|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,482.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$992.80 |
| Max. Negotiated Rate |
$1,639.32 |
| Rate for Payer: Aetna Commercial |
$1,525.48
|
| Rate for Payer: Aetna Medicare |
$1,138.42
|
| Rate for Payer: BCBS Complete |
$992.80
|
| Rate for Payer: BCBS MAPPO |
$1,138.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,138.42
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cash Price |
$1,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,639.32
|
| Rate for Payer: Cofinity Commercial |
$1,525.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,138.42
|
| Rate for Payer: Healthscope Commercial |
$1,366.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,195.34
|
| Rate for Payer: Nomi Health Commercial |
$1,366.10
|
| Rate for Payer: PACE SWMI |
$1,138.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,138.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.30
|
| Rate for Payer: Priority Health Medicare |
$1,138.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,138.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,138.42
|
| Rate for Payer: UHCCP DNSP |
$1,138.42
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$756.87 |
| Max. Negotiated Rate |
$1,678.30 |
| Rate for Payer: Aetna Commercial |
$1,014.21
|
| Rate for Payer: Aetna Medicare |
$756.87
|
| Rate for Payer: BCBS Complete |
$1,032.80
|
| Rate for Payer: BCBS MAPPO |
$756.87
|
| Rate for Payer: BCN Medicare Advantage |
$756.87
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.89
|
| Rate for Payer: Cofinity Commercial |
$1,014.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.87
|
| Rate for Payer: Healthscope Commercial |
$908.24
|
| Rate for Payer: Healthscope Whirlpool |
$908.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.71
|
| Rate for Payer: Nomi Health Commercial |
$908.24
|
| Rate for Payer: PACE SWMI |
$756.87
|
| Rate for Payer: PHP Medicare Advantage |
$756.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health Medicare |
$756.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$756.87
|
| Rate for Payer: UHC Medicare Advantage |
$756.87
|
| Rate for Payer: UHCCP DNSP |
$756.87
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$685.69 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: Aetna Medicare |
$685.69
|
| Rate for Payer: BCBS Complete |
$971.20
|
| Rate for Payer: BCBS MAPPO |
$685.69
|
| Rate for Payer: BCN Medicare Advantage |
$685.69
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cash Price |
$1,942.40
|
| Rate for Payer: Cofinity Commercial |
$987.39
|
| Rate for Payer: Cofinity Commercial |
$918.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.69
|
| Rate for Payer: Healthscope Commercial |
$822.83
|
| Rate for Payer: Healthscope Whirlpool |
$822.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.97
|
| Rate for Payer: Nomi Health Commercial |
$822.83
|
| Rate for Payer: PACE SWMI |
$685.69
|
| Rate for Payer: PHP Medicare Advantage |
$685.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.20
|
| Rate for Payer: Priority Health Medicare |
$685.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$685.69
|
| Rate for Payer: UHC Medicare Advantage |
$685.69
|
| Rate for Payer: UHCCP DNSP |
$685.69
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$652.05 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$873.75
|
| Rate for Payer: Aetna Medicare |
$652.05
|
| Rate for Payer: BCBS Complete |
$1,238.80
|
| Rate for Payer: BCBS MAPPO |
$652.05
|
| Rate for Payer: BCN Medicare Advantage |
$652.05
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$938.95
|
| Rate for Payer: Cofinity Commercial |
$873.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.05
|
| Rate for Payer: Healthscope Commercial |
$782.46
|
| Rate for Payer: Healthscope Whirlpool |
$782.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.65
|
| Rate for Payer: Nomi Health Commercial |
$782.46
|
| Rate for Payer: PACE SWMI |
$652.05
|
| Rate for Payer: PHP Medicare Advantage |
$652.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$652.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.05
|
| Rate for Payer: UHC Medicare Advantage |
$652.05
|
| Rate for Payer: UHCCP DNSP |
$652.05
|
|
|
PR AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 28825
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$874.90 |
| Rate for Payer: Aetna Commercial |
$222.91
|
| Rate for Payer: Aetna Medicare |
$166.35
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$166.35
|
| Rate for Payer: BCN Medicare Advantage |
$166.35
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$239.54
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.35
|
| Rate for Payer: Healthscope Commercial |
$199.62
|
| Rate for Payer: Healthscope Whirlpool |
$199.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.67
|
| Rate for Payer: Nomi Health Commercial |
$199.62
|
| Rate for Payer: PACE SWMI |
$166.35
|
| Rate for Payer: PHP Medicare Advantage |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.90
|
| Rate for Payer: Priority Health Medicare |
$166.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.35
|
| Rate for Payer: UHC Medicare Advantage |
$166.35
|
| Rate for Payer: UHCCP DNSP |
$166.35
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,012.05 |
| Max. Negotiated Rate |
$1,557.00 |
| Rate for Payer: Aetna Commercial |
$1,401.30
|
| Rate for Payer: ASR ASR |
$1,510.29
|
| Rate for Payer: ASR Commercial |
$1,510.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.80
|
| Rate for Payer: BCN Commercial |
$1,207.14
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,463.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Healthscope Commercial |
$1,557.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,510.29
|
| Rate for Payer: Mclaren Commercial |
$1,401.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: Nomi Health Commercial |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,370.16
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$170.56
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCN Medicare Advantage |
$170.56
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.56
|
| Rate for Payer: Healthscope Commercial |
$204.67
|
| Rate for Payer: Healthscope Whirlpool |
$204.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE SWMI |
$170.56
|
| Rate for Payer: PHP Medicare Advantage |
$170.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$170.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
| Rate for Payer: UHCCP DNSP |
$170.56
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
28820
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,012.05 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,401.30
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$1,510.29
|
| Rate for Payer: ASR Commercial |
$1,510.29
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.03
|
| Rate for Payer: BCN Commercial |
$1,207.14
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$1,463.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,557.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,510.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,401.30
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,323.45
|
| Rate for Payer: Nomi Health Commercial |
$1,276.74
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,364.24
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,091.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,370.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$228.55
|
| Rate for Payer: Aetna Medicare |
$170.56
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$170.56
|
| Rate for Payer: BCN Medicare Advantage |
$170.56
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$245.61
|
| Rate for Payer: Cofinity Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.56
|
| Rate for Payer: Healthscope Commercial |
$204.67
|
| Rate for Payer: Healthscope Whirlpool |
$204.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.09
|
| Rate for Payer: Nomi Health Commercial |
$204.67
|
| Rate for Payer: PACE SWMI |
$170.56
|
| Rate for Payer: PHP Medicare Advantage |
$170.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$170.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.56
|
| Rate for Payer: UHC Medicare Advantage |
$170.56
|
| Rate for Payer: UHCCP DNSP |
$170.56
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 92603
|
| Min. Negotiated Rate |
$111.22 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$149.03
|
| Rate for Payer: Aetna Medicare |
$111.22
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$111.22
|
| Rate for Payer: BCN Medicare Advantage |
$111.22
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$160.16
|
| Rate for Payer: Cofinity Commercial |
$149.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.22
|
| Rate for Payer: Healthscope Commercial |
$133.46
|
| Rate for Payer: Healthscope Whirlpool |
$133.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$133.46
|
| Rate for Payer: PACE SWMI |
$111.22
|
| Rate for Payer: PHP Medicare Advantage |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$111.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.22
|
| Rate for Payer: UHC Medicare Advantage |
$111.22
|
| Rate for Payer: UHCCP DNSP |
$111.22
|
|
|
PR ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 92604
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$82.95
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS MAPPO |
$61.90
|
| Rate for Payer: BCN Medicare Advantage |
$61.90
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.90
|
| Rate for Payer: Healthscope Commercial |
$74.28
|
| Rate for Payer: Healthscope Whirlpool |
$74.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.00
|
| Rate for Payer: Nomi Health Commercial |
$74.28
|
| Rate for Payer: PACE SWMI |
$61.90
|
| Rate for Payer: PHP Medicare Advantage |
$61.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health Medicare |
$61.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.90
|
| Rate for Payer: UHC Medicare Advantage |
$61.90
|
| Rate for Payer: UHCCP DNSP |
$61.90
|
|
|
PR ANALYZE NEUROSTIM BRAIN, FIRST 1H
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 95978
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$329.55 |
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
|
|
PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 95979
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
|
|
PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES
|
Professional
|
Both
|
$7,866.00
|
|
|
Service Code
|
HCPCS 61711
|
| Min. Negotiated Rate |
$2,586.63 |
| Max. Negotiated Rate |
$5,112.90 |
| Rate for Payer: Aetna Commercial |
$3,466.08
|
| Rate for Payer: Aetna Medicare |
$2,586.63
|
| Rate for Payer: BCBS Complete |
$3,146.40
|
| Rate for Payer: BCBS MAPPO |
$2,586.63
|
| Rate for Payer: BCN Medicare Advantage |
$2,586.63
|
| Rate for Payer: Cash Price |
$6,292.80
|
| Rate for Payer: Cash Price |
$6,292.80
|
| Rate for Payer: Cofinity Commercial |
$3,724.75
|
| Rate for Payer: Cofinity Commercial |
$3,466.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,586.63
|
| Rate for Payer: Healthscope Commercial |
$3,103.96
|
| Rate for Payer: Healthscope Whirlpool |
$3,103.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,715.96
|
| Rate for Payer: Nomi Health Commercial |
$3,103.96
|
| Rate for Payer: PACE SWMI |
$2,586.63
|
| Rate for Payer: PHP Medicare Advantage |
$2,586.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,112.90
|
| Rate for Payer: Priority Health Medicare |
$2,586.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,586.63
|
| Rate for Payer: UHC Medicare Advantage |
$2,586.63
|
| Rate for Payer: UHCCP DNSP |
$2,586.63
|
|
|
PR ANAST INTRAHEPATC DUCTS & GI TRACT
|
Professional
|
Both
|
$6,161.00
|
|
|
Service Code
|
HCPCS 47765
|
| Min. Negotiated Rate |
$2,464.40 |
| Max. Negotiated Rate |
$4,234.90 |
| Rate for Payer: Aetna Commercial |
$3,940.81
|
| Rate for Payer: Aetna Medicare |
$2,940.90
|
| Rate for Payer: BCBS Complete |
$2,464.40
|
| Rate for Payer: BCBS MAPPO |
$2,940.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,940.90
|
| Rate for Payer: Cash Price |
$4,928.80
|
| Rate for Payer: Cash Price |
$4,928.80
|
| Rate for Payer: Cofinity Commercial |
$4,234.90
|
| Rate for Payer: Cofinity Commercial |
$3,940.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,940.90
|
| Rate for Payer: Healthscope Commercial |
$3,529.08
|
| Rate for Payer: Healthscope Whirlpool |
$3,529.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,087.95
|
| Rate for Payer: Nomi Health Commercial |
$3,529.08
|
| Rate for Payer: PACE SWMI |
$2,940.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,940.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,004.65
|
| Rate for Payer: Priority Health Medicare |
$2,940.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,940.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,940.90
|
| Rate for Payer: UHCCP DNSP |
$2,940.90
|
|
|
PR ANASTOMOSIS FACIAL HYPOGLOSSAL
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
HCPCS 64868
|
| Min. Negotiated Rate |
$743.20 |
| Max. Negotiated Rate |
$1,353.25 |
| Rate for Payer: Aetna Commercial |
$1,259.28
|
| Rate for Payer: Aetna Medicare |
$939.76
|
| Rate for Payer: BCBS Complete |
$743.20
|
| Rate for Payer: BCBS MAPPO |
$939.76
|
| Rate for Payer: BCN Medicare Advantage |
$939.76
|
| Rate for Payer: Cash Price |
$1,486.40
|
| Rate for Payer: Cash Price |
$1,486.40
|
| Rate for Payer: Cofinity Commercial |
$1,353.25
|
| Rate for Payer: Cofinity Commercial |
$1,259.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.76
|
| Rate for Payer: Healthscope Commercial |
$1,127.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.75
|
| Rate for Payer: Nomi Health Commercial |
$1,127.71
|
| Rate for Payer: PACE SWMI |
$939.76
|
| Rate for Payer: PHP Medicare Advantage |
$939.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.70
|
| Rate for Payer: Priority Health Medicare |
$939.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.76
|
| Rate for Payer: UHC Medicare Advantage |
$939.76
|
| Rate for Payer: UHCCP DNSP |
$939.76
|
|
|
PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 47780
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$3,456.50 |
| Rate for Payer: Aetna Commercial |
$3,216.47
|
| Rate for Payer: Aetna Medicare |
$2,400.35
|
| Rate for Payer: BCBS Complete |
$1,884.00
|
| Rate for Payer: BCBS MAPPO |
$2,400.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,400.35
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cash Price |
$3,768.00
|
| Rate for Payer: Cofinity Commercial |
$3,456.50
|
| Rate for Payer: Cofinity Commercial |
$3,216.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,400.35
|
| Rate for Payer: Healthscope Commercial |
$2,880.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,880.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,520.37
|
| Rate for Payer: Nomi Health Commercial |
$2,880.42
|
| Rate for Payer: PACE SWMI |
$2,400.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,400.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.50
|
| Rate for Payer: Priority Health Medicare |
$2,400.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,400.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,400.35
|
| Rate for Payer: UHCCP DNSP |
$2,400.35
|
|
|
PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT
|
Professional
|
Both
|
$4,268.00
|
|
|
Service Code
|
HCPCS 47760
|
| Min. Negotiated Rate |
$1,707.20 |
| Max. Negotiated Rate |
$3,140.25 |
| Rate for Payer: Aetna Commercial |
$2,922.18
|
| Rate for Payer: Aetna Medicare |
$2,180.73
|
| Rate for Payer: BCBS Complete |
$1,707.20
|
| Rate for Payer: BCBS MAPPO |
$2,180.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,180.73
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cofinity Commercial |
$3,140.25
|
| Rate for Payer: Cofinity Commercial |
$2,922.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,180.73
|
| Rate for Payer: Healthscope Commercial |
$2,616.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,616.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,289.77
|
| Rate for Payer: Nomi Health Commercial |
$2,616.88
|
| Rate for Payer: PACE SWMI |
$2,180.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,180.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,774.20
|
| Rate for Payer: Priority Health Medicare |
$2,180.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,180.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,180.73
|
| Rate for Payer: UHCCP DNSP |
$2,180.73
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG 4-9% TBSA
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01952
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG <4% TBSA
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01951
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG EA 9%TBSA
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS 01953
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
|
|
PR ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS 01842
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
|
|
PR ANES ARTERIES OF KNEE & POPLITEAL AREA NOS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01440
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
|
|
PR ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01654
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
|
|
PR ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 01638
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
