|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$479.04 |
| Max. Negotiated Rate |
$1,449.49 |
| Rate for Payer: Aetna Commercial |
$981.62
|
| Rate for Payer: Aetna Medicare |
$732.55
|
| Rate for Payer: BCBS Complete |
$502.99
|
| Rate for Payer: BCBS MAPPO |
$732.55
|
| Rate for Payer: BCN Commercial |
$1,270.85
|
| Rate for Payer: BCN Medicare Advantage |
$732.55
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cofinity Commercial |
$981.62
|
| Rate for Payer: Cofinity Commercial |
$1,054.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$732.55
|
| Rate for Payer: Healthscope Commercial |
$879.06
|
| Rate for Payer: Healthscope Whirlpool |
$879.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.18
|
| Rate for Payer: Meridian Medicaid |
$502.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$805.80
|
| Rate for Payer: Nomi Health Commercial |
$879.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,338.75
|
| Rate for Payer: PACE SWMI |
$732.55
|
| Rate for Payer: PHP Medicare Advantage |
$732.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,163.15
|
| Rate for Payer: Priority Health Medicare |
$732.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,163.15
|
| Rate for Payer: Railroad Medicare Medicare |
$732.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,449.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$732.55
|
| Rate for Payer: UHC Exchange |
$1,449.49
|
| Rate for Payer: UHC Medicaid |
$479.04
|
| Rate for Payer: UHCCP DNSP |
$732.55
|
| Rate for Payer: UHCCP Medicaid |
$479.04
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$26.40
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$26.40
|
| Rate for Payer: BCN Commercial |
$46.81
|
| Rate for Payer: BCN Medicare Advantage |
$26.40
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$38.02
|
| Rate for Payer: Cofinity Commercial |
$35.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$31.68
|
| Rate for Payer: Healthscope Whirlpool |
$31.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.72
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$31.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.50
|
| Rate for Payer: PACE SWMI |
$26.40
|
| Rate for Payer: PHP Medicare Advantage |
$26.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.06
|
| Rate for Payer: Priority Health Medicare |
$26.40
|
| Rate for Payer: Priority Health Narrow Network |
$40.06
|
| Rate for Payer: Railroad Medicare Medicare |
$26.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.40
|
| Rate for Payer: UHC Exchange |
$42.14
|
| Rate for Payer: UHC Medicaid |
$17.04
|
| Rate for Payer: UHCCP DNSP |
$26.40
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$5.59
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$5.66
|
| Rate for Payer: BCN Medicare Advantage |
$5.59
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.59
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: Healthscope Whirlpool |
$6.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.15
|
| Rate for Payer: Nomi Health Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: PACE SWMI |
$5.59
|
| Rate for Payer: PHP Medicare Advantage |
$5.59
|
| Rate for Payer: Priority Health Medicare |
$5.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.59
|
| Rate for Payer: UHC Exchange |
$6.20
|
| Rate for Payer: UHCCP DNSP |
$5.59
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.62
|
| Rate for Payer: UHC Exchange |
$18.62
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.94
|
| Rate for Payer: UHC Exchange |
$55.94
|
|
|
PR FOLLOWUP EVAL OF FOOT PT LOP
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0246
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: Aetna Medicare |
$17.28
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$17.28
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$17.28
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.28
|
| Rate for Payer: Healthscope Commercial |
$20.74
|
| Rate for Payer: Healthscope Whirlpool |
$20.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$20.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.00
|
| Rate for Payer: PACE SWMI |
$17.28
|
| Rate for Payer: PHP Medicare Advantage |
$17.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.37
|
| Rate for Payer: Priority Health Medicare |
$17.28
|
| Rate for Payer: Priority Health Narrow Network |
$22.37
|
| Rate for Payer: Railroad Medicare Medicare |
$17.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.28
|
| Rate for Payer: UHC Exchange |
$29.71
|
| Rate for Payer: UHCCP DNSP |
$17.28
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Commercial |
$20.00
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$80.57 |
| Max. Negotiated Rate |
$355.78 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna Medicare |
$247.07
|
| Rate for Payer: BCBS Complete |
$85.20
|
| Rate for Payer: BCBS MAPPO |
$247.07
|
| Rate for Payer: BCN Commercial |
$236.55
|
| Rate for Payer: BCN Medicare Advantage |
$247.07
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$355.78
|
| Rate for Payer: Cofinity Commercial |
$331.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.07
|
| Rate for Payer: Healthscope Commercial |
$296.48
|
| Rate for Payer: Healthscope Whirlpool |
$296.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.78
|
| Rate for Payer: Nomi Health Commercial |
$296.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.75
|
| Rate for Payer: PACE SWMI |
$247.07
|
| Rate for Payer: PHP Medicare Advantage |
$247.07
|
| Rate for Payer: Priority Health Medicare |
$247.07
|
| Rate for Payer: Railroad Medicare Medicare |
$247.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$247.07
|
| Rate for Payer: UHC Exchange |
$80.57
|
| Rate for Payer: UHCCP DNSP |
$247.07
|
|
|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$130.54 |
| Rate for Payer: Aetna Commercial |
$121.47
|
| Rate for Payer: Aetna Medicare |
$90.65
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$90.65
|
| Rate for Payer: BCN Commercial |
$86.79
|
| Rate for Payer: BCN Medicare Advantage |
$90.65
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$121.47
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.65
|
| Rate for Payer: Healthscope Commercial |
$108.78
|
| Rate for Payer: Healthscope Whirlpool |
$108.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.72
|
| Rate for Payer: Nomi Health Commercial |
$108.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PACE SWMI |
$90.65
|
| Rate for Payer: PHP Medicare Advantage |
$90.65
|
| Rate for Payer: Priority Health Medicare |
$90.65
|
| Rate for Payer: Railroad Medicare Medicare |
$90.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$90.65
|
| Rate for Payer: UHC Exchange |
$29.56
|
| Rate for Payer: UHCCP DNSP |
$90.65
|
|
|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$90.03 |
| Rate for Payer: Aetna Commercial |
$83.78
|
| Rate for Payer: Aetna Medicare |
$62.52
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$62.52
|
| Rate for Payer: BCN Commercial |
$59.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.52
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$90.03
|
| Rate for Payer: Cofinity Commercial |
$83.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.52
|
| Rate for Payer: Healthscope Commercial |
$75.02
|
| Rate for Payer: Healthscope Whirlpool |
$75.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.77
|
| Rate for Payer: Nomi Health Commercial |
$75.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE SWMI |
$62.52
|
| Rate for Payer: PHP Medicare Advantage |
$62.52
|
| Rate for Payer: Priority Health Medicare |
$62.52
|
| Rate for Payer: Railroad Medicare Medicare |
$62.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.52
|
| Rate for Payer: UHC Exchange |
$20.38
|
| Rate for Payer: UHCCP DNSP |
$62.52
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$98.45
|
| Rate for Payer: Aetna Medicare |
$73.47
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$73.47
|
| Rate for Payer: BCN Commercial |
$70.34
|
| Rate for Payer: BCN Medicare Advantage |
$73.47
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$98.45
|
| Rate for Payer: Cofinity Commercial |
$105.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.47
|
| Rate for Payer: Healthscope Commercial |
$88.16
|
| Rate for Payer: Healthscope Whirlpool |
$88.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.82
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.00
|
| Rate for Payer: PACE SWMI |
$73.47
|
| Rate for Payer: PHP Medicare Advantage |
$73.47
|
| Rate for Payer: Priority Health Medicare |
$73.47
|
| Rate for Payer: Railroad Medicare Medicare |
$73.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.47
|
| Rate for Payer: UHC Exchange |
$23.96
|
| Rate for Payer: UHCCP DNSP |
$73.47
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,100.48 |
| Rate for Payer: Aetna Commercial |
$1,024.05
|
| Rate for Payer: Aetna Medicare |
$764.22
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$764.22
|
| Rate for Payer: BCN Commercial |
$731.68
|
| Rate for Payer: BCN Medicare Advantage |
$764.22
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$1,100.48
|
| Rate for Payer: Cofinity Commercial |
$1,024.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.22
|
| Rate for Payer: Healthscope Commercial |
$917.06
|
| Rate for Payer: Healthscope Whirlpool |
$917.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$802.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$840.64
|
| Rate for Payer: Nomi Health Commercial |
$917.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.75
|
| Rate for Payer: PACE SWMI |
$764.22
|
| Rate for Payer: PHP Medicare Advantage |
$764.22
|
| Rate for Payer: Priority Health Medicare |
$764.22
|
| Rate for Payer: Railroad Medicare Medicare |
$764.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$764.22
|
| Rate for Payer: UHC Exchange |
$249.19
|
| Rate for Payer: UHCCP DNSP |
$764.22
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,327.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$1,745.25 |
| Rate for Payer: Aetna Commercial |
$1,148.76
|
| Rate for Payer: Aetna Medicare |
$857.28
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: BCBS MAPPO |
$857.28
|
| Rate for Payer: BCN Commercial |
$1,498.42
|
| Rate for Payer: BCN Medicare Advantage |
$857.28
|
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Cofinity Commercial |
$1,234.48
|
| Rate for Payer: Cofinity Commercial |
$1,148.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$857.28
|
| Rate for Payer: Healthscope Commercial |
$1,028.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,028.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$900.14
|
| Rate for Payer: Meridian Medicaid |
$587.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$943.01
|
| Rate for Payer: Nomi Health Commercial |
$1,028.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,745.25
|
| Rate for Payer: PACE SWMI |
$857.28
|
| Rate for Payer: PHP Medicare Advantage |
$857.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$559.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,371.45
|
| Rate for Payer: Priority Health Medicare |
$857.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,371.45
|
| Rate for Payer: Railroad Medicare Medicare |
$857.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,735.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$857.28
|
| Rate for Payer: UHC Exchange |
$1,735.06
|
| Rate for Payer: UHC Medicaid |
$559.55
|
| Rate for Payer: UHCCP DNSP |
$857.28
|
| Rate for Payer: UHCCP Medicaid |
$559.55
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Commercial |
$67.40
|
| Rate for Payer: Aetna Medicare |
$50.30
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.30
|
| Rate for Payer: BCN Commercial |
$85.15
|
| Rate for Payer: BCN Medicare Advantage |
$50.30
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.30
|
| Rate for Payer: Healthscope Commercial |
$60.36
|
| Rate for Payer: Healthscope Whirlpool |
$60.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.81
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.33
|
| Rate for Payer: Nomi Health Commercial |
$60.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: PACE SWMI |
$50.30
|
| Rate for Payer: PHP Medicare Advantage |
$50.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.76
|
| Rate for Payer: Priority Health Medicare |
$50.30
|
| Rate for Payer: Priority Health Narrow Network |
$92.76
|
| Rate for Payer: Railroad Medicare Medicare |
$50.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50.30
|
| Rate for Payer: UHC Exchange |
$102.05
|
| Rate for Payer: UHC Medicaid |
$32.16
|
| Rate for Payer: UHCCP DNSP |
$50.30
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$77.82 |
| Max. Negotiated Rate |
$343.64 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: Aetna Medicare |
$238.64
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCBS MAPPO |
$238.64
|
| Rate for Payer: BCN Commercial |
$228.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.64
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$343.64
|
| Rate for Payer: Cofinity Commercial |
$319.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.64
|
| Rate for Payer: Healthscope Commercial |
$286.37
|
| Rate for Payer: Healthscope Whirlpool |
$286.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$262.50
|
| Rate for Payer: Nomi Health Commercial |
$286.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.50
|
| Rate for Payer: PACE SWMI |
$238.64
|
| Rate for Payer: PHP Medicare Advantage |
$238.64
|
| Rate for Payer: Priority Health Medicare |
$238.64
|
| Rate for Payer: Railroad Medicare Medicare |
$238.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$238.64
|
| Rate for Payer: UHC Exchange |
$77.82
|
| Rate for Payer: UHCCP DNSP |
$238.64
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
|
|
PR FRAC NECK
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR FRAC SCARS PER INCH
|
Professional
|
Both
|
$53.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
|
|
PR FRAC THGH/ABD/BACK
|
Professional
|
Both
|
$473.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.75
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna Commercial |
$139.94
|
| Rate for Payer: Aetna Medicare |
$104.43
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$104.43
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Medicare Advantage |
$104.43
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cofinity Commercial |
$139.94
|
| Rate for Payer: Cofinity Commercial |
$150.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.43
|
| Rate for Payer: Healthscope Commercial |
$125.32
|
| Rate for Payer: Healthscope Whirlpool |
$125.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.65
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.87
|
| Rate for Payer: Nomi Health Commercial |
$125.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.00
|
| Rate for Payer: PACE SWMI |
$104.43
|
| Rate for Payer: PHP Medicare Advantage |
$104.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$104.43
|
| Rate for Payer: Priority Health Narrow Network |
$168.35
|
| Rate for Payer: Railroad Medicare Medicare |
$104.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.43
|
| Rate for Payer: UHC Exchange |
$201.58
|
| Rate for Payer: UHC Medicaid |
$69.44
|
| Rate for Payer: UHCCP DNSP |
$104.43
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$463.57 |
| Rate for Payer: Aetna Commercial |
$296.57
|
| Rate for Payer: Aetna Medicare |
$221.32
|
| Rate for Payer: BCBS Complete |
$154.32
|
| Rate for Payer: BCBS MAPPO |
$221.32
|
| Rate for Payer: BCN Commercial |
$380.46
|
| Rate for Payer: BCN Medicare Advantage |
$221.32
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cofinity Commercial |
$296.57
|
| Rate for Payer: Cofinity Commercial |
$318.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.32
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Healthscope Whirlpool |
$265.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.39
|
| Rate for Payer: Meridian Medicaid |
$154.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$243.45
|
| Rate for Payer: Nomi Health Commercial |
$265.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.50
|
| Rate for Payer: PACE SWMI |
$221.32
|
| Rate for Payer: PHP Medicare Advantage |
$221.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$463.57
|
| Rate for Payer: Priority Health Medicare |
$221.32
|
| Rate for Payer: Priority Health Narrow Network |
$463.57
|
| Rate for Payer: Railroad Medicare Medicare |
$221.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$221.32
|
| Rate for Payer: UHC Exchange |
$423.97
|
| Rate for Payer: UHC Medicaid |
$146.97
|
| Rate for Payer: UHCCP DNSP |
$221.32
|
| Rate for Payer: UHCCP Medicaid |
$146.97
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Aetna Commercial |
$240.99
|
| Rate for Payer: Aetna Medicare |
$179.84
|
| Rate for Payer: BCBS Complete |
$124.13
|
| Rate for Payer: BCBS MAPPO |
$179.84
|
| Rate for Payer: BCN Commercial |
$295.30
|
| Rate for Payer: BCN Medicare Advantage |
$179.84
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Cofinity Commercial |
$240.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.84
|
| Rate for Payer: Healthscope Commercial |
$215.81
|
| Rate for Payer: Healthscope Whirlpool |
$215.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.83
|
| Rate for Payer: Meridian Medicaid |
$124.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$197.82
|
| Rate for Payer: Nomi Health Commercial |
$215.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.50
|
| Rate for Payer: PACE SWMI |
$179.84
|
| Rate for Payer: PHP Medicare Advantage |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$321.67
|
| Rate for Payer: Priority Health Medicare |
$179.84
|
| Rate for Payer: Priority Health Narrow Network |
$321.67
|
| Rate for Payer: Railroad Medicare Medicare |
$179.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$179.84
|
| Rate for Payer: UHC Exchange |
$335.05
|
| Rate for Payer: UHC Medicaid |
$118.22
|
| Rate for Payer: UHCCP DNSP |
$179.84
|
| Rate for Payer: UHCCP Medicaid |
$118.22
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,280.69 |
| Rate for Payer: Aetna Commercial |
$880.97
|
| Rate for Payer: Aetna Medicare |
$657.44
|
| Rate for Payer: BCBS Complete |
$450.43
|
| Rate for Payer: BCBS MAPPO |
$657.44
|
| Rate for Payer: BCN Commercial |
$1,098.05
|
| Rate for Payer: BCN Medicare Advantage |
$657.44
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$946.71
|
| Rate for Payer: Cofinity Commercial |
$880.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.44
|
| Rate for Payer: Healthscope Commercial |
$788.93
|
| Rate for Payer: Healthscope Whirlpool |
$788.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.31
|
| Rate for Payer: Meridian Medicaid |
$450.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$723.18
|
| Rate for Payer: Nomi Health Commercial |
$788.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.00
|
| Rate for Payer: PACE SWMI |
$657.44
|
| Rate for Payer: PHP Medicare Advantage |
$657.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,005.00
|
| Rate for Payer: Priority Health Medicare |
$657.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,005.00
|
| Rate for Payer: Railroad Medicare Medicare |
$657.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,280.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$657.44
|
| Rate for Payer: UHC Exchange |
$1,280.69
|
| Rate for Payer: UHC Medicaid |
$428.98
|
| Rate for Payer: UHCCP DNSP |
$657.44
|
| Rate for Payer: UHCCP Medicaid |
$428.98
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$359.33 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Aetna Commercial |
$735.87
|
| Rate for Payer: Aetna Medicare |
$549.16
|
| Rate for Payer: BCBS Complete |
$377.30
|
| Rate for Payer: BCBS MAPPO |
$549.16
|
| Rate for Payer: BCN Commercial |
$977.53
|
| Rate for Payer: BCN Medicare Advantage |
$549.16
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Cofinity Commercial |
$790.79
|
| Rate for Payer: Cofinity Commercial |
$735.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.16
|
| Rate for Payer: Healthscope Commercial |
$658.99
|
| Rate for Payer: Healthscope Whirlpool |
$658.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.62
|
| Rate for Payer: Meridian Medicaid |
$377.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$604.08
|
| Rate for Payer: Nomi Health Commercial |
$658.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,254.00
|
| Rate for Payer: PACE SWMI |
$549.16
|
| Rate for Payer: PHP Medicare Advantage |
$549.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$894.70
|
| Rate for Payer: Priority Health Medicare |
$549.16
|
| Rate for Payer: Priority Health Narrow Network |
$894.70
|
| Rate for Payer: Railroad Medicare Medicare |
$549.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,143.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$549.16
|
| Rate for Payer: UHC Exchange |
$1,143.77
|
| Rate for Payer: UHC Medicaid |
$359.33
|
| Rate for Payer: UHCCP DNSP |
$549.16
|
| Rate for Payer: UHCCP Medicaid |
$359.33
|
|
