|
PR CORRECTION HAMMERTOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$371.34 |
| Max. Negotiated Rate |
$621.40 |
| Rate for Payer: Aetna Commercial |
$497.60
|
| Rate for Payer: Aetna Medicare |
$371.34
|
| Rate for Payer: BCBS Complete |
$382.40
|
| Rate for Payer: BCBS MAPPO |
$371.34
|
| Rate for Payer: BCN Medicare Advantage |
$371.34
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$534.73
|
| Rate for Payer: Cofinity Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.34
|
| Rate for Payer: Healthscope Commercial |
$445.61
|
| Rate for Payer: Healthscope Whirlpool |
$445.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.91
|
| Rate for Payer: Nomi Health Commercial |
$445.61
|
| Rate for Payer: PACE SWMI |
$371.34
|
| Rate for Payer: PHP Medicare Advantage |
$371.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health Medicare |
$371.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.34
|
| Rate for Payer: UHC Medicare Advantage |
$371.34
|
| Rate for Payer: UHCCP DNSP |
$371.34
|
|
|
PR CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 19355
|
| Min. Negotiated Rate |
$591.15 |
| Max. Negotiated Rate |
$1,075.75 |
| Rate for Payer: Aetna Commercial |
$792.14
|
| Rate for Payer: Aetna Medicare |
$591.15
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$591.15
|
| Rate for Payer: BCN Medicare Advantage |
$591.15
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$851.26
|
| Rate for Payer: Cofinity Commercial |
$792.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.15
|
| Rate for Payer: Healthscope Commercial |
$709.38
|
| Rate for Payer: Healthscope Whirlpool |
$709.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.71
|
| Rate for Payer: Nomi Health Commercial |
$709.38
|
| Rate for Payer: PACE SWMI |
$591.15
|
| Rate for Payer: PHP Medicare Advantage |
$591.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$591.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.15
|
| Rate for Payer: UHC Medicare Advantage |
$591.15
|
| Rate for Payer: UHCCP DNSP |
$591.15
|
|
|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$20.54
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$20.54
|
| Rate for Payer: BCN Medicare Advantage |
$20.54
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$24.65
|
| Rate for Payer: Healthscope Whirlpool |
$24.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$24.65
|
| Rate for Payer: PACE SWMI |
$20.54
|
| Rate for Payer: PHP Medicare Advantage |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$20.54
|
| Rate for Payer: UHCCP DNSP |
$20.54
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$493.38 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$661.13
|
| Rate for Payer: Aetna Medicare |
$493.38
|
| Rate for Payer: BCBS Complete |
$896.40
|
| Rate for Payer: BCBS MAPPO |
$493.38
|
| Rate for Payer: BCN Medicare Advantage |
$493.38
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cofinity Commercial |
$710.47
|
| Rate for Payer: Cofinity Commercial |
$661.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.38
|
| Rate for Payer: Healthscope Commercial |
$592.06
|
| Rate for Payer: Healthscope Whirlpool |
$592.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$518.05
|
| Rate for Payer: Nomi Health Commercial |
$592.06
|
| Rate for Payer: PACE SWMI |
$493.38
|
| Rate for Payer: PHP Medicare Advantage |
$493.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health Medicare |
$493.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.38
|
| Rate for Payer: UHC Medicare Advantage |
$493.38
|
| Rate for Payer: UHCCP DNSP |
$493.38
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$573.09 |
| Max. Negotiated Rate |
$1,285.70 |
| Rate for Payer: Aetna Commercial |
$767.94
|
| Rate for Payer: Aetna Medicare |
$573.09
|
| Rate for Payer: BCBS Complete |
$791.20
|
| Rate for Payer: BCBS MAPPO |
$573.09
|
| Rate for Payer: BCN Medicare Advantage |
$573.09
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$825.25
|
| Rate for Payer: Cofinity Commercial |
$767.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.09
|
| Rate for Payer: Healthscope Commercial |
$687.71
|
| Rate for Payer: Healthscope Whirlpool |
$687.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.74
|
| Rate for Payer: Nomi Health Commercial |
$687.71
|
| Rate for Payer: PACE SWMI |
$573.09
|
| Rate for Payer: PHP Medicare Advantage |
$573.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health Medicare |
$573.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.09
|
| Rate for Payer: UHC Medicare Advantage |
$573.09
|
| Rate for Payer: UHCCP DNSP |
$573.09
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 28297
|
| Min. Negotiated Rate |
$573.09 |
| Max. Negotiated Rate |
$1,285.70 |
| Rate for Payer: Aetna Commercial |
$767.94
|
| Rate for Payer: Aetna Medicare |
$573.09
|
| Rate for Payer: BCBS Complete |
$791.20
|
| Rate for Payer: BCBS MAPPO |
$573.09
|
| Rate for Payer: BCN Medicare Advantage |
$573.09
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$825.25
|
| Rate for Payer: Cofinity Commercial |
$767.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.09
|
| Rate for Payer: Healthscope Commercial |
$687.71
|
| Rate for Payer: Healthscope Whirlpool |
$687.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.74
|
| Rate for Payer: Nomi Health Commercial |
$687.71
|
| Rate for Payer: PACE SWMI |
$573.09
|
| Rate for Payer: PHP Medicare Advantage |
$573.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health Medicare |
$573.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.09
|
| Rate for Payer: UHC Medicare Advantage |
$573.09
|
| Rate for Payer: UHCCP DNSP |
$573.09
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,285.70 |
| Max. Negotiated Rate |
$1,978.00 |
| Rate for Payer: Aetna Commercial |
$1,780.20
|
| Rate for Payer: ASR ASR |
$1,918.66
|
| Rate for Payer: ASR Commercial |
$1,918.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.87
|
| Rate for Payer: BCN Commercial |
$1,533.54
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,859.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.40
|
| Rate for Payer: Healthscope Commercial |
$1,978.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.66
|
| Rate for Payer: Mclaren Commercial |
$1,780.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.30
|
| Rate for Payer: Nomi Health Commercial |
$1,621.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.64
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,285.70 |
| Max. Negotiated Rate |
$19,450.56 |
| Rate for Payer: Aetna Commercial |
$1,780.20
|
| Rate for Payer: Aetna Medicare |
$12,548.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: ASR ASR |
$1,918.66
|
| Rate for Payer: ASR Commercial |
$1,918.66
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.78
|
| Rate for Payer: BCN Commercial |
$1,533.54
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,859.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Healthscope Commercial |
$1,978.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,548.75
|
| Rate for Payer: Mclaren Commercial |
$1,780.20
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.30
|
| Rate for Payer: Nomi Health Commercial |
$1,621.96
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Commercial |
$13,803.62
|
| Rate for Payer: PHP Medicaid |
$6,726.13
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.12
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,386.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$19,450.56
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP DNSP |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
HCPCS 28295
|
| Min. Negotiated Rate |
$572.46 |
| Max. Negotiated Rate |
$1,068.60 |
| Rate for Payer: Aetna Commercial |
$767.10
|
| Rate for Payer: Aetna Medicare |
$572.46
|
| Rate for Payer: BCBS Complete |
$657.60
|
| Rate for Payer: BCBS MAPPO |
$572.46
|
| Rate for Payer: BCN Medicare Advantage |
$572.46
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cofinity Commercial |
$824.34
|
| Rate for Payer: Cofinity Commercial |
$767.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.46
|
| Rate for Payer: Healthscope Commercial |
$686.95
|
| Rate for Payer: Healthscope Whirlpool |
$686.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.08
|
| Rate for Payer: Nomi Health Commercial |
$686.95
|
| Rate for Payer: PACE SWMI |
$572.46
|
| Rate for Payer: PHP Medicare Advantage |
$572.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,068.60
|
| Rate for Payer: Priority Health Medicare |
$572.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.46
|
| Rate for Payer: UHC Medicare Advantage |
$572.46
|
| Rate for Payer: UHCCP DNSP |
$572.46
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 28298
|
| Min. Negotiated Rate |
$485.21 |
| Max. Negotiated Rate |
$1,242.15 |
| Rate for Payer: Aetna Commercial |
$650.18
|
| Rate for Payer: Aetna Medicare |
$485.21
|
| Rate for Payer: BCBS Complete |
$764.40
|
| Rate for Payer: BCBS MAPPO |
$485.21
|
| Rate for Payer: BCN Medicare Advantage |
$485.21
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$698.70
|
| Rate for Payer: Cofinity Commercial |
$650.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.21
|
| Rate for Payer: Healthscope Commercial |
$582.25
|
| Rate for Payer: Healthscope Whirlpool |
$582.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.47
|
| Rate for Payer: Nomi Health Commercial |
$582.25
|
| Rate for Payer: PACE SWMI |
$485.21
|
| Rate for Payer: PHP Medicare Advantage |
$485.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.15
|
| Rate for Payer: Priority Health Medicare |
$485.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$485.21
|
| Rate for Payer: UHC Medicare Advantage |
$485.21
|
| Rate for Payer: UHCCP DNSP |
$485.21
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$465.49 |
| Max. Negotiated Rate |
$1,157.00 |
| Rate for Payer: Aetna Commercial |
$623.76
|
| Rate for Payer: Aetna Medicare |
$465.49
|
| Rate for Payer: BCBS Complete |
$712.00
|
| Rate for Payer: BCBS MAPPO |
$465.49
|
| Rate for Payer: BCN Medicare Advantage |
$465.49
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$670.31
|
| Rate for Payer: Cofinity Commercial |
$623.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.49
|
| Rate for Payer: Healthscope Commercial |
$558.59
|
| Rate for Payer: Healthscope Whirlpool |
$558.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.76
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: PACE SWMI |
$465.49
|
| Rate for Payer: PHP Medicare Advantage |
$465.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.00
|
| Rate for Payer: Priority Health Medicare |
$465.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.49
|
| Rate for Payer: UHC Medicare Advantage |
$465.49
|
| Rate for Payer: UHCCP DNSP |
$465.49
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 28299
|
| Min. Negotiated Rate |
$571.07 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Commercial |
$765.23
|
| Rate for Payer: Aetna Medicare |
$571.07
|
| Rate for Payer: BCBS Complete |
$962.40
|
| Rate for Payer: BCBS MAPPO |
$571.07
|
| Rate for Payer: BCN Medicare Advantage |
$571.07
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cofinity Commercial |
$822.34
|
| Rate for Payer: Cofinity Commercial |
$765.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.07
|
| Rate for Payer: Healthscope Commercial |
$685.28
|
| Rate for Payer: Healthscope Whirlpool |
$685.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.62
|
| Rate for Payer: Nomi Health Commercial |
$685.28
|
| Rate for Payer: PACE SWMI |
$571.07
|
| Rate for Payer: PHP Medicare Advantage |
$571.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
| Rate for Payer: Priority Health Medicare |
$571.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.07
|
| Rate for Payer: UHC Medicare Advantage |
$571.07
|
| Rate for Payer: UHCCP DNSP |
$571.07
|
|
|
PR CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 67912
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$1,948.05 |
| Rate for Payer: Aetna Commercial |
$602.73
|
| Rate for Payer: Aetna Medicare |
$449.80
|
| Rate for Payer: BCBS Complete |
$1,198.80
|
| Rate for Payer: BCBS MAPPO |
$449.80
|
| Rate for Payer: BCN Medicare Advantage |
$449.80
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$647.71
|
| Rate for Payer: Cofinity Commercial |
$602.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.80
|
| Rate for Payer: Healthscope Commercial |
$539.76
|
| Rate for Payer: Healthscope Whirlpool |
$539.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.29
|
| Rate for Payer: Nomi Health Commercial |
$539.76
|
| Rate for Payer: PACE SWMI |
$449.80
|
| Rate for Payer: PHP Medicare Advantage |
$449.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health Medicare |
$449.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.80
|
| Rate for Payer: UHC Medicare Advantage |
$449.80
|
| Rate for Payer: UHCCP DNSP |
$449.80
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$1,268.80 |
| Max. Negotiated Rate |
$2,090.52 |
| Rate for Payer: Aetna Commercial |
$1,945.35
|
| Rate for Payer: Aetna Medicare |
$1,451.75
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: BCBS MAPPO |
$1,451.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.75
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$2,090.52
|
| Rate for Payer: Cofinity Commercial |
$1,945.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.75
|
| Rate for Payer: Healthscope Commercial |
$1,742.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,742.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.34
|
| Rate for Payer: Nomi Health Commercial |
$1,742.10
|
| Rate for Payer: PACE SWMI |
$1,451.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health Medicare |
$1,451.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.75
|
| Rate for Payer: UHCCP DNSP |
$1,451.75
|
|
|
PR COSMETIC CORRECTION OF INVERTED NIPPLES
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 00557
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
|
|
PR COSMETIC SCLEROTHERAPY
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00181
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG
|
Professional
|
Both
|
$6,256.00
|
|
|
Service Code
|
HCPCS 63064
|
| Min. Negotiated Rate |
$1,734.16 |
| Max. Negotiated Rate |
$4,066.40 |
| Rate for Payer: Aetna Commercial |
$2,323.77
|
| Rate for Payer: Aetna Medicare |
$1,734.16
|
| Rate for Payer: BCBS Complete |
$2,502.40
|
| Rate for Payer: BCBS MAPPO |
$1,734.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,734.16
|
| Rate for Payer: Cash Price |
$5,004.80
|
| Rate for Payer: Cash Price |
$5,004.80
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Cofinity Commercial |
$2,323.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,734.16
|
| Rate for Payer: Healthscope Commercial |
$2,080.99
|
| Rate for Payer: Healthscope Whirlpool |
$2,080.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,820.87
|
| Rate for Payer: Nomi Health Commercial |
$2,080.99
|
| Rate for Payer: PACE SWMI |
$1,734.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,734.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,066.40
|
| Rate for Payer: Priority Health Medicare |
$1,734.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,734.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,734.16
|
| Rate for Payer: UHCCP DNSP |
$1,734.16
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,145.00
|
|
|
Service Code
|
HCPCS 63066
|
| Min. Negotiated Rate |
$203.53 |
| Max. Negotiated Rate |
$1,394.25 |
| Rate for Payer: Aetna Commercial |
$272.73
|
| Rate for Payer: Aetna Medicare |
$203.53
|
| Rate for Payer: BCBS Complete |
$858.00
|
| Rate for Payer: BCBS MAPPO |
$203.53
|
| Rate for Payer: BCN Medicare Advantage |
$203.53
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cofinity Commercial |
$293.08
|
| Rate for Payer: Cofinity Commercial |
$272.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.53
|
| Rate for Payer: Healthscope Commercial |
$244.24
|
| Rate for Payer: Healthscope Whirlpool |
$244.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.71
|
| Rate for Payer: Nomi Health Commercial |
$244.24
|
| Rate for Payer: PACE SWMI |
$203.53
|
| Rate for Payer: PHP Medicare Advantage |
$203.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.25
|
| Rate for Payer: Priority Health Medicare |
$203.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.53
|
| Rate for Payer: UHC Medicare Advantage |
$203.53
|
| Rate for Payer: UHCCP DNSP |
$203.53
|
|
|
PR COUDE TIP URINARY CATHETER
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4352
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$10.21
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$7.62
|
| Rate for Payer: BCN Medicare Advantage |
$7.62
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$10.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$9.14
|
| Rate for Payer: Healthscope Whirlpool |
$9.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$9.14
|
| Rate for Payer: PACE SWMI |
$7.62
|
| Rate for Payer: PHP Medicare Advantage |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$7.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.62
|
| Rate for Payer: UHC Medicare Advantage |
$7.62
|
| Rate for Payer: UHCCP DNSP |
$7.62
|
|
|
PR COUNSEL IMMUNE <21 16-30 M
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0314
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
|
|
PR COUNSEL IMMUNE <21 5-15 M
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0315
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR CPAP VENTILATION CPAP INITIATION&MGMT
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 94660
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$151.45 |
| Rate for Payer: Aetna Commercial |
$46.54
|
| Rate for Payer: Aetna Medicare |
$34.73
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$34.73
|
| Rate for Payer: BCN Medicare Advantage |
$34.73
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$50.01
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.73
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Healthscope Whirlpool |
$41.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.47
|
| Rate for Payer: Nomi Health Commercial |
$41.68
|
| Rate for Payer: PACE SWMI |
$34.73
|
| Rate for Payer: PHP Medicare Advantage |
$34.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$34.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.73
|
| Rate for Payer: UHC Medicare Advantage |
$34.73
|
| Rate for Payer: UHCCP DNSP |
$34.73
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 99489
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Aetna Commercial |
$62.19
|
| Rate for Payer: Aetna Medicare |
$46.41
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$66.83
|
| Rate for Payer: Cofinity Commercial |
$62.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$51.05
|
| Rate for Payer: Healthscope Whirlpool |
$51.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$46.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP DNSP |
$46.41
|
|
