|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,079.00 |
| Rate for Payer: Aetna Commercial |
$743.69
|
| Rate for Payer: Aetna Medicare |
$554.99
|
| Rate for Payer: BCBS Complete |
$385.57
|
| Rate for Payer: BCBS MAPPO |
$554.99
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,079.00
|
| Rate for Payer: BCN Medicare Advantage |
$554.99
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cofinity Commercial |
$799.19
|
| Rate for Payer: Cofinity Commercial |
$743.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.99
|
| Rate for Payer: Healthscope Commercial |
$665.99
|
| Rate for Payer: Healthscope Whirlpool |
$665.99
|
| Rate for Payer: Meridian Medicaid |
$385.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$582.74
|
| Rate for Payer: PACE SWMI |
$554.99
|
| Rate for Payer: PHP Medicare Advantage |
$554.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.18
|
| Rate for Payer: Priority Health Medicare |
$554.99
|
| Rate for Payer: Priority Health Narrow Network |
$871.18
|
| Rate for Payer: UHC Medicare Advantage |
$571.64
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$873.76 |
| Rate for Payer: Aetna Commercial |
$655.82
|
| Rate for Payer: Aetna Medicare |
$489.42
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$489.42
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$873.76
|
| Rate for Payer: BCN Medicare Advantage |
$489.42
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$704.76
|
| Rate for Payer: Cofinity Commercial |
$655.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.42
|
| Rate for Payer: Healthscope Commercial |
$587.30
|
| Rate for Payer: Healthscope Whirlpool |
$587.30
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.89
|
| Rate for Payer: PACE SWMI |
$489.42
|
| Rate for Payer: PHP Medicare Advantage |
$489.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.74
|
| Rate for Payer: Priority Health Medicare |
$489.42
|
| Rate for Payer: Priority Health Narrow Network |
$615.74
|
| Rate for Payer: UHC Medicare Advantage |
$504.10
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$328.87 |
| Max. Negotiated Rate |
$889.40 |
| Rate for Payer: Aetna Commercial |
$665.43
|
| Rate for Payer: Aetna Medicare |
$496.59
|
| Rate for Payer: BCBS Complete |
$345.31
|
| Rate for Payer: BCBS MAPPO |
$496.59
|
| Rate for Payer: BCBS Trust/PPO |
$529.69
|
| Rate for Payer: BCN Commercial |
$889.40
|
| Rate for Payer: BCN Medicare Advantage |
$496.59
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$715.09
|
| Rate for Payer: Cofinity Commercial |
$665.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.59
|
| Rate for Payer: Healthscope Commercial |
$595.91
|
| Rate for Payer: Healthscope Whirlpool |
$595.91
|
| Rate for Payer: Meridian Medicaid |
$345.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.42
|
| Rate for Payer: PACE SWMI |
$496.59
|
| Rate for Payer: PHP Medicare Advantage |
$496.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.78
|
| Rate for Payer: Priority Health Medicare |
$496.59
|
| Rate for Payer: Priority Health Narrow Network |
$624.78
|
| Rate for Payer: UHC Medicare Advantage |
$511.49
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$273.17 |
| Rate for Payer: Aetna Commercial |
$190.09
|
| Rate for Payer: Aetna Medicare |
$141.86
|
| Rate for Payer: BCBS Complete |
$95.28
|
| Rate for Payer: BCBS MAPPO |
$141.86
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$141.86
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$190.09
|
| Rate for Payer: Cofinity Commercial |
$204.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.86
|
| Rate for Payer: Healthscope Commercial |
$170.23
|
| Rate for Payer: Healthscope Whirlpool |
$170.23
|
| Rate for Payer: Meridian Medicaid |
$95.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.95
|
| Rate for Payer: PACE SWMI |
$141.86
|
| Rate for Payer: PHP Medicare Advantage |
$141.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.93
|
| Rate for Payer: Priority Health Medicare |
$141.86
|
| Rate for Payer: Priority Health Narrow Network |
$175.93
|
| Rate for Payer: UHC Medicare Advantage |
$146.12
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$145.83
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS MAPPO |
$145.83
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$279.04
|
| Rate for Payer: BCN Medicare Advantage |
$145.83
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$195.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.83
|
| Rate for Payer: Healthscope Commercial |
$175.00
|
| Rate for Payer: Healthscope Whirlpool |
$175.00
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.12
|
| Rate for Payer: PACE SWMI |
$145.83
|
| Rate for Payer: PHP Medicare Advantage |
$145.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.85
|
| Rate for Payer: Priority Health Medicare |
$145.83
|
| Rate for Payer: Priority Health Narrow Network |
$180.85
|
| Rate for Payer: UHC Medicare Advantage |
$150.20
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$308.42 |
| Max. Negotiated Rate |
$703.20 |
| Rate for Payer: Aetna Commercial |
$631.72
|
| Rate for Payer: Aetna Medicare |
$471.43
|
| Rate for Payer: BCBS Complete |
$323.84
|
| Rate for Payer: BCBS MAPPO |
$471.43
|
| Rate for Payer: BCBS Trust/PPO |
$543.75
|
| Rate for Payer: BCN Commercial |
$703.20
|
| Rate for Payer: BCN Medicare Advantage |
$471.43
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$678.86
|
| Rate for Payer: Cofinity Commercial |
$631.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.43
|
| Rate for Payer: Healthscope Commercial |
$565.72
|
| Rate for Payer: Healthscope Whirlpool |
$565.72
|
| Rate for Payer: Meridian Medicaid |
$323.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.00
|
| Rate for Payer: PACE SWMI |
$471.43
|
| Rate for Payer: PHP Medicare Advantage |
$471.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$591.49
|
| Rate for Payer: Priority Health Medicare |
$471.43
|
| Rate for Payer: Priority Health Narrow Network |
$591.49
|
| Rate for Payer: UHC Medicare Advantage |
$485.57
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$1,095.99 |
| Rate for Payer: Aetna Commercial |
$823.81
|
| Rate for Payer: Aetna Medicare |
$614.78
|
| Rate for Payer: BCBS Complete |
$418.45
|
| Rate for Payer: BCBS MAPPO |
$614.78
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$910.89
|
| Rate for Payer: BCN Medicare Advantage |
$614.78
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cofinity Commercial |
$823.81
|
| Rate for Payer: Cofinity Commercial |
$885.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.78
|
| Rate for Payer: Healthscope Commercial |
$737.74
|
| Rate for Payer: Healthscope Whirlpool |
$737.74
|
| Rate for Payer: Meridian Medicaid |
$418.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.52
|
| Rate for Payer: PACE SWMI |
$614.78
|
| Rate for Payer: PHP Medicare Advantage |
$614.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,095.99
|
| Rate for Payer: Priority Health Medicare |
$614.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,095.99
|
| Rate for Payer: UHC Medicare Advantage |
$633.22
|
|
|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$3,048.82 |
| Rate for Payer: Aetna Commercial |
$15.08
|
| Rate for Payer: Aetna Medicare |
$11.25
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,048.82
|
| Rate for Payer: BCN Commercial |
$18.08
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Whirlpool |
$13.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.10
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow Network |
$15.10
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$1,235.69 |
| Rate for Payer: Aetna Commercial |
$31.07
|
| Rate for Payer: Aetna Medicare |
$23.19
|
| Rate for Payer: BCBS Complete |
$16.11
|
| Rate for Payer: BCBS MAPPO |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.69
|
| Rate for Payer: BCN Commercial |
$31.02
|
| Rate for Payer: BCN Medicare Advantage |
$23.19
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$33.39
|
| Rate for Payer: Cofinity Commercial |
$31.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.19
|
| Rate for Payer: Healthscope Commercial |
$27.83
|
| Rate for Payer: Healthscope Whirlpool |
$27.83
|
| Rate for Payer: Meridian Medicaid |
$16.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.35
|
| Rate for Payer: PACE SWMI |
$23.19
|
| Rate for Payer: PHP Medicare Advantage |
$23.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.48
|
| Rate for Payer: Priority Health Medicare |
$23.19
|
| Rate for Payer: Priority Health Narrow Network |
$33.48
|
| Rate for Payer: UHC Medicare Advantage |
$23.89
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,557.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$790.34 |
| Max. Negotiated Rate |
$2,538.28 |
| Rate for Payer: Aetna Commercial |
$1,928.94
|
| Rate for Payer: Aetna Medicare |
$1,439.51
|
| Rate for Payer: BCBS Complete |
$972.21
|
| Rate for Payer: BCBS MAPPO |
$1,439.51
|
| Rate for Payer: BCBS Trust/PPO |
$790.34
|
| Rate for Payer: BCN Commercial |
$2,109.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,439.51
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cofinity Commercial |
$2,072.89
|
| Rate for Payer: Cofinity Commercial |
$1,928.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,439.51
|
| Rate for Payer: Healthscope Commercial |
$1,727.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,727.41
|
| Rate for Payer: Meridian Medicaid |
$972.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,511.49
|
| Rate for Payer: PACE SWMI |
$1,439.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,439.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,789.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,538.28
|
| Rate for Payer: Priority Health Medicare |
$1,439.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,538.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,482.70
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,687.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$979.00 |
| Max. Negotiated Rate |
$3,565.47 |
| Rate for Payer: Aetna Commercial |
$2,714.97
|
| Rate for Payer: Aetna Medicare |
$2,026.10
|
| Rate for Payer: BCBS Complete |
$1,362.03
|
| Rate for Payer: BCBS MAPPO |
$2,026.10
|
| Rate for Payer: BCBS Trust/PPO |
$979.00
|
| Rate for Payer: BCN Commercial |
$2,963.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,026.10
|
| Rate for Payer: Cash Price |
$2,949.60
|
| Rate for Payer: Cash Price |
$2,949.60
|
| Rate for Payer: Cofinity Commercial |
$2,917.58
|
| Rate for Payer: Cofinity Commercial |
$2,714.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,026.10
|
| Rate for Payer: Healthscope Commercial |
$2,431.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,431.32
|
| Rate for Payer: Meridian Medicaid |
$1,362.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,127.40
|
| Rate for Payer: PACE SWMI |
$2,026.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,026.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,297.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,580.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,565.47
|
| Rate for Payer: Priority Health Medicare |
$2,026.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,565.47
|
| Rate for Payer: UHC Medicare Advantage |
$2,086.88
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$1,227.31 |
| Max. Negotiated Rate |
$3,367.91 |
| Rate for Payer: Aetna Commercial |
$2,563.77
|
| Rate for Payer: Aetna Medicare |
$1,913.26
|
| Rate for Payer: BCBS Complete |
$1,288.68
|
| Rate for Payer: BCBS MAPPO |
$1,913.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.24
|
| Rate for Payer: BCN Commercial |
$2,799.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.26
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cofinity Commercial |
$2,563.77
|
| Rate for Payer: Cofinity Commercial |
$2,755.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.26
|
| Rate for Payer: Healthscope Commercial |
$2,295.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,295.91
|
| Rate for Payer: Meridian Medicaid |
$1,288.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,008.92
|
| Rate for Payer: PACE SWMI |
$1,913.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,227.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,364.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,367.91
|
| Rate for Payer: Priority Health Medicare |
$1,913.26
|
| Rate for Payer: Priority Health Narrow Network |
$3,367.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,970.66
|
|
|
PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY
|
Professional
|
Both
|
$6,486.00
|
|
|
Service Code
|
HCPCS 43620
|
| Min. Negotiated Rate |
$734.87 |
| Max. Negotiated Rate |
$4,540.20 |
| Rate for Payer: Aetna Commercial |
$2,645.55
|
| Rate for Payer: Aetna Medicare |
$1,974.29
|
| Rate for Payer: BCBS Complete |
$1,326.92
|
| Rate for Payer: BCBS MAPPO |
$1,974.29
|
| Rate for Payer: BCBS Trust/PPO |
$734.87
|
| Rate for Payer: BCN Commercial |
$2,887.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,974.29
|
| Rate for Payer: Cash Price |
$5,188.80
|
| Rate for Payer: Cash Price |
$5,188.80
|
| Rate for Payer: Cofinity Commercial |
$2,645.55
|
| Rate for Payer: Cofinity Commercial |
$2,842.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,974.29
|
| Rate for Payer: Healthscope Commercial |
$2,369.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,369.15
|
| Rate for Payer: Meridian Medicaid |
$1,326.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,073.00
|
| Rate for Payer: PACE SWMI |
$1,974.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,974.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,263.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,540.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,473.75
|
| Rate for Payer: Priority Health Medicare |
$1,974.29
|
| Rate for Payer: Priority Health Narrow Network |
$3,473.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,033.52
|
|
|
PR HAIR REDUC 1/2 LEGS
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00060
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
PR HAIR REDUC ABD TRAIL
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00052
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR HAIR REDUC BACK
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00054
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR HAIR REDUC BIKINI LN
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00055
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR HAIR REDUC BRAZ
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00056
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
PR HAIR REDUC BROW/NOSE/EARS/TOE/HND
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 00061
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
PR HAIR REDUC CHIN/NECK
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00057
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR HAIR REDUC FL FACE/SCALP/FL ABD
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 00058
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
|
|
PR HAIR REDUC FL LEGS
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 00059
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
|
|
PR HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00053
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR HAIR REDUC LIP
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 00062
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
PR HAIR REDUC LIP & CHIN
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 00063
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
|
