|
PR REPAIR ANORECTAL FISTULA PLUG
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
HCPCS 46707
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$891.96 |
| Rate for Payer: Aetna Commercial |
$665.35
|
| Rate for Payer: Aetna Medicare |
$496.53
|
| Rate for Payer: BCBS Complete |
$341.29
|
| Rate for Payer: BCBS MAPPO |
$496.53
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: BCN Medicare Advantage |
$496.53
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cofinity Commercial |
$665.35
|
| Rate for Payer: Cofinity Commercial |
$715.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.53
|
| Rate for Payer: Healthscope Commercial |
$595.84
|
| Rate for Payer: Healthscope Whirlpool |
$595.84
|
| Rate for Payer: Meridian Medicaid |
$341.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.36
|
| Rate for Payer: PACE SWMI |
$496.53
|
| Rate for Payer: PHP Medicare Advantage |
$496.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$891.96
|
| Rate for Payer: Priority Health Medicare |
$496.53
|
| Rate for Payer: Priority Health Narrow Network |
$891.96
|
| Rate for Payer: UHC Medicare Advantage |
$511.43
|
|
|
PR REPAIR BIFID EARLOBES - BILATERAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 00535
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
|
|
PR REPAIR BIFID EARLOBES - UNILATERAL
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00534
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
PR REPAIR BLOOD VESSEL DIRECT HAND FINGER
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 35207
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$1,208.08 |
| Rate for Payer: Aetna Commercial |
$998.81
|
| Rate for Payer: Aetna Medicare |
$745.38
|
| Rate for Payer: BCBS Complete |
$508.81
|
| Rate for Payer: BCBS MAPPO |
$745.38
|
| Rate for Payer: BCBS Trust/PPO |
$292.68
|
| Rate for Payer: BCN Commercial |
$1,109.79
|
| Rate for Payer: BCN Medicare Advantage |
$745.38
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$998.81
|
| Rate for Payer: Cofinity Commercial |
$1,073.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.38
|
| Rate for Payer: Healthscope Commercial |
$894.46
|
| Rate for Payer: Healthscope Whirlpool |
$894.46
|
| Rate for Payer: Meridian Medicaid |
$508.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$782.65
|
| Rate for Payer: PACE SWMI |
$745.38
|
| Rate for Payer: PHP Medicare Advantage |
$745.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.08
|
| Rate for Payer: Priority Health Medicare |
$745.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.08
|
| Rate for Payer: UHC Medicare Advantage |
$767.74
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,157.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$586.18 |
| Max. Negotiated Rate |
$2,909.90 |
| Rate for Payer: Aetna Commercial |
$1,233.36
|
| Rate for Payer: Aetna Medicare |
$920.42
|
| Rate for Payer: BCBS Complete |
$615.49
|
| Rate for Payer: BCBS MAPPO |
$920.42
|
| Rate for Payer: BCBS Trust/PPO |
$871.17
|
| Rate for Payer: BCN Commercial |
$1,340.94
|
| Rate for Payer: BCN Medicare Advantage |
$920.42
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cash Price |
$3,325.60
|
| Rate for Payer: Cofinity Commercial |
$1,325.40
|
| Rate for Payer: Cofinity Commercial |
$1,233.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$920.42
|
| Rate for Payer: Healthscope Commercial |
$1,104.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,104.50
|
| Rate for Payer: Meridian Medicaid |
$615.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$966.44
|
| Rate for Payer: PACE SWMI |
$920.42
|
| Rate for Payer: PHP Medicare Advantage |
$920.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,909.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,459.68
|
| Rate for Payer: Priority Health Medicare |
$920.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.68
|
| Rate for Payer: UHC Medicare Advantage |
$948.03
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$2,735.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$497.99 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,035.77
|
| Rate for Payer: Aetna Medicare |
$772.96
|
| Rate for Payer: BCBS Complete |
$522.89
|
| Rate for Payer: BCBS MAPPO |
$772.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.46
|
| Rate for Payer: BCN Commercial |
$1,129.33
|
| Rate for Payer: BCN Medicare Advantage |
$772.96
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cofinity Commercial |
$1,035.77
|
| Rate for Payer: Cofinity Commercial |
$1,113.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.96
|
| Rate for Payer: Healthscope Commercial |
$927.55
|
| Rate for Payer: Healthscope Whirlpool |
$927.55
|
| Rate for Payer: Meridian Medicaid |
$522.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$811.61
|
| Rate for Payer: PACE SWMI |
$772.96
|
| Rate for Payer: PHP Medicare Advantage |
$772.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,229.35
|
| Rate for Payer: Priority Health Medicare |
$772.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,229.35
|
| Rate for Payer: UHC Medicare Advantage |
$796.15
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,764.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$808.30 |
| Max. Negotiated Rate |
$2,736.93 |
| Rate for Payer: Aetna Commercial |
$2,315.01
|
| Rate for Payer: Aetna Medicare |
$1,727.62
|
| Rate for Payer: BCBS Complete |
$1,146.21
|
| Rate for Payer: BCBS MAPPO |
$1,727.62
|
| Rate for Payer: BCBS Trust/PPO |
$808.30
|
| Rate for Payer: BCN Commercial |
$2,514.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,727.62
|
| Rate for Payer: Cash Price |
$3,011.20
|
| Rate for Payer: Cash Price |
$3,011.20
|
| Rate for Payer: Cofinity Commercial |
$2,487.77
|
| Rate for Payer: Cofinity Commercial |
$2,315.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,727.62
|
| Rate for Payer: Healthscope Commercial |
$2,073.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,073.14
|
| Rate for Payer: Meridian Medicaid |
$1,146.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,814.00
|
| Rate for Payer: PACE SWMI |
$1,727.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,727.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,091.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,634.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,736.93
|
| Rate for Payer: Priority Health Medicare |
$1,727.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,736.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,779.45
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,485.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$3,139.50 |
| Rate for Payer: Aetna Commercial |
$1,346.20
|
| Rate for Payer: Aetna Medicare |
$1,004.63
|
| Rate for Payer: BCBS Complete |
$664.02
|
| Rate for Payer: BCBS MAPPO |
$1,004.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,015.92
|
| Rate for Payer: BCN Commercial |
$1,459.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,004.63
|
| Rate for Payer: Cash Price |
$3,588.00
|
| Rate for Payer: Cash Price |
$3,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,346.20
|
| Rate for Payer: Cofinity Commercial |
$1,446.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,004.63
|
| Rate for Payer: Healthscope Commercial |
$1,205.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,205.56
|
| Rate for Payer: Meridian Medicaid |
$664.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,054.86
|
| Rate for Payer: PACE SWMI |
$1,004.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,004.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$632.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,139.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,588.42
|
| Rate for Payer: Priority Health Medicare |
$1,004.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,588.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,034.77
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$613.23 |
| Max. Negotiated Rate |
$3,220.00 |
| Rate for Payer: Aetna Commercial |
$1,294.95
|
| Rate for Payer: Aetna Medicare |
$966.38
|
| Rate for Payer: BCBS Complete |
$643.89
|
| Rate for Payer: BCBS MAPPO |
$966.38
|
| Rate for Payer: BCBS Trust/PPO |
$773.96
|
| Rate for Payer: BCN Commercial |
$1,398.59
|
| Rate for Payer: BCN Medicare Advantage |
$966.38
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$1,391.59
|
| Rate for Payer: Cofinity Commercial |
$1,294.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.38
|
| Rate for Payer: Healthscope Commercial |
$1,159.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,159.66
|
| Rate for Payer: Meridian Medicaid |
$643.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,014.70
|
| Rate for Payer: PACE SWMI |
$966.38
|
| Rate for Payer: PHP Medicare Advantage |
$966.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$613.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,220.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.46
|
| Rate for Payer: Priority Health Medicare |
$966.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.46
|
| Rate for Payer: UHC Medicare Advantage |
$995.37
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,859.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$788.95 |
| Max. Negotiated Rate |
$2,591.31 |
| Rate for Payer: Aetna Commercial |
$1,646.83
|
| Rate for Payer: Aetna Medicare |
$1,228.98
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$1,228.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.31
|
| Rate for Payer: BCN Commercial |
$1,810.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,228.98
|
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Cash Price |
$1,487.20
|
| Rate for Payer: Cofinity Commercial |
$1,769.73
|
| Rate for Payer: Cofinity Commercial |
$1,646.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,228.98
|
| Rate for Payer: Healthscope Commercial |
$1,474.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,474.78
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,290.43
|
| Rate for Payer: PACE SWMI |
$1,228.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,228.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,970.37
|
| Rate for Payer: Priority Health Medicare |
$1,228.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,970.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,265.85
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,625.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$627.07 |
| Max. Negotiated Rate |
$2,563.84 |
| Rate for Payer: Aetna Commercial |
$1,312.97
|
| Rate for Payer: Aetna Medicare |
$979.83
|
| Rate for Payer: BCBS Complete |
$658.42
|
| Rate for Payer: BCBS MAPPO |
$979.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,563.84
|
| Rate for Payer: BCN Commercial |
$1,427.91
|
| Rate for Payer: BCN Medicare Advantage |
$979.83
|
| Rate for Payer: Cash Price |
$2,900.00
|
| Rate for Payer: Cash Price |
$2,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,312.97
|
| Rate for Payer: Cofinity Commercial |
$1,410.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.83
|
| Rate for Payer: Healthscope Commercial |
$1,175.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.80
|
| Rate for Payer: Meridian Medicaid |
$658.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,028.82
|
| Rate for Payer: PACE SWMI |
$979.83
|
| Rate for Payer: PHP Medicare Advantage |
$979.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,537.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,554.37
|
| Rate for Payer: Priority Health Medicare |
$979.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,554.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,009.22
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$183.32 |
| Max. Negotiated Rate |
$944.61 |
| Rate for Payer: Aetna Commercial |
$647.19
|
| Rate for Payer: Aetna Medicare |
$482.98
|
| Rate for Payer: BCBS Complete |
$335.93
|
| Rate for Payer: BCBS MAPPO |
$482.98
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$944.61
|
| Rate for Payer: BCN Medicare Advantage |
$482.98
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cofinity Commercial |
$695.49
|
| Rate for Payer: Cofinity Commercial |
$647.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.98
|
| Rate for Payer: Healthscope Commercial |
$579.58
|
| Rate for Payer: Healthscope Whirlpool |
$579.58
|
| Rate for Payer: Meridian Medicaid |
$335.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$507.13
|
| Rate for Payer: PACE SWMI |
$482.98
|
| Rate for Payer: PHP Medicare Advantage |
$482.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.52
|
| Rate for Payer: Priority Health Medicare |
$482.98
|
| Rate for Payer: Priority Health Narrow Network |
$870.52
|
| Rate for Payer: UHC Medicare Advantage |
$497.47
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,535.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$786.64 |
| Max. Negotiated Rate |
$6,356.36 |
| Rate for Payer: Aetna Commercial |
$5,387.04
|
| Rate for Payer: Aetna Medicare |
$4,020.18
|
| Rate for Payer: BCBS Complete |
$2,687.82
|
| Rate for Payer: BCBS MAPPO |
$4,020.18
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$5,839.21
|
| Rate for Payer: BCN Medicare Advantage |
$4,020.18
|
| Rate for Payer: Cash Price |
$6,028.00
|
| Rate for Payer: Cash Price |
$6,028.00
|
| Rate for Payer: Cofinity Commercial |
$5,789.06
|
| Rate for Payer: Cofinity Commercial |
$5,387.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,020.18
|
| Rate for Payer: Healthscope Commercial |
$4,824.22
|
| Rate for Payer: Healthscope Whirlpool |
$4,824.22
|
| Rate for Payer: Meridian Medicaid |
$2,687.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,221.19
|
| Rate for Payer: PACE SWMI |
$4,020.18
|
| Rate for Payer: PHP Medicare Advantage |
$4,020.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,356.36
|
| Rate for Payer: Priority Health Medicare |
$4,020.18
|
| Rate for Payer: Priority Health Narrow Network |
$6,356.36
|
| Rate for Payer: UHC Medicare Advantage |
$4,140.79
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,507.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,529.34 |
| Max. Negotiated Rate |
$3,794.45 |
| Rate for Payer: Aetna Commercial |
$3,210.93
|
| Rate for Payer: Aetna Medicare |
$2,396.22
|
| Rate for Payer: BCBS Complete |
$1,605.81
|
| Rate for Payer: BCBS MAPPO |
$2,396.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.84
|
| Rate for Payer: BCN Commercial |
$3,485.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,396.22
|
| Rate for Payer: Cash Price |
$3,605.60
|
| Rate for Payer: Cash Price |
$3,605.60
|
| Rate for Payer: Cofinity Commercial |
$3,450.56
|
| Rate for Payer: Cofinity Commercial |
$3,210.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,396.22
|
| Rate for Payer: Healthscope Commercial |
$2,875.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,875.46
|
| Rate for Payer: Meridian Medicaid |
$1,605.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,516.03
|
| Rate for Payer: PACE SWMI |
$2,396.22
|
| Rate for Payer: PHP Medicare Advantage |
$2,396.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,529.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,154.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,794.45
|
| Rate for Payer: Priority Health Medicare |
$2,396.22
|
| Rate for Payer: Priority Health Narrow Network |
$3,794.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,468.11
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$476.27 |
| Max. Negotiated Rate |
$1,096.60 |
| Rate for Payer: Aetna Commercial |
$968.77
|
| Rate for Payer: Aetna Medicare |
$722.96
|
| Rate for Payer: BCBS Complete |
$500.08
|
| Rate for Payer: BCBS MAPPO |
$722.96
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$1,096.60
|
| Rate for Payer: BCN Medicare Advantage |
$722.96
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$968.77
|
| Rate for Payer: Cofinity Commercial |
$1,041.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.96
|
| Rate for Payer: Healthscope Commercial |
$867.55
|
| Rate for Payer: Healthscope Whirlpool |
$867.55
|
| Rate for Payer: Meridian Medicaid |
$500.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$759.11
|
| Rate for Payer: PACE SWMI |
$722.96
|
| Rate for Payer: PHP Medicare Advantage |
$722.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,039.07
|
| Rate for Payer: Priority Health Medicare |
$722.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,039.07
|
| Rate for Payer: UHC Medicare Advantage |
$744.65
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$1,139.30 |
| Rate for Payer: Aetna Commercial |
$362.87
|
| Rate for Payer: Aetna Medicare |
$270.80
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS MAPPO |
$270.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.30
|
| Rate for Payer: BCN Commercial |
$622.09
|
| Rate for Payer: BCN Medicare Advantage |
$270.80
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cofinity Commercial |
$362.87
|
| Rate for Payer: Cofinity Commercial |
$389.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.80
|
| Rate for Payer: Healthscope Commercial |
$324.96
|
| Rate for Payer: Healthscope Whirlpool |
$324.96
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.34
|
| Rate for Payer: PACE SWMI |
$270.80
|
| Rate for Payer: PHP Medicare Advantage |
$270.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.11
|
| Rate for Payer: Priority Health Medicare |
$270.80
|
| Rate for Payer: Priority Health Narrow Network |
$339.11
|
| Rate for Payer: UHC Medicare Advantage |
$278.92
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,208.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$2,272.50 |
| Rate for Payer: Aetna Commercial |
$437.64
|
| Rate for Payer: Aetna Medicare |
$326.60
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$326.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.50
|
| Rate for Payer: BCN Commercial |
$729.10
|
| Rate for Payer: BCN Medicare Advantage |
$326.60
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Cofinity Commercial |
$470.30
|
| Rate for Payer: Cofinity Commercial |
$437.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.60
|
| Rate for Payer: Healthscope Commercial |
$391.92
|
| Rate for Payer: Healthscope Whirlpool |
$391.92
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.93
|
| Rate for Payer: PACE SWMI |
$326.60
|
| Rate for Payer: PHP Medicare Advantage |
$326.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.57
|
| Rate for Payer: Priority Health Medicare |
$326.60
|
| Rate for Payer: Priority Health Narrow Network |
$408.57
|
| Rate for Payer: UHC Medicare Advantage |
$336.40
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$314.56
|
| Rate for Payer: Aetna Medicare |
$234.75
|
| Rate for Payer: BCBS Complete |
$161.25
|
| Rate for Payer: BCBS MAPPO |
$234.75
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$570.29
|
| Rate for Payer: BCN Medicare Advantage |
$234.75
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$314.56
|
| Rate for Payer: Cofinity Commercial |
$338.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.75
|
| Rate for Payer: Healthscope Commercial |
$281.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.70
|
| Rate for Payer: Meridian Medicaid |
$161.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.49
|
| Rate for Payer: PACE SWMI |
$234.75
|
| Rate for Payer: PHP Medicare Advantage |
$234.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.30
|
| Rate for Payer: Priority Health Medicare |
$234.75
|
| Rate for Payer: Priority Health Narrow Network |
$294.30
|
| Rate for Payer: UHC Medicare Advantage |
$241.79
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Aetna Commercial |
$394.51
|
| Rate for Payer: Aetna Medicare |
$294.41
|
| Rate for Payer: BCBS Complete |
$201.28
|
| Rate for Payer: BCBS MAPPO |
$294.41
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$691.96
|
| Rate for Payer: BCN Medicare Advantage |
$294.41
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$423.95
|
| Rate for Payer: Cofinity Commercial |
$394.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.41
|
| Rate for Payer: Healthscope Commercial |
$353.29
|
| Rate for Payer: Healthscope Whirlpool |
$353.29
|
| Rate for Payer: Meridian Medicaid |
$201.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.13
|
| Rate for Payer: PACE SWMI |
$294.41
|
| Rate for Payer: PHP Medicare Advantage |
$294.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.70
|
| Rate for Payer: Priority Health Medicare |
$294.41
|
| Rate for Payer: Priority Health Narrow Network |
$368.70
|
| Rate for Payer: UHC Medicare Advantage |
$303.24
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$163.52
|
| Rate for Payer: Aetna Medicare |
$122.03
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$122.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,316.25
|
| Rate for Payer: BCN Commercial |
$245.80
|
| Rate for Payer: BCN Medicare Advantage |
$122.03
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$175.72
|
| Rate for Payer: Cofinity Commercial |
$163.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.03
|
| Rate for Payer: Healthscope Commercial |
$146.44
|
| Rate for Payer: Healthscope Whirlpool |
$146.44
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.13
|
| Rate for Payer: PACE SWMI |
$122.03
|
| Rate for Payer: PHP Medicare Advantage |
$122.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.67
|
| Rate for Payer: Priority Health Medicare |
$122.03
|
| Rate for Payer: Priority Health Narrow Network |
$151.67
|
| Rate for Payer: UHC Medicare Advantage |
$125.69
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$522.88 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Aetna Medicare |
$224.68
|
| Rate for Payer: BCBS Complete |
$154.54
|
| Rate for Payer: BCBS MAPPO |
$224.68
|
| Rate for Payer: BCBS Trust/PPO |
$84.02
|
| Rate for Payer: BCN Commercial |
$522.88
|
| Rate for Payer: BCN Medicare Advantage |
$224.68
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cofinity Commercial |
$301.07
|
| Rate for Payer: Cofinity Commercial |
$323.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.68
|
| Rate for Payer: Healthscope Commercial |
$269.62
|
| Rate for Payer: Healthscope Whirlpool |
$269.62
|
| Rate for Payer: Meridian Medicaid |
$154.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$235.91
|
| Rate for Payer: PACE SWMI |
$224.68
|
| Rate for Payer: PHP Medicare Advantage |
$224.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.20
|
| Rate for Payer: Priority Health Medicare |
$224.68
|
| Rate for Payer: Priority Health Narrow Network |
$283.20
|
| Rate for Payer: UHC Medicare Advantage |
$231.42
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$305.37 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$792.00
|
| Rate for Payer: Aetna Medicare |
$558.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: ASR ASR |
$853.60
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$682.26
|
| Rate for Payer: BCN Commercial |
$682.26
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cofinity Commercial |
$827.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$880.00
|
| Rate for Payer: Healthscope Whirlpool |
$853.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.26
|
| Rate for Payer: Mclaren Commercial |
$792.00
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$748.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$614.09
|
| Rate for Payer: PHP Medicaid |
$305.37
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.41
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$357.93
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.40
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 13121
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$624.53 |
| Rate for Payer: Aetna Commercial |
$334.68
|
| Rate for Payer: Aetna Medicare |
$249.76
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: BCBS MAPPO |
$249.76
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| Rate for Payer: BCN Medicare Advantage |
$249.76
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cofinity Commercial |
$359.65
|
| Rate for Payer: Cofinity Commercial |
$334.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.76
|
| Rate for Payer: Healthscope Commercial |
$299.71
|
| Rate for Payer: Healthscope Whirlpool |
$299.71
|
| Rate for Payer: Meridian Medicaid |
$171.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.25
|
| Rate for Payer: PACE SWMI |
$249.76
|
| Rate for Payer: PHP Medicare Advantage |
$249.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.21
|
| Rate for Payer: Priority Health Medicare |
$249.76
|
| Rate for Payer: Priority Health Narrow Network |
$313.21
|
| Rate for Payer: UHC Medicare Advantage |
$257.25
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$624.53 |
| Rate for Payer: Aetna Commercial |
$334.68
|
| Rate for Payer: Aetna Medicare |
$249.76
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: BCBS MAPPO |
$249.76
|
| Rate for Payer: BCBS Trust/PPO |
$347.82
|
| Rate for Payer: BCN Commercial |
$624.53
|
| Rate for Payer: BCN Medicare Advantage |
$249.76
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cofinity Commercial |
$359.65
|
| Rate for Payer: Cofinity Commercial |
$334.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.76
|
| Rate for Payer: Healthscope Commercial |
$299.71
|
| Rate for Payer: Healthscope Whirlpool |
$299.71
|
| Rate for Payer: Meridian Medicaid |
$171.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.25
|
| Rate for Payer: PACE SWMI |
$249.76
|
| Rate for Payer: PHP Medicare Advantage |
$249.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.21
|
| Rate for Payer: Priority Health Medicare |
$249.76
|
| Rate for Payer: Priority Health Narrow Network |
$313.21
|
| Rate for Payer: UHC Medicare Advantage |
$257.25
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$616.00 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$792.00
|
| Rate for Payer: ASR ASR |
$853.60
|
| Rate for Payer: BCBS Trust/PPO |
$682.26
|
| Rate for Payer: BCN Commercial |
$682.26
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cofinity Commercial |
$827.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.00
|
| Rate for Payer: Healthscope Commercial |
$880.00
|
| Rate for Payer: Healthscope Whirlpool |
$853.60
|
| Rate for Payer: Mclaren Commercial |
$792.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$748.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.40
|
|
