|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 38206
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$299.65 |
| Rate for Payer: Aetna Commercial |
$103.27
|
| Rate for Payer: Aetna Medicare |
$77.07
|
| Rate for Payer: BCBS Complete |
$184.40
|
| Rate for Payer: BCBS MAPPO |
$77.07
|
| Rate for Payer: BCN Medicare Advantage |
$77.07
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$103.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.07
|
| Rate for Payer: Healthscope Commercial |
$92.48
|
| Rate for Payer: Healthscope Whirlpool |
$92.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.92
|
| Rate for Payer: Nomi Health Commercial |
$92.48
|
| Rate for Payer: PACE SWMI |
$77.07
|
| Rate for Payer: PHP Medicare Advantage |
$77.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health Medicare |
$77.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.07
|
| Rate for Payer: UHC Medicare Advantage |
$77.07
|
| Rate for Payer: UHCCP DNSP |
$77.07
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: Aetna Medicare |
$28.55
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS MAPPO |
$28.55
|
| Rate for Payer: BCN Medicare Advantage |
$28.55
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.55
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Healthscope Whirlpool |
$34.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.98
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE SWMI |
$28.55
|
| Rate for Payer: PHP Medicare Advantage |
$28.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health Medicare |
$28.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$28.55
|
| Rate for Payer: UHCCP DNSP |
$28.55
|
|
|
PR BLEPHAROPLASTY LOWER EYELID W/HERNIATED FAT PAD
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$735.35 |
| Rate for Payer: Aetna Commercial |
$684.28
|
| Rate for Payer: Aetna Medicare |
$510.66
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$510.66
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$735.35
|
| Rate for Payer: Cofinity Commercial |
$684.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.66
|
| Rate for Payer: Healthscope Commercial |
$612.79
|
| Rate for Payer: Healthscope Whirlpool |
$612.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.19
|
| Rate for Payer: Nomi Health Commercial |
$612.79
|
| Rate for Payer: PACE SWMI |
$510.66
|
| Rate for Payer: PHP Medicare Advantage |
$510.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$510.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.66
|
| Rate for Payer: UHC Medicare Advantage |
$510.66
|
| Rate for Payer: UHCCP DNSP |
$510.66
|
|
|
PR BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 15822
|
| Min. Negotiated Rate |
$369.76 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$495.48
|
| Rate for Payer: Aetna Medicare |
$369.76
|
| Rate for Payer: BCBS Complete |
$377.60
|
| Rate for Payer: BCBS MAPPO |
$369.76
|
| Rate for Payer: BCN Medicare Advantage |
$369.76
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$532.45
|
| Rate for Payer: Cofinity Commercial |
$495.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.76
|
| Rate for Payer: Healthscope Commercial |
$443.71
|
| Rate for Payer: Healthscope Whirlpool |
$443.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.25
|
| Rate for Payer: Nomi Health Commercial |
$443.71
|
| Rate for Payer: PACE SWMI |
$369.76
|
| Rate for Payer: PHP Medicare Advantage |
$369.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health Medicare |
$369.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.76
|
| Rate for Payer: UHC Medicare Advantage |
$369.76
|
| Rate for Payer: UHCCP DNSP |
$369.76
|
|
|
PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15823
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$734.86 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$510.32
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$510.32
|
| Rate for Payer: BCN Medicare Advantage |
$510.32
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$683.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.32
|
| Rate for Payer: Healthscope Commercial |
$612.38
|
| Rate for Payer: Healthscope Whirlpool |
$612.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.84
|
| Rate for Payer: Nomi Health Commercial |
$612.38
|
| Rate for Payer: PACE SWMI |
$510.32
|
| Rate for Payer: PHP Medicare Advantage |
$510.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$510.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Medicare Advantage |
$510.32
|
| Rate for Payer: UHCCP DNSP |
$510.32
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$107.89 |
| Max. Negotiated Rate |
$287.95 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Aetna Medicare |
$107.89
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS MAPPO |
$107.89
|
| Rate for Payer: BCN Medicare Advantage |
$107.89
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Cofinity Commercial |
$144.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.89
|
| Rate for Payer: Healthscope Commercial |
$129.47
|
| Rate for Payer: Healthscope Whirlpool |
$129.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.28
|
| Rate for Payer: Nomi Health Commercial |
$129.47
|
| Rate for Payer: PACE SWMI |
$107.89
|
| Rate for Payer: PHP Medicare Advantage |
$107.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health Medicare |
$107.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.89
|
| Rate for Payer: UHC Medicare Advantage |
$107.89
|
| Rate for Payer: UHCCP DNSP |
$107.89
|
|
|
PR BLUE TIDAL
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00072
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$262.65 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$351.95
|
| Rate for Payer: Aetna Medicare |
$262.65
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS MAPPO |
$262.65
|
| Rate for Payer: BCN Medicare Advantage |
$262.65
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$378.22
|
| Rate for Payer: Cofinity Commercial |
$351.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.65
|
| Rate for Payer: Healthscope Commercial |
$315.18
|
| Rate for Payer: Healthscope Whirlpool |
$315.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.78
|
| Rate for Payer: Nomi Health Commercial |
$315.18
|
| Rate for Payer: PACE SWMI |
$262.65
|
| Rate for Payer: PHP Medicare Advantage |
$262.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health Medicare |
$262.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.65
|
| Rate for Payer: UHC Medicare Advantage |
$262.65
|
| Rate for Payer: UHCCP DNSP |
$262.65
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$172.59 |
| Max. Negotiated Rate |
$590.85 |
| Rate for Payer: Aetna Commercial |
$231.27
|
| Rate for Payer: Aetna Medicare |
$172.59
|
| Rate for Payer: BCBS Complete |
$363.60
|
| Rate for Payer: BCBS MAPPO |
$172.59
|
| Rate for Payer: BCN Medicare Advantage |
$172.59
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$248.53
|
| Rate for Payer: Cofinity Commercial |
$231.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.59
|
| Rate for Payer: Healthscope Commercial |
$207.11
|
| Rate for Payer: Healthscope Whirlpool |
$207.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.22
|
| Rate for Payer: Nomi Health Commercial |
$207.11
|
| Rate for Payer: PACE SWMI |
$172.59
|
| Rate for Payer: PHP Medicare Advantage |
$172.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.85
|
| Rate for Payer: Priority Health Medicare |
$172.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.59
|
| Rate for Payer: UHC Medicare Advantage |
$172.59
|
| Rate for Payer: UHCCP DNSP |
$172.59
|
|
|
PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR
|
Professional
|
Both
|
$4,588.00
|
|
|
Service Code
|
HCPCS 20962
|
| Min. Negotiated Rate |
$1,835.20 |
| Max. Negotiated Rate |
$3,689.47 |
| Rate for Payer: Aetna Commercial |
$3,433.25
|
| Rate for Payer: Aetna Medicare |
$2,562.13
|
| Rate for Payer: BCBS Complete |
$1,835.20
|
| Rate for Payer: BCBS MAPPO |
$2,562.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,562.13
|
| Rate for Payer: Cash Price |
$3,670.40
|
| Rate for Payer: Cash Price |
$3,670.40
|
| Rate for Payer: Cofinity Commercial |
$3,689.47
|
| Rate for Payer: Cofinity Commercial |
$3,433.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,562.13
|
| Rate for Payer: Healthscope Commercial |
$3,074.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,074.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,690.24
|
| Rate for Payer: Nomi Health Commercial |
$3,074.56
|
| Rate for Payer: PACE SWMI |
$2,562.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,562.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,982.20
|
| Rate for Payer: Priority Health Medicare |
$2,562.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,562.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,562.13
|
| Rate for Payer: UHCCP DNSP |
$2,562.13
|
|
|
PR BOTOX UNIT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 00084
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
|
|
PR BRACHIOPLASTY
|
Professional
|
Both
|
$4,590.00
|
|
|
Service Code
|
HCPCS 00537
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Aetna Medicare |
$2,295.00
|
| Rate for Payer: BCBS Complete |
$1,836.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$588.61 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Commercial |
$788.74
|
| Rate for Payer: Aetna Medicare |
$588.61
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: BCBS MAPPO |
$588.61
|
| Rate for Payer: BCN Medicare Advantage |
$588.61
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$847.60
|
| Rate for Payer: Cofinity Commercial |
$788.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.61
|
| Rate for Payer: Healthscope Commercial |
$706.33
|
| Rate for Payer: Healthscope Whirlpool |
$706.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.04
|
| Rate for Payer: Nomi Health Commercial |
$706.33
|
| Rate for Payer: PACE SWMI |
$588.61
|
| Rate for Payer: PHP Medicare Advantage |
$588.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: Priority Health Medicare |
$588.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.61
|
| Rate for Payer: UHC Medicare Advantage |
$588.61
|
| Rate for Payer: UHCCP DNSP |
$588.61
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 2.5
|
Professional
|
Both
|
$6,671.00
|
|
|
Service Code
|
HCPCS 00258
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,668.40 |
| Max. Negotiated Rate |
$4,336.15 |
| Rate for Payer: Aetna Medicare |
$3,335.50
|
| Rate for Payer: BCBS Complete |
$2,668.40
|
| Rate for Payer: Cash Price |
$5,336.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,336.15
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 3.5
|
Professional
|
Both
|
$7,589.00
|
|
|
Service Code
|
HCPCS 00260
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$3,035.60 |
| Max. Negotiated Rate |
$4,932.85 |
| Rate for Payer: Aetna Medicare |
$3,794.50
|
| Rate for Payer: BCBS Complete |
$3,035.60
|
| Rate for Payer: Cash Price |
$6,071.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,932.85
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5
|
Professional
|
Both
|
$5,610.00
|
|
|
Service Code
|
HCPCS 00257
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,244.00 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Aetna Medicare |
$2,805.00
|
| Rate for Payer: BCBS Complete |
$2,244.00
|
| Rate for Payer: Cash Price |
$4,488.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,646.50
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5
|
Professional
|
Both
|
$6,528.00
|
|
|
Service Code
|
HCPCS 00259
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,611.20 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Aetna Medicare |
$3,264.00
|
| Rate for Payer: BCBS Complete |
$2,611.20
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,243.20
|
|
|
PR BREAST IMPLANT WARRANTY
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00523
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$4,809.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,923.60 |
| Max. Negotiated Rate |
$3,125.85 |
| Rate for Payer: Aetna Commercial |
$2,781.24
|
| Rate for Payer: Aetna Medicare |
$2,075.55
|
| Rate for Payer: BCBS Complete |
$1,923.60
|
| Rate for Payer: BCBS MAPPO |
$2,075.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,075.55
|
| Rate for Payer: Cash Price |
$3,847.20
|
| Rate for Payer: Cash Price |
$3,847.20
|
| Rate for Payer: Cofinity Commercial |
$2,781.24
|
| Rate for Payer: Cofinity Commercial |
$2,988.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,075.55
|
| Rate for Payer: Healthscope Commercial |
$2,490.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,490.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,179.33
|
| Rate for Payer: Nomi Health Commercial |
$2,490.66
|
| Rate for Payer: PACE SWMI |
$2,075.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,075.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,125.85
|
| Rate for Payer: Priority Health Medicare |
$2,075.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,075.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,075.55
|
| Rate for Payer: UHCCP DNSP |
$2,075.55
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$1,685.20 |
| Max. Negotiated Rate |
$2,776.28 |
| Rate for Payer: Aetna Commercial |
$2,583.48
|
| Rate for Payer: Aetna Medicare |
$1,927.97
|
| Rate for Payer: BCBS Complete |
$1,685.20
|
| Rate for Payer: BCBS MAPPO |
$1,927.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,927.97
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cofinity Commercial |
$2,776.28
|
| Rate for Payer: Cofinity Commercial |
$2,583.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,927.97
|
| Rate for Payer: Healthscope Commercial |
$2,313.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,313.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,024.37
|
| Rate for Payer: Nomi Health Commercial |
$2,313.56
|
| Rate for Payer: PACE SWMI |
$1,927.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,927.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health Medicare |
$1,927.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,927.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,927.97
|
| Rate for Payer: UHCCP DNSP |
$1,927.97
|
|
|
PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP
|
Professional
|
Both
|
$3,032.00
|
|
|
Service Code
|
HCPCS 19367
|
| Min. Negotiated Rate |
$1,212.80 |
| Max. Negotiated Rate |
$2,440.35 |
| Rate for Payer: Aetna Commercial |
$2,270.88
|
| Rate for Payer: Aetna Medicare |
$1,694.69
|
| Rate for Payer: BCBS Complete |
$1,212.80
|
| Rate for Payer: BCBS MAPPO |
$1,694.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,694.69
|
| Rate for Payer: Cash Price |
$2,425.60
|
| Rate for Payer: Cash Price |
$2,425.60
|
| Rate for Payer: Cofinity Commercial |
$2,440.35
|
| Rate for Payer: Cofinity Commercial |
$2,270.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,694.69
|
| Rate for Payer: Healthscope Commercial |
$2,033.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,033.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.42
|
| Rate for Payer: Nomi Health Commercial |
$2,033.63
|
| Rate for Payer: PACE SWMI |
$1,694.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,694.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,970.80
|
| Rate for Payer: Priority Health Medicare |
$1,694.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,694.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,694.69
|
| Rate for Payer: UHCCP DNSP |
$1,694.69
|
|
|
PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP
|
Professional
|
Both
|
$2,920.00
|
|
|
Service Code
|
HCPCS 19361
|
| Min. Negotiated Rate |
$1,168.00 |
| Max. Negotiated Rate |
$2,148.97 |
| Rate for Payer: Aetna Commercial |
$1,999.74
|
| Rate for Payer: Aetna Medicare |
$1,492.34
|
| Rate for Payer: BCBS Complete |
$1,168.00
|
| Rate for Payer: BCBS MAPPO |
$1,492.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,492.34
|
| Rate for Payer: Cash Price |
$2,336.00
|
| Rate for Payer: Cash Price |
$2,336.00
|
| Rate for Payer: Cofinity Commercial |
$2,148.97
|
| Rate for Payer: Cofinity Commercial |
$1,999.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,492.34
|
| Rate for Payer: Healthscope Commercial |
$1,790.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,790.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,566.96
|
| Rate for Payer: Nomi Health Commercial |
$1,790.81
|
| Rate for Payer: PACE SWMI |
$1,492.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,492.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,898.00
|
| Rate for Payer: Priority Health Medicare |
$1,492.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,492.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,492.34
|
| Rate for Payer: UHCCP DNSP |
$1,492.34
|
|
|
PR BREAST RECONSTRUC W OTHR TECHNIQ
|
Professional
|
Both
|
$2,903.00
|
|
|
Service Code
|
HCPCS 19366
|
| Min. Negotiated Rate |
$1,161.20 |
| Max. Negotiated Rate |
$1,886.95 |
| Rate for Payer: Aetna Medicare |
$1,451.50
|
| Rate for Payer: BCBS Complete |
$1,161.20
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.95
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,509.61 |
| Rate for Payer: Aetna Commercial |
$1,404.78
|
| Rate for Payer: Aetna Medicare |
$1,048.34
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$1,048.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.34
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,509.61
|
| Rate for Payer: Cofinity Commercial |
$1,404.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.34
|
| Rate for Payer: Healthscope Commercial |
$1,258.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,258.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.76
|
| Rate for Payer: Nomi Health Commercial |
$1,258.01
|
| Rate for Payer: PACE SWMI |
$1,048.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$1,048.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.34
|
| Rate for Payer: UHCCP DNSP |
$1,048.34
|
|
|
PR BREAST REDUCTION
|
Facility
|
OP
|
$1,938.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
19318
|
| Min. Negotiated Rate |
$1,259.70 |
| Max. Negotiated Rate |
$9,858.39 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: Aetna Medicare |
$6,360.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: ASR ASR |
$1,879.86
|
| Rate for Payer: ASR Commercial |
$1,879.86
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.03
|
| Rate for Payer: BCN Commercial |
$1,502.53
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,821.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$1,938.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,879.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,360.25
|
| Rate for Payer: Mclaren Commercial |
$1,744.20
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.30
|
| Rate for Payer: Nomi Health Commercial |
$1,589.16
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$6,996.27
|
| Rate for Payer: PHP Medicaid |
$3,409.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.08
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,358.54
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$9,858.39
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP DNSP |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
