|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$191.08 |
| Max. Negotiated Rate |
$449.15 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: Aetna Medicare |
$191.08
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$191.08
|
| Rate for Payer: BCN Medicare Advantage |
$191.08
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$275.16
|
| Rate for Payer: Cofinity Commercial |
$256.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.08
|
| Rate for Payer: Healthscope Commercial |
$229.30
|
| Rate for Payer: Healthscope Whirlpool |
$229.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.63
|
| Rate for Payer: Nomi Health Commercial |
$229.30
|
| Rate for Payer: PACE SWMI |
$191.08
|
| Rate for Payer: PHP Medicare Advantage |
$191.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$191.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.08
|
| Rate for Payer: UHC Medicare Advantage |
$191.08
|
| Rate for Payer: UHCCP DNSP |
$191.08
|
|
|
PR CLOSURE RECTOURETHRAL FISTULA
|
Professional
|
Both
|
$3,283.00
|
|
|
Service Code
|
HCPCS 45820
|
| Min. Negotiated Rate |
$1,237.34 |
| Max. Negotiated Rate |
$2,133.95 |
| Rate for Payer: Aetna Commercial |
$1,658.04
|
| Rate for Payer: Aetna Medicare |
$1,237.34
|
| Rate for Payer: BCBS Complete |
$1,313.20
|
| Rate for Payer: BCBS MAPPO |
$1,237.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.34
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,781.77
|
| Rate for Payer: Cofinity Commercial |
$1,658.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.34
|
| Rate for Payer: Healthscope Commercial |
$1,484.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,299.21
|
| Rate for Payer: Nomi Health Commercial |
$1,484.81
|
| Rate for Payer: PACE SWMI |
$1,237.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,133.95
|
| Rate for Payer: Priority Health Medicare |
$1,237.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,237.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,237.34
|
| Rate for Payer: UHCCP DNSP |
$1,237.34
|
|
|
PR CLOSURE RECTOVESICAL FISTULA
|
Professional
|
Both
|
$2,859.00
|
|
|
Service Code
|
HCPCS 45800
|
| Min. Negotiated Rate |
$1,143.60 |
| Max. Negotiated Rate |
$1,858.35 |
| Rate for Payer: Aetna Commercial |
$1,654.14
|
| Rate for Payer: Aetna Medicare |
$1,234.43
|
| Rate for Payer: BCBS Complete |
$1,143.60
|
| Rate for Payer: BCBS MAPPO |
$1,234.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,234.43
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cofinity Commercial |
$1,777.58
|
| Rate for Payer: Cofinity Commercial |
$1,654.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,234.43
|
| Rate for Payer: Healthscope Commercial |
$1,481.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,481.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,296.15
|
| Rate for Payer: Nomi Health Commercial |
$1,481.32
|
| Rate for Payer: PACE SWMI |
$1,234.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,234.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,858.35
|
| Rate for Payer: Priority Health Medicare |
$1,234.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,234.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,234.43
|
| Rate for Payer: UHCCP DNSP |
$1,234.43
|
|
|
PR CLOSURE SALIVARY FISTULA
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 42600
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$531.70 |
| Rate for Payer: Aetna Commercial |
$455.55
|
| Rate for Payer: Aetna Medicare |
$339.96
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$339.96
|
| Rate for Payer: BCN Medicare Advantage |
$339.96
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$489.54
|
| Rate for Payer: Cofinity Commercial |
$455.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.96
|
| Rate for Payer: Healthscope Commercial |
$407.95
|
| Rate for Payer: Healthscope Whirlpool |
$407.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.96
|
| Rate for Payer: Nomi Health Commercial |
$407.95
|
| Rate for Payer: PACE SWMI |
$339.96
|
| Rate for Payer: PHP Medicare Advantage |
$339.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$339.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.96
|
| Rate for Payer: UHC Medicare Advantage |
$339.96
|
| Rate for Payer: UHCCP DNSP |
$339.96
|
|
|
PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
HCPCS 57320
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$776.55 |
| Rate for Payer: Aetna Commercial |
$722.62
|
| Rate for Payer: Aetna Medicare |
$539.27
|
| Rate for Payer: BCBS Complete |
$385.20
|
| Rate for Payer: BCBS MAPPO |
$539.27
|
| Rate for Payer: BCN Medicare Advantage |
$539.27
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cofinity Commercial |
$776.55
|
| Rate for Payer: Cofinity Commercial |
$722.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.27
|
| Rate for Payer: Healthscope Commercial |
$647.12
|
| Rate for Payer: Healthscope Whirlpool |
$647.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.23
|
| Rate for Payer: Nomi Health Commercial |
$647.12
|
| Rate for Payer: PACE SWMI |
$539.27
|
| Rate for Payer: PHP Medicare Advantage |
$539.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.95
|
| Rate for Payer: Priority Health Medicare |
$539.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$539.27
|
| Rate for Payer: UHC Medicare Advantage |
$539.27
|
| Rate for Payer: UHCCP DNSP |
$539.27
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$231.66 |
| Max. Negotiated Rate |
$388.70 |
| Rate for Payer: Aetna Commercial |
$310.42
|
| Rate for Payer: Aetna Medicare |
$231.66
|
| Rate for Payer: BCBS Complete |
$239.20
|
| Rate for Payer: BCBS MAPPO |
$231.66
|
| Rate for Payer: BCN Medicare Advantage |
$231.66
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cofinity Commercial |
$333.59
|
| Rate for Payer: Cofinity Commercial |
$310.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.66
|
| Rate for Payer: Healthscope Commercial |
$277.99
|
| Rate for Payer: Healthscope Whirlpool |
$277.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.24
|
| Rate for Payer: Nomi Health Commercial |
$277.99
|
| Rate for Payer: PACE SWMI |
$231.66
|
| Rate for Payer: PHP Medicare Advantage |
$231.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.70
|
| Rate for Payer: Priority Health Medicare |
$231.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.66
|
| Rate for Payer: UHC Medicare Advantage |
$231.66
|
| Rate for Payer: UHCCP DNSP |
$231.66
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$335.40 |
| Rate for Payer: Aetna Commercial |
$302.12
|
| Rate for Payer: Aetna Medicare |
$225.46
|
| Rate for Payer: BCBS Complete |
$206.40
|
| Rate for Payer: BCBS MAPPO |
$225.46
|
| Rate for Payer: BCN Medicare Advantage |
$225.46
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$324.66
|
| Rate for Payer: Cofinity Commercial |
$302.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.46
|
| Rate for Payer: Healthscope Commercial |
$270.55
|
| Rate for Payer: Healthscope Whirlpool |
$270.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.73
|
| Rate for Payer: Nomi Health Commercial |
$270.55
|
| Rate for Payer: PACE SWMI |
$225.46
|
| Rate for Payer: PHP Medicare Advantage |
$225.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.40
|
| Rate for Payer: Priority Health Medicare |
$225.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.46
|
| Rate for Payer: UHC Medicare Advantage |
$225.46
|
| Rate for Payer: UHCCP DNSP |
$225.46
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$326.97 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$438.14
|
| Rate for Payer: Aetna Medicare |
$326.97
|
| Rate for Payer: BCBS Complete |
$337.60
|
| Rate for Payer: BCBS MAPPO |
$326.97
|
| Rate for Payer: BCN Medicare Advantage |
$326.97
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cofinity Commercial |
$470.84
|
| Rate for Payer: Cofinity Commercial |
$438.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.97
|
| Rate for Payer: Healthscope Commercial |
$392.36
|
| Rate for Payer: Healthscope Whirlpool |
$392.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.32
|
| Rate for Payer: Nomi Health Commercial |
$392.36
|
| Rate for Payer: PACE SWMI |
$326.97
|
| Rate for Payer: PHP Medicare Advantage |
$326.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.60
|
| Rate for Payer: Priority Health Medicare |
$326.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.97
|
| Rate for Payer: UHC Medicare Advantage |
$326.97
|
| Rate for Payer: UHCCP DNSP |
$326.97
|
|
|
PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 27198
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$438.88 |
| Rate for Payer: Aetna Commercial |
$408.41
|
| Rate for Payer: Aetna Medicare |
$304.78
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$304.78
|
| Rate for Payer: BCN Medicare Advantage |
$304.78
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Cofinity Commercial |
$408.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.78
|
| Rate for Payer: Healthscope Commercial |
$365.74
|
| Rate for Payer: Healthscope Whirlpool |
$365.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.02
|
| Rate for Payer: Nomi Health Commercial |
$365.74
|
| Rate for Payer: PACE SWMI |
$304.78
|
| Rate for Payer: PHP Medicare Advantage |
$304.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health Medicare |
$304.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.78
|
| Rate for Payer: UHC Medicare Advantage |
$304.78
|
| Rate for Payer: UHCCP DNSP |
$304.78
|
|
|
PR CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 27197
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna Commercial |
$168.33
|
| Rate for Payer: Aetna Medicare |
$125.62
|
| Rate for Payer: BCBS Complete |
$94.40
|
| Rate for Payer: BCBS MAPPO |
$125.62
|
| Rate for Payer: BCN Medicare Advantage |
$125.62
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$180.89
|
| Rate for Payer: Cofinity Commercial |
$168.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.62
|
| Rate for Payer: Healthscope Commercial |
$150.74
|
| Rate for Payer: Healthscope Whirlpool |
$150.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.90
|
| Rate for Payer: Nomi Health Commercial |
$150.74
|
| Rate for Payer: PACE SWMI |
$125.62
|
| Rate for Payer: PHP Medicare Advantage |
$125.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.40
|
| Rate for Payer: Priority Health Medicare |
$125.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.62
|
| Rate for Payer: UHC Medicare Advantage |
$125.62
|
| Rate for Payer: UHCCP DNSP |
$125.62
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 23655
|
| Min. Negotiated Rate |
$395.87 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$530.47
|
| Rate for Payer: Aetna Medicare |
$395.87
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$395.87
|
| Rate for Payer: BCN Medicare Advantage |
$395.87
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$570.05
|
| Rate for Payer: Cofinity Commercial |
$530.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.87
|
| Rate for Payer: Healthscope Commercial |
$475.04
|
| Rate for Payer: Healthscope Whirlpool |
$475.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.66
|
| Rate for Payer: Nomi Health Commercial |
$475.04
|
| Rate for Payer: PACE SWMI |
$395.87
|
| Rate for Payer: PHP Medicare Advantage |
$395.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$395.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.87
|
| Rate for Payer: UHC Medicare Advantage |
$395.87
|
| Rate for Payer: UHCCP DNSP |
$395.87
|
|
|
PR CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 23650
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$451.10 |
| Rate for Payer: Aetna Commercial |
$397.31
|
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: BCBS Complete |
$277.60
|
| Rate for Payer: BCBS MAPPO |
$296.50
|
| Rate for Payer: BCN Medicare Advantage |
$296.50
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cofinity Commercial |
$426.96
|
| Rate for Payer: Cofinity Commercial |
$397.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.50
|
| Rate for Payer: Healthscope Commercial |
$355.80
|
| Rate for Payer: Healthscope Whirlpool |
$355.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.32
|
| Rate for Payer: Nomi Health Commercial |
$355.80
|
| Rate for Payer: PACE SWMI |
$296.50
|
| Rate for Payer: PHP Medicare Advantage |
$296.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.10
|
| Rate for Payer: Priority Health Medicare |
$296.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.50
|
| Rate for Payer: UHC Medicare Advantage |
$296.50
|
| Rate for Payer: UHCCP DNSP |
$296.50
|
|
|
PR CLSR ANAL FSTL W/RCT ADVMNT FLAP
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 46288
|
| Min. Negotiated Rate |
$535.63 |
| Max. Negotiated Rate |
$1,090.70 |
| Rate for Payer: Aetna Commercial |
$717.74
|
| Rate for Payer: Aetna Medicare |
$535.63
|
| Rate for Payer: BCBS Complete |
$671.20
|
| Rate for Payer: BCBS MAPPO |
$535.63
|
| Rate for Payer: BCN Medicare Advantage |
$535.63
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cofinity Commercial |
$771.31
|
| Rate for Payer: Cofinity Commercial |
$717.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$535.63
|
| Rate for Payer: Healthscope Commercial |
$642.76
|
| Rate for Payer: Healthscope Whirlpool |
$642.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$562.41
|
| Rate for Payer: Nomi Health Commercial |
$642.76
|
| Rate for Payer: PACE SWMI |
$535.63
|
| Rate for Payer: PHP Medicare Advantage |
$535.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.70
|
| Rate for Payer: Priority Health Medicare |
$535.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$535.63
|
| Rate for Payer: UHC Medicare Advantage |
$535.63
|
| Rate for Payer: UHCCP DNSP |
$535.63
|
|
|
PR CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA
|
Professional
|
Both
|
$1,872.00
|
|
|
Service Code
|
HCPCS 32810
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$1,248.41 |
| Rate for Payer: Aetna Commercial |
$1,161.71
|
| Rate for Payer: Aetna Medicare |
$866.95
|
| Rate for Payer: BCBS Complete |
$748.80
|
| Rate for Payer: BCBS MAPPO |
$866.95
|
| Rate for Payer: BCN Medicare Advantage |
$866.95
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cash Price |
$1,497.60
|
| Rate for Payer: Cofinity Commercial |
$1,248.41
|
| Rate for Payer: Cofinity Commercial |
$1,161.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.95
|
| Rate for Payer: Healthscope Commercial |
$1,040.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.30
|
| Rate for Payer: Nomi Health Commercial |
$1,040.34
|
| Rate for Payer: PACE SWMI |
$866.95
|
| Rate for Payer: PHP Medicare Advantage |
$866.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.80
|
| Rate for Payer: Priority Health Medicare |
$866.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.95
|
| Rate for Payer: UHC Medicare Advantage |
$866.95
|
| Rate for Payer: UHCCP DNSP |
$866.95
|
|
|
PR CLSR ENTEROENTERIC/ENTEROCOLIC FSTL
|
Professional
|
Both
|
$2,579.00
|
|
|
Service Code
|
HCPCS 44650
|
| Min. Negotiated Rate |
$1,031.60 |
| Max. Negotiated Rate |
$1,995.39 |
| Rate for Payer: Aetna Commercial |
$1,856.82
|
| Rate for Payer: Aetna Medicare |
$1,385.69
|
| Rate for Payer: BCBS Complete |
$1,031.60
|
| Rate for Payer: BCBS MAPPO |
$1,385.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,385.69
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cash Price |
$2,063.20
|
| Rate for Payer: Cofinity Commercial |
$1,995.39
|
| Rate for Payer: Cofinity Commercial |
$1,856.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,385.69
|
| Rate for Payer: Healthscope Commercial |
$1,662.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,662.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,454.97
|
| Rate for Payer: Nomi Health Commercial |
$1,662.83
|
| Rate for Payer: PACE SWMI |
$1,385.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,385.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,676.35
|
| Rate for Payer: Priority Health Medicare |
$1,385.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,385.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,385.69
|
| Rate for Payer: UHCCP DNSP |
$1,385.69
|
|
|
PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ
|
Professional
|
Both
|
$3,576.00
|
|
|
Service Code
|
HCPCS 44661
|
| Min. Negotiated Rate |
$1,430.40 |
| Max. Negotiated Rate |
$2,324.40 |
| Rate for Payer: Aetna Commercial |
$1,995.19
|
| Rate for Payer: Aetna Medicare |
$1,488.95
|
| Rate for Payer: BCBS Complete |
$1,430.40
|
| Rate for Payer: BCBS MAPPO |
$1,488.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,488.95
|
| Rate for Payer: Cash Price |
$2,860.80
|
| Rate for Payer: Cash Price |
$2,860.80
|
| Rate for Payer: Cofinity Commercial |
$2,144.09
|
| Rate for Payer: Cofinity Commercial |
$1,995.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,488.95
|
| Rate for Payer: Healthscope Commercial |
$1,786.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,786.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,563.40
|
| Rate for Payer: Nomi Health Commercial |
$1,786.74
|
| Rate for Payer: PACE SWMI |
$1,488.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,488.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,324.40
|
| Rate for Payer: Priority Health Medicare |
$1,488.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,488.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,488.95
|
| Rate for Payer: UHCCP DNSP |
$1,488.95
|
|
|
PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ
|
Professional
|
Both
|
$2,662.00
|
|
|
Service Code
|
HCPCS 44660
|
| Min. Negotiated Rate |
$1,064.80 |
| Max. Negotiated Rate |
$1,856.22 |
| Rate for Payer: Aetna Commercial |
$1,727.31
|
| Rate for Payer: Aetna Medicare |
$1,289.04
|
| Rate for Payer: BCBS Complete |
$1,064.80
|
| Rate for Payer: BCBS MAPPO |
$1,289.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.04
|
| Rate for Payer: Cash Price |
$2,129.60
|
| Rate for Payer: Cash Price |
$2,129.60
|
| Rate for Payer: Cofinity Commercial |
$1,856.22
|
| Rate for Payer: Cofinity Commercial |
$1,727.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.04
|
| Rate for Payer: Healthscope Commercial |
$1,546.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,546.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,353.49
|
| Rate for Payer: Nomi Health Commercial |
$1,546.85
|
| Rate for Payer: PACE SWMI |
$1,289.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,730.30
|
| Rate for Payer: Priority Health Medicare |
$1,289.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,289.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,289.04
|
| Rate for Payer: UHCCP DNSP |
$1,289.04
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR
|
Professional
|
Both
|
$2,693.00
|
|
|
Service Code
|
HCPCS 43420
|
| Min. Negotiated Rate |
$973.77 |
| Max. Negotiated Rate |
$1,750.45 |
| Rate for Payer: Aetna Commercial |
$1,304.85
|
| Rate for Payer: Aetna Medicare |
$973.77
|
| Rate for Payer: BCBS Complete |
$1,077.20
|
| Rate for Payer: BCBS MAPPO |
$973.77
|
| Rate for Payer: BCN Medicare Advantage |
$973.77
|
| Rate for Payer: Cash Price |
$2,154.40
|
| Rate for Payer: Cash Price |
$2,154.40
|
| Rate for Payer: Cofinity Commercial |
$1,402.23
|
| Rate for Payer: Cofinity Commercial |
$1,304.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.77
|
| Rate for Payer: Healthscope Commercial |
$1,168.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.46
|
| Rate for Payer: Nomi Health Commercial |
$1,168.52
|
| Rate for Payer: PACE SWMI |
$973.77
|
| Rate for Payer: PHP Medicare Advantage |
$973.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.45
|
| Rate for Payer: Priority Health Medicare |
$973.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$973.77
|
| Rate for Payer: UHC Medicare Advantage |
$973.77
|
| Rate for Payer: UHCCP DNSP |
$973.77
|
|
|
PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR
|
Professional
|
Both
|
$4,177.00
|
|
|
Service Code
|
HCPCS 43425
|
| Min. Negotiated Rate |
$1,389.59 |
| Max. Negotiated Rate |
$2,715.05 |
| Rate for Payer: Aetna Commercial |
$1,862.05
|
| Rate for Payer: Aetna Medicare |
$1,389.59
|
| Rate for Payer: BCBS Complete |
$1,670.80
|
| Rate for Payer: BCBS MAPPO |
$1,389.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,389.59
|
| Rate for Payer: Cash Price |
$3,341.60
|
| Rate for Payer: Cash Price |
$3,341.60
|
| Rate for Payer: Cofinity Commercial |
$2,001.01
|
| Rate for Payer: Cofinity Commercial |
$1,862.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,389.59
|
| Rate for Payer: Healthscope Commercial |
$1,667.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,667.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,459.07
|
| Rate for Payer: Nomi Health Commercial |
$1,667.51
|
| Rate for Payer: PACE SWMI |
$1,389.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,389.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,715.05
|
| Rate for Payer: Priority Health Medicare |
$1,389.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.59
|
| Rate for Payer: UHCCP DNSP |
$1,389.59
|
|
|
PR CLSR LACRIMAL PUNCTUM PLUG EACH
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 68761
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$198.25 |
| Rate for Payer: Aetna Commercial |
$144.04
|
| Rate for Payer: Aetna Medicare |
$107.49
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$107.49
|
| Rate for Payer: BCN Medicare Advantage |
$107.49
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$154.79
|
| Rate for Payer: Cofinity Commercial |
$144.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.49
|
| Rate for Payer: Healthscope Commercial |
$128.99
|
| Rate for Payer: Healthscope Whirlpool |
$128.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.86
|
| Rate for Payer: Nomi Health Commercial |
$128.99
|
| Rate for Payer: PACE SWMI |
$107.49
|
| Rate for Payer: PHP Medicare Advantage |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$107.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.49
|
| Rate for Payer: UHC Medicare Advantage |
$107.49
|
| Rate for Payer: UHCCP DNSP |
$107.49
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$2,913.00
|
|
|
Service Code
|
HCPCS 44625
|
| Min. Negotiated Rate |
$971.22 |
| Max. Negotiated Rate |
$1,893.45 |
| Rate for Payer: Aetna Commercial |
$1,301.43
|
| Rate for Payer: Aetna Medicare |
$971.22
|
| Rate for Payer: BCBS Complete |
$1,165.20
|
| Rate for Payer: BCBS MAPPO |
$971.22
|
| Rate for Payer: BCN Medicare Advantage |
$971.22
|
| Rate for Payer: Cash Price |
$2,330.40
|
| Rate for Payer: Cash Price |
$2,330.40
|
| Rate for Payer: Cofinity Commercial |
$1,398.56
|
| Rate for Payer: Cofinity Commercial |
$1,301.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,165.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,165.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,019.78
|
| Rate for Payer: Nomi Health Commercial |
$1,165.46
|
| Rate for Payer: PACE SWMI |
$971.22
|
| Rate for Payer: PHP Medicare Advantage |
$971.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,893.45
|
| Rate for Payer: Priority Health Medicare |
$971.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$971.22
|
| Rate for Payer: UHC Medicare Advantage |
$971.22
|
| Rate for Payer: UHCCP DNSP |
$971.22
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 44626
|
| Min. Negotiated Rate |
$1,188.80 |
| Max. Negotiated Rate |
$2,209.20 |
| Rate for Payer: Aetna Commercial |
$2,055.79
|
| Rate for Payer: Aetna Medicare |
$1,534.17
|
| Rate for Payer: BCBS Complete |
$1,188.80
|
| Rate for Payer: BCBS MAPPO |
$1,534.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,534.17
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cofinity Commercial |
$2,209.20
|
| Rate for Payer: Cofinity Commercial |
$2,055.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,534.17
|
| Rate for Payer: Healthscope Commercial |
$1,841.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,841.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,610.88
|
| Rate for Payer: Nomi Health Commercial |
$1,841.00
|
| Rate for Payer: PACE SWMI |
$1,534.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,534.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,931.80
|
| Rate for Payer: Priority Health Medicare |
$1,534.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,534.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,534.17
|
| Rate for Payer: UHCCP DNSP |
$1,534.17
|
|
|
PR CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ
|
Professional
|
Both
|
$1,471.00
|
|
|
Service Code
|
HCPCS 57308
|
| Min. Negotiated Rate |
$588.40 |
| Max. Negotiated Rate |
$956.15 |
| Rate for Payer: Aetna Commercial |
$849.59
|
| Rate for Payer: Aetna Medicare |
$634.02
|
| Rate for Payer: BCBS Complete |
$588.40
|
| Rate for Payer: BCBS MAPPO |
$634.02
|
| Rate for Payer: BCN Medicare Advantage |
$634.02
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cash Price |
$1,176.80
|
| Rate for Payer: Cofinity Commercial |
$912.99
|
| Rate for Payer: Cofinity Commercial |
$849.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$634.02
|
| Rate for Payer: Healthscope Commercial |
$760.82
|
| Rate for Payer: Healthscope Whirlpool |
$760.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.72
|
| Rate for Payer: Nomi Health Commercial |
$760.82
|
| Rate for Payer: PACE SWMI |
$634.02
|
| Rate for Payer: PHP Medicare Advantage |
$634.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.15
|
| Rate for Payer: Priority Health Medicare |
$634.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$634.02
|
| Rate for Payer: UHC Medicare Advantage |
$634.02
|
| Rate for Payer: UHCCP DNSP |
$634.02
|
|
|
PR CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,976.00
|
|
|
Service Code
|
HCPCS 57305
|
| Min. Negotiated Rate |
$790.40 |
| Max. Negotiated Rate |
$1,340.93 |
| Rate for Payer: Aetna Commercial |
$1,247.81
|
| Rate for Payer: Aetna Medicare |
$931.20
|
| Rate for Payer: BCBS Complete |
$790.40
|
| Rate for Payer: BCBS MAPPO |
$931.20
|
| Rate for Payer: BCN Medicare Advantage |
$931.20
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cofinity Commercial |
$1,340.93
|
| Rate for Payer: Cofinity Commercial |
$1,247.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.20
|
| Rate for Payer: Healthscope Commercial |
$1,117.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.76
|
| Rate for Payer: Nomi Health Commercial |
$1,117.44
|
| Rate for Payer: PACE SWMI |
$931.20
|
| Rate for Payer: PHP Medicare Advantage |
$931.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.40
|
| Rate for Payer: Priority Health Medicare |
$931.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.20
|
| Rate for Payer: UHC Medicare Advantage |
$931.20
|
| Rate for Payer: UHCCP DNSP |
$931.20
|
|
|
PR CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR
|
Professional
|
Both
|
$1,321.00
|
|
|
Service Code
|
HCPCS 57300
|
| Min. Negotiated Rate |
$528.40 |
| Max. Negotiated Rate |
$858.65 |
| Rate for Payer: Aetna Commercial |
$779.89
|
| Rate for Payer: Aetna Medicare |
$582.01
|
| Rate for Payer: BCBS Complete |
$528.40
|
| Rate for Payer: BCBS MAPPO |
$582.01
|
| Rate for Payer: BCN Medicare Advantage |
$582.01
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Cash Price |
$1,056.80
|
| Rate for Payer: Cofinity Commercial |
$838.09
|
| Rate for Payer: Cofinity Commercial |
$779.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$582.01
|
| Rate for Payer: Healthscope Commercial |
$698.41
|
| Rate for Payer: Healthscope Whirlpool |
$698.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$611.11
|
| Rate for Payer: Nomi Health Commercial |
$698.41
|
| Rate for Payer: PACE SWMI |
$582.01
|
| Rate for Payer: PHP Medicare Advantage |
$582.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.65
|
| Rate for Payer: Priority Health Medicare |
$582.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$582.01
|
| Rate for Payer: UHC Medicare Advantage |
$582.01
|
| Rate for Payer: UHCCP DNSP |
$582.01
|
|
