345.25 |
| Rate for Payer: Aetna Commercial |
$208.97
|
| Rate for Payer: Aetna Medicare |
$162.19
|
| Rate for Payer: BCBS Complete |
$2,674.00
|
| Rate for Payer: BCBS MAPPO |
$155.95
|
| Rate for Payer: BCN Medicare Advantage |
$155.95
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cofinity Commercial |
$224.57
|
| Rate for Payer: Cofinity Commercial |
$208.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.75
|
| Rate for Payer: Nomi Health Commercial |
$187.14
|
| Rate for Payer: PACE SWMI |
$155.95
|
| Rate for Payer: PHP Medicare Advantage |
$155.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,345.25
|
| Rate for Payer: Priority Health Medicare |
$157.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.95
|
| Rate for Payer: UHC Exchange |
$155.95
|
| Rate for Payer: UHC Medicare Advantage |
$155.95
|
|
|
PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 55875
|
| Min. Negotiated Rate |
$745.84 |
| Max. Negotiated Rate |
$1,768.65 |
| Rate for Payer: Aetna Commercial |
$999.43
|
| Rate for Payer: Aetna Medicare |
$775.67
|
| Rate for Payer: BCBS Complete |
$1,088.40
|
| Rate for Payer: BCBS MAPPO |
$745.84
|
| Rate for Payer: BCN Medicare Advantage |
$745.84
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cofinity Commercial |
$999.43
|
| Rate for Payer: Cofinity Commercial |
$1,074.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.13
|
| Rate for Payer: Nomi Health Commercial |
$895.01
|
| Rate for Payer: PACE SWMI |
$745.84
|
| Rate for Payer: PHP Medicare Advantage |
$745.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.65
|
| Rate for Payer: Priority Health Medicare |
$753.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$745.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.84
|
| Rate for Payer: UHC Exchange |
$745.84
|
| Rate for Payer: UHC Medicare Advantage |
$745.84
|
|
|
PR TRANSPLANTATION TESTIS TO THIGH
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 54680
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$1,083.89 |
| Rate for Payer: Aetna Commercial |
$1,008.62
|
| Rate for Payer: Aetna Medicare |
$782.81
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$752.70
|
| Rate for Payer: BCN Medicare Advantage |
$752.70
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,083.89
|
| Rate for Payer: Cofinity Commercial |
$1,008.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$790.34
|
| Rate for Payer: Nomi Health Commercial |
$903.24
|
| Rate for Payer: PACE SWMI |
$752.70
|
| Rate for Payer: PHP Medicare Advantage |
$752.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$760.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$752.70
|
| Rate for Payer: UHC Exchange |
$752.70
|
| Rate for Payer: UHC Medicare Advantage |
$752.70
|
|
|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS 27397
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$1,273.49 |
| Rate for Payer: Aetna Commercial |
$1,185.06
|
| Rate for Payer: Aetna Medicare |
$919.74
|
| Rate for Payer: BCBS Complete |
$752.00
|
| Rate for Payer: BCBS MAPPO |
$884.37
|
| Rate for Payer: BCN Medicare Advantage |
$884.37
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Commercial |
$1,273.49
|
| Rate for Payer: Cofinity Commercial |
$1,185.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.59
|
| Rate for Payer: Nomi Health Commercial |
$1,061.24
|
| Rate for Payer: PACE SWMI |
$884.37
|
| Rate for Payer: PHP Medicare Advantage |
$884.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.00
|
| Rate for Payer: Priority Health Medicare |
$893.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$884.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.37
|
| Rate for Payer: UHC Exchange |
$884.37
|
| Rate for Payer: UHC Medicare Advantage |
$884.37
|
|
|
PR TRANSPOSITION OVARY
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 58825
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$979.37 |
| Rate for Payer: Aetna Commercial |
$911.36
|
| Rate for Payer: Aetna Medicare |
$707.32
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: BCBS MAPPO |
$680.12
|
| Rate for Payer: BCN Medicare Advantage |
$680.12
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cofinity Commercial |
$979.37
|
| Rate for Payer: Cofinity Commercial |
$911.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.13
|
| Rate for Payer: Nomi Health Commercial |
$816.14
|
| Rate for Payer: PACE SWMI |
$680.12
|
| Rate for Payer: PHP Medicare Advantage |
$680.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
| Rate for Payer: Priority Health Medicare |
$686.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.12
|
| Rate for Payer: UHC Exchange |
$680.12
|
| Rate for Payer: UHC Medicare Advantage |
$680.12
|
|
|
PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM
|
Professional
|
Both
|
$5,079.00
|
|
|
Service Code
|
HCPCS 61598
|
| Min. Negotiated Rate |
$2,031.60 |
| Max. Negotiated Rate |
$4,003.78 |
| Rate for Payer: Aetna Commercial |
$3,725.74
|
| Rate for Payer: Aetna Medicare |
$2,891.62
|
| Rate for Payer: BCBS Complete |
$2,031.60
|
| Rate for Payer: BCBS MAPPO |
$2,780.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,780.40
|
| Rate for Payer: Cash Price |
$4,063.20
|
| Rate for Payer: Cash Price |
$4,063.20
|
| Rate for Payer: Cofinity Commercial |
$4,003.78
|
| Rate for Payer: Cofinity Commercial |
$3,725.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,780.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,919.42
|
| Rate for Payer: Nomi Health Commercial |
$3,336.48
|
| Rate for Payer: PACE SWMI |
$2,780.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,780.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,301.35
|
| Rate for Payer: Priority Health Medicare |
$2,808.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,780.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,780.40
|
| Rate for Payer: UHC Exchange |
$2,780.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,780.40
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$591.97 |
| Rate for Payer: Aetna Commercial |
$550.86
|
| Rate for Payer: Aetna Medicare |
$427.53
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$411.09
|
| Rate for Payer: BCN Medicare Advantage |
$411.09
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$591.97
|
| Rate for Payer: Cofinity Commercial |
$550.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.64
|
| Rate for Payer: Nomi Health Commercial |
$493.31
|
| Rate for Payer: PACE SWMI |
$411.09
|
| Rate for Payer: PHP Medicare Advantage |
$411.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$415.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.09
|
| Rate for Payer: UHC Exchange |
$411.09
|
| Rate for Payer: UHC Medicare Advantage |
$411.09
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCN Medicare Advantage |
$37.60
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$50.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: Nomi Health Commercial |
$45.12
|
| Rate for Payer: PACE SWMI |
$37.60
|
| Rate for Payer: PHP Medicare Advantage |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$37.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.60
|
| Rate for Payer: UHC Exchange |
$37.60
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
|
