|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$801.31 |
| Max. Negotiated Rate |
$2,463.44 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Medicare |
$1,251.03
|
| Rate for Payer: BCBS Complete |
$841.38
|
| Rate for Payer: BCBS MAPPO |
$1,251.03
|
| Rate for Payer: BCN Commercial |
$2,021.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,251.03
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cofinity Commercial |
$1,801.48
|
| Rate for Payer: Cofinity Commercial |
$1,676.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,251.03
|
| Rate for Payer: Healthscope Commercial |
$1,501.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,501.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,313.58
|
| Rate for Payer: Meridian Medicaid |
$841.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,376.13
|
| Rate for Payer: Nomi Health Commercial |
$1,501.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,025.00
|
| Rate for Payer: PACE SWMI |
$1,251.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,251.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,463.44
|
| Rate for Payer: Priority Health Medicare |
$1,251.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,463.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,251.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,399.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,251.03
|
| Rate for Payer: UHC Exchange |
$2,399.58
|
| Rate for Payer: UHC Medicaid |
$801.31
|
| Rate for Payer: UHCCP DNSP |
$1,251.03
|
| Rate for Payer: UHCCP Medicaid |
$801.31
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,658.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$784.69 |
| Max. Negotiated Rate |
$2,403.98 |
| Rate for Payer: Aetna Commercial |
$1,642.95
|
| Rate for Payer: Aetna Medicare |
$1,226.08
|
| Rate for Payer: BCBS Complete |
$823.92
|
| Rate for Payer: BCBS MAPPO |
$1,226.08
|
| Rate for Payer: BCN Commercial |
$1,973.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,226.08
|
| Rate for Payer: Cash Price |
$2,126.40
|
| Rate for Payer: Cash Price |
$2,126.40
|
| Rate for Payer: Cofinity Commercial |
$1,765.56
|
| Rate for Payer: Cofinity Commercial |
$1,642.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,226.08
|
| Rate for Payer: Healthscope Commercial |
$1,471.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,471.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,287.38
|
| Rate for Payer: Meridian Medicaid |
$823.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,348.69
|
| Rate for Payer: Nomi Health Commercial |
$1,471.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,993.50
|
| Rate for Payer: PACE SWMI |
$1,226.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,226.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,403.98
|
| Rate for Payer: Priority Health Medicare |
$1,226.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,403.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,226.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,340.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,226.08
|
| Rate for Payer: UHC Exchange |
$2,340.68
|
| Rate for Payer: UHC Medicaid |
$784.69
|
| Rate for Payer: UHCCP DNSP |
$1,226.08
|
| Rate for Payer: UHCCP Medicaid |
$784.69
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$811.53 |
| Max. Negotiated Rate |
$2,490.13 |
| Rate for Payer: Aetna Commercial |
$1,698.96
|
| Rate for Payer: Aetna Medicare |
$1,267.88
|
| Rate for Payer: BCBS Complete |
$852.11
|
| Rate for Payer: BCBS MAPPO |
$1,267.88
|
| Rate for Payer: BCN Commercial |
$2,043.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,267.88
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cofinity Commercial |
$1,825.75
|
| Rate for Payer: Cofinity Commercial |
$1,698.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,267.88
|
| Rate for Payer: Healthscope Commercial |
$1,521.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.27
|
| Rate for Payer: Meridian Medicaid |
$852.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,394.67
|
| Rate for Payer: Nomi Health Commercial |
$1,521.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,179.50
|
| Rate for Payer: PACE SWMI |
$1,267.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,267.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,490.13
|
| Rate for Payer: Priority Health Medicare |
$1,267.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,490.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,267.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,429.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,267.88
|
| Rate for Payer: UHC Exchange |
$2,429.67
|
| Rate for Payer: UHC Medicaid |
$811.53
|
| Rate for Payer: UHCCP DNSP |
$1,267.88
|
| Rate for Payer: UHCCP Medicaid |
$811.53
|
|
|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$381.91 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$786.19
|
| Rate for Payer: Aetna Medicare |
$586.71
|
| Rate for Payer: BCBS Complete |
$401.01
|
| Rate for Payer: BCBS MAPPO |
$586.71
|
| Rate for Payer: BCN Commercial |
$923.26
|
| Rate for Payer: BCN Medicare Advantage |
$586.71
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cofinity Commercial |
$844.86
|
| Rate for Payer: Cofinity Commercial |
$786.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.71
|
| Rate for Payer: Healthscope Commercial |
$704.05
|
| Rate for Payer: Healthscope Whirlpool |
$704.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.05
|
| Rate for Payer: Meridian Medicaid |
$401.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$645.38
|
| Rate for Payer: Nomi Health Commercial |
$704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,647.00
|
| Rate for Payer: PACE SWMI |
$586.71
|
| Rate for Payer: PHP Medicare Advantage |
$586.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,124.92
|
| Rate for Payer: Priority Health Medicare |
$586.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,124.92
|
| Rate for Payer: Railroad Medicare Medicare |
$586.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,062.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$586.71
|
| Rate for Payer: UHC Exchange |
$1,062.84
|
| Rate for Payer: UHC Medicaid |
$381.91
|
| Rate for Payer: UHCCP DNSP |
$586.71
|
| Rate for Payer: UHCCP Medicaid |
$381.91
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$3,022.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$628.78 |
| Max. Negotiated Rate |
$2,266.50 |
| Rate for Payer: Aetna Commercial |
$1,314.47
|
| Rate for Payer: Aetna Medicare |
$980.95
|
| Rate for Payer: BCBS Complete |
$660.22
|
| Rate for Payer: BCBS MAPPO |
$980.95
|
| Rate for Payer: BCN Commercial |
$1,575.11
|
| Rate for Payer: BCN Medicare Advantage |
$980.95
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cofinity Commercial |
$1,412.57
|
| Rate for Payer: Cofinity Commercial |
$1,314.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.95
|
| Rate for Payer: Healthscope Commercial |
$1,177.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.00
|
| Rate for Payer: Meridian Medicaid |
$660.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,079.05
|
| Rate for Payer: Nomi Health Commercial |
$1,177.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,266.50
|
| Rate for Payer: PACE SWMI |
$980.95
|
| Rate for Payer: PHP Medicare Advantage |
$980.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$628.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,919.17
|
| Rate for Payer: Priority Health Medicare |
$980.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,919.17
|
| Rate for Payer: Railroad Medicare Medicare |
$980.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,856.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$980.95
|
| Rate for Payer: UHC Exchange |
$1,856.63
|
| Rate for Payer: UHC Medicaid |
$628.78
|
| Rate for Payer: UHCCP DNSP |
$980.95
|
| Rate for Payer: UHCCP Medicaid |
$628.78
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$894.18
|
| Rate for Payer: Aetna Medicare |
$667.30
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS MAPPO |
$667.30
|
| Rate for Payer: BCN Commercial |
$1,060.21
|
| Rate for Payer: BCN Medicare Advantage |
$667.30
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cofinity Commercial |
$960.91
|
| Rate for Payer: Cofinity Commercial |
$894.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.30
|
| Rate for Payer: Healthscope Commercial |
$800.76
|
| Rate for Payer: Healthscope Whirlpool |
$800.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$700.66
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$734.03
|
| Rate for Payer: Nomi Health Commercial |
$800.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,647.00
|
| Rate for Payer: PACE SWMI |
$667.30
|
| Rate for Payer: PHP Medicare Advantage |
$667.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,291.79
|
| Rate for Payer: Priority Health Medicare |
$667.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,291.79
|
| Rate for Payer: Railroad Medicare Medicare |
$667.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,245.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$667.30
|
| Rate for Payer: UHC Exchange |
$1,245.75
|
| Rate for Payer: UHC Medicaid |
$431.11
|
| Rate for Payer: UHCCP DNSP |
$667.30
|
| Rate for Payer: UHCCP Medicaid |
$431.11
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$479.46 |
| Max. Negotiated Rate |
$1,743.00 |
| Rate for Payer: Aetna Commercial |
$999.81
|
| Rate for Payer: Aetna Medicare |
$746.13
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS MAPPO |
$746.13
|
| Rate for Payer: BCN Commercial |
$1,188.18
|
| Rate for Payer: BCN Medicare Advantage |
$746.13
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cofinity Commercial |
$999.81
|
| Rate for Payer: Cofinity Commercial |
$1,074.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.13
|
| Rate for Payer: Healthscope Commercial |
$895.36
|
| Rate for Payer: Healthscope Whirlpool |
$895.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.44
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$820.74
|
| Rate for Payer: Nomi Health Commercial |
$895.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,743.00
|
| Rate for Payer: PACE SWMI |
$746.13
|
| Rate for Payer: PHP Medicare Advantage |
$746.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,447.73
|
| Rate for Payer: Priority Health Medicare |
$746.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,447.73
|
| Rate for Payer: Railroad Medicare Medicare |
$746.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,395.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$746.13
|
| Rate for Payer: UHC Exchange |
$1,395.50
|
| Rate for Payer: UHC Medicaid |
$479.46
|
| Rate for Payer: UHCCP DNSP |
$746.13
|
| Rate for Payer: UHCCP Medicaid |
$479.46
|
|
|
PR GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC
|
Professional
|
Both
|
$3,057.00
|
|
|
Service Code
|
HCPCS 43502
|
| Min. Negotiated Rate |
$907.59 |
| Max. Negotiated Rate |
$2,791.09 |
| Rate for Payer: Aetna Commercial |
$1,903.40
|
| Rate for Payer: Aetna Medicare |
$1,420.45
|
| Rate for Payer: BCBS Complete |
$952.97
|
| Rate for Payer: BCBS MAPPO |
$1,420.45
|
| Rate for Payer: BCN Commercial |
$2,290.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,420.45
|
| Rate for Payer: Cash Price |
$2,445.60
|
| Rate for Payer: Cash Price |
$2,445.60
|
| Rate for Payer: Cofinity Commercial |
$2,045.45
|
| Rate for Payer: Cofinity Commercial |
$1,903.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,420.45
|
| Rate for Payer: Healthscope Commercial |
$1,704.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,491.47
|
| Rate for Payer: Meridian Medicaid |
$952.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,562.49
|
| Rate for Payer: Nomi Health Commercial |
$1,704.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,292.75
|
| Rate for Payer: PACE SWMI |
$1,420.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,420.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,791.09
|
| Rate for Payer: Priority Health Medicare |
$1,420.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,791.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,420.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,727.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,420.45
|
| Rate for Payer: UHC Exchange |
$2,727.45
|
| Rate for Payer: UHC Medicaid |
$907.59
|
| Rate for Payer: UHCCP DNSP |
$1,420.45
|
| Rate for Payer: UHCCP Medicaid |
$907.59
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$808.97 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna Commercial |
$1,694.18
|
| Rate for Payer: Aetna Medicare |
$1,264.31
|
| Rate for Payer: BCBS Complete |
$849.42
|
| Rate for Payer: BCBS MAPPO |
$1,264.31
|
| Rate for Payer: BCN Commercial |
$2,021.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.31
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,820.61
|
| Rate for Payer: Cofinity Commercial |
$1,694.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.31
|
| Rate for Payer: Healthscope Commercial |
$1,517.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,327.53
|
| Rate for Payer: Meridian Medicaid |
$849.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,390.74
|
| Rate for Payer: Nomi Health Commercial |
$1,517.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,071.25
|
| Rate for Payer: PACE SWMI |
$1,264.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,462.82
|
| Rate for Payer: Priority Health Medicare |
$1,264.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,462.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,264.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,405.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,264.31
|
| Rate for Payer: UHC Exchange |
$2,405.65
|
| Rate for Payer: UHC Medicaid |
$808.97
|
| Rate for Payer: UHCCP DNSP |
$1,264.31
|
| Rate for Payer: UHCCP Medicaid |
$808.97
|
|
|
PR GEL-ONE
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$526.79 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna Commercial |
$705.90
|
| Rate for Payer: Aetna Medicare |
$526.79
|
| Rate for Payer: BCBS MAPPO |
$526.79
|
| Rate for Payer: BCBS Trust/PPO |
$538.01
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: BCN Medicare Advantage |
$526.79
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cofinity Commercial |
$758.58
|
| Rate for Payer: Cofinity Commercial |
$705.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.79
|
| Rate for Payer: Healthscope Commercial |
$632.15
|
| Rate for Payer: Healthscope Whirlpool |
$632.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$579.47
|
| Rate for Payer: Nomi Health Commercial |
$632.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$526.79
|
| Rate for Payer: PHP Medicare Advantage |
$526.79
|
| Rate for Payer: Priority Health Medicare |
$526.79
|
| Rate for Payer: Railroad Medicare Medicare |
$526.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$526.79
|
| Rate for Payer: UHC Exchange |
$528.05
|
| Rate for Payer: UHCCP DNSP |
$526.79
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$2,333.04 |
| Rate for Payer: Aetna Commercial |
$2,171.03
|
| Rate for Payer: Aetna Commercial |
$2,171.03
|
| Rate for Payer: Aetna Medicare |
$1,620.17
|
| Rate for Payer: Aetna Medicare |
$1,620.17
|
| Rate for Payer: BCBS MAPPO |
$1,620.17
|
| Rate for Payer: BCBS MAPPO |
$1,620.17
|
| Rate for Payer: BCN Commercial |
$2,275.28
|
| Rate for Payer: BCN Commercial |
$2,275.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.17
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cofinity Commercial |
$2,171.03
|
| Rate for Payer: Cofinity Commercial |
$2,333.04
|
| Rate for Payer: Cofinity Commercial |
$2,171.03
|
| Rate for Payer: Cofinity Commercial |
$2,333.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.17
|
| Rate for Payer: Healthscope Commercial |
$1,944.20
|
| Rate for Payer: Healthscope Commercial |
$1,944.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,944.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,944.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,701.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,701.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,782.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,782.19
|
| Rate for Payer: Nomi Health Commercial |
$1,944.20
|
| Rate for Payer: Nomi Health Commercial |
$1,944.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,640.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.50
|
| Rate for Payer: PACE SWMI |
$1,620.17
|
| Rate for Payer: PACE SWMI |
$1,620.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,098.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,098.28
|
| Rate for Payer: Priority Health Medicare |
$1,620.17
|
| Rate for Payer: Priority Health Medicare |
$1,620.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,098.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,098.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,190.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,190.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,620.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,620.17
|
| Rate for Payer: UHC Exchange |
$2,190.07
|
| Rate for Payer: UHC Exchange |
$2,190.07
|
| Rate for Payer: UHCCP DNSP |
$1,620.17
|
| Rate for Payer: UHCCP DNSP |
$1,620.17
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$739.47 |
| Max. Negotiated Rate |
$1,308.43 |
| Rate for Payer: Aetna Commercial |
$990.89
|
| Rate for Payer: Aetna Medicare |
$739.47
|
| Rate for Payer: BCBS MAPPO |
$739.47
|
| Rate for Payer: BCN Commercial |
$1,040.28
|
| Rate for Payer: BCN Medicare Advantage |
$739.47
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,064.84
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.47
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$887.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$813.42
|
| Rate for Payer: Nomi Health Commercial |
$887.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,250.25
|
| Rate for Payer: PACE SWMI |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$959.36
|
| Rate for Payer: Priority Health Medicare |
$739.47
|
| Rate for Payer: Priority Health Narrow Network |
$959.36
|
| Rate for Payer: Railroad Medicare Medicare |
$739.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,308.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$739.47
|
| Rate for Payer: UHC Exchange |
$1,308.43
|
| Rate for Payer: UHCCP DNSP |
$739.47
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$755.51 |
| Max. Negotiated Rate |
$2,377.88 |
| Rate for Payer: Aetna Commercial |
$1,531.23
|
| Rate for Payer: Aetna Medicare |
$1,142.71
|
| Rate for Payer: BCBS Complete |
$793.29
|
| Rate for Payer: BCBS MAPPO |
$1,142.71
|
| Rate for Payer: BCN Commercial |
$1,951.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.71
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,645.50
|
| Rate for Payer: Cofinity Commercial |
$1,531.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.71
|
| Rate for Payer: Healthscope Commercial |
$1,371.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,371.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.85
|
| Rate for Payer: Meridian Medicaid |
$793.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,256.98
|
| Rate for Payer: Nomi Health Commercial |
$1,371.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,845.00
|
| Rate for Payer: PACE SWMI |
$1,142.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,377.88
|
| Rate for Payer: Priority Health Medicare |
$1,142.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,377.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,254.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,142.71
|
| Rate for Payer: UHC Exchange |
$2,254.74
|
| Rate for Payer: UHC Medicaid |
$755.51
|
| Rate for Payer: UHCCP DNSP |
$1,142.71
|
| Rate for Payer: UHCCP Medicaid |
$755.51
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,957.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$623.45 |
| Max. Negotiated Rate |
$1,921.59 |
| Rate for Payer: Aetna Commercial |
$1,253.92
|
| Rate for Payer: Aetna Medicare |
$935.76
|
| Rate for Payer: BCBS Complete |
$654.62
|
| Rate for Payer: BCBS MAPPO |
$935.76
|
| Rate for Payer: BCN Commercial |
$1,577.10
|
| Rate for Payer: BCN Medicare Advantage |
$935.76
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cofinity Commercial |
$1,347.49
|
| Rate for Payer: Cofinity Commercial |
$1,253.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$935.76
|
| Rate for Payer: Healthscope Commercial |
$1,122.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,122.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$982.55
|
| Rate for Payer: Meridian Medicaid |
$654.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,029.34
|
| Rate for Payer: Nomi Health Commercial |
$1,122.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,467.75
|
| Rate for Payer: PACE SWMI |
$935.76
|
| Rate for Payer: PHP Medicare Advantage |
$935.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,921.59
|
| Rate for Payer: Priority Health Medicare |
$935.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,921.59
|
| Rate for Payer: Railroad Medicare Medicare |
$935.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,813.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$935.76
|
| Rate for Payer: UHC Exchange |
$1,813.64
|
| Rate for Payer: UHC Medicaid |
$623.45
|
| Rate for Payer: UHCCP DNSP |
$935.76
|
| Rate for Payer: UHCCP Medicaid |
$623.45
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$4,063.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$1,222.41 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$2,501.74
|
| Rate for Payer: Aetna Medicare |
$1,866.97
|
| Rate for Payer: BCBS Complete |
$1,283.53
|
| Rate for Payer: BCBS MAPPO |
$1,866.97
|
| Rate for Payer: BCN Commercial |
$3,215.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,866.97
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cofinity Commercial |
$2,688.44
|
| Rate for Payer: Cofinity Commercial |
$2,501.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,866.97
|
| Rate for Payer: Healthscope Commercial |
$2,240.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,240.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,960.32
|
| Rate for Payer: Meridian Medicaid |
$1,283.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,240.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.25
|
| Rate for Payer: PACE SWMI |
$1,866.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,866.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,222.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,918.45
|
| Rate for Payer: Priority Health Medicare |
$1,866.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,918.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,866.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,749.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,866.97
|
| Rate for Payer: UHC Exchange |
$3,749.20
|
| Rate for Payer: UHC Medicaid |
$1,222.41
|
| Rate for Payer: UHCCP DNSP |
$1,866.97
|
| Rate for Payer: UHCCP Medicaid |
$1,222.41
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$4,221.00
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$1,238.60 |
| Max. Negotiated Rate |
$3,974.27 |
| Rate for Payer: Aetna Commercial |
$2,531.22
|
| Rate for Payer: Aetna Medicare |
$1,888.97
|
| Rate for Payer: BCBS Complete |
$1,300.53
|
| Rate for Payer: BCBS MAPPO |
$1,888.97
|
| Rate for Payer: BCN Commercial |
$3,261.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,888.97
|
| Rate for Payer: Cash Price |
$3,376.80
|
| Rate for Payer: Cash Price |
$3,376.80
|
| Rate for Payer: Cofinity Commercial |
$2,720.12
|
| Rate for Payer: Cofinity Commercial |
$2,531.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,888.97
|
| Rate for Payer: Healthscope Commercial |
$2,266.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,266.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,983.42
|
| Rate for Payer: Meridian Medicaid |
$1,300.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,077.87
|
| Rate for Payer: Nomi Health Commercial |
$2,266.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,165.75
|
| Rate for Payer: PACE SWMI |
$1,888.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,888.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,238.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,974.27
|
| Rate for Payer: Priority Health Medicare |
$1,888.97
|
| Rate for Payer: Priority Health Narrow Network |
$3,974.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,888.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,790.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,888.97
|
| Rate for Payer: UHC Exchange |
$3,790.80
|
| Rate for Payer: UHC Medicaid |
$1,238.60
|
| Rate for Payer: UHCCP DNSP |
$1,888.97
|
| Rate for Payer: UHCCP Medicaid |
$1,238.60
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$23.13
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$19.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.86
|
| Rate for Payer: Meridian Medicaid |
$10.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.50
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.57
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow Network |
$25.57
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.06
|
| Rate for Payer: UHC Exchange |
$26.13
|
| Rate for Payer: UHC Medicaid |
$10.44
|
| Rate for Payer: UHCCP DNSP |
$16.06
|
| Rate for Payer: UHCCP Medicaid |
$10.44
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$389.79 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Aetna Commercial |
$798.08
|
| Rate for Payer: Aetna Medicare |
$595.58
|
| Rate for Payer: BCBS Complete |
$409.28
|
| Rate for Payer: BCBS MAPPO |
$595.58
|
| Rate for Payer: BCN Commercial |
$1,051.73
|
| Rate for Payer: BCN Medicare Advantage |
$595.58
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cofinity Commercial |
$857.64
|
| Rate for Payer: Cofinity Commercial |
$798.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.58
|
| Rate for Payer: Healthscope Commercial |
$714.70
|
| Rate for Payer: Healthscope Whirlpool |
$714.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.36
|
| Rate for Payer: Meridian Medicaid |
$409.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$655.14
|
| Rate for Payer: Nomi Health Commercial |
$714.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,315.50
|
| Rate for Payer: PACE SWMI |
$595.58
|
| Rate for Payer: PHP Medicare Advantage |
$595.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$962.61
|
| Rate for Payer: Priority Health Medicare |
$595.58
|
| Rate for Payer: Priority Health Narrow Network |
$962.61
|
| Rate for Payer: Railroad Medicare Medicare |
$595.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,213.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$595.58
|
| Rate for Payer: UHC Exchange |
$1,213.25
|
| Rate for Payer: UHC Medicaid |
$389.79
|
| Rate for Payer: UHCCP DNSP |
$595.58
|
| Rate for Payer: UHCCP Medicaid |
$389.79
|
|
|
PR GRAFT DERMA-FAT-FASCIA
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 15770
|
| Min. Negotiated Rate |
$386.60 |
| Max. Negotiated Rate |
$1,149.22 |
| Rate for Payer: Aetna Commercial |
$789.33
|
| Rate for Payer: Aetna Medicare |
$589.05
|
| Rate for Payer: BCBS Complete |
$405.93
|
| Rate for Payer: BCBS MAPPO |
$589.05
|
| Rate for Payer: BCN Commercial |
$1,018.87
|
| Rate for Payer: BCN Medicare Advantage |
$589.05
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$848.23
|
| Rate for Payer: Cofinity Commercial |
$789.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.05
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Healthscope Whirlpool |
$706.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.50
|
| Rate for Payer: Meridian Medicaid |
$405.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$647.96
|
| Rate for Payer: Nomi Health Commercial |
$706.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,134.75
|
| Rate for Payer: PACE SWMI |
$589.05
|
| Rate for Payer: PHP Medicare Advantage |
$589.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$932.53
|
| Rate for Payer: Priority Health Medicare |
$589.05
|
| Rate for Payer: Priority Health Narrow Network |
$932.53
|
| Rate for Payer: Railroad Medicare Medicare |
$589.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$589.05
|
| Rate for Payer: UHC Exchange |
$1,149.22
|
| Rate for Payer: UHC Medicaid |
$386.60
|
| Rate for Payer: UHCCP DNSP |
$589.05
|
| Rate for Payer: UHCCP Medicaid |
$386.60
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$971.32 |
| Rate for Payer: Aetna Commercial |
$657.40
|
| Rate for Payer: Aetna Medicare |
$490.60
|
| Rate for Payer: BCBS Complete |
$338.83
|
| Rate for Payer: BCBS MAPPO |
$490.60
|
| Rate for Payer: BCN Commercial |
$862.50
|
| Rate for Payer: BCN Medicare Advantage |
$490.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cofinity Commercial |
$706.46
|
| Rate for Payer: Cofinity Commercial |
$657.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.60
|
| Rate for Payer: Healthscope Commercial |
$588.72
|
| Rate for Payer: Healthscope Whirlpool |
$588.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.13
|
| Rate for Payer: Meridian Medicaid |
$338.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$539.66
|
| Rate for Payer: Nomi Health Commercial |
$588.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$946.50
|
| Rate for Payer: PACE SWMI |
$490.60
|
| Rate for Payer: PHP Medicare Advantage |
$490.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$921.99
|
| Rate for Payer: Priority Health Medicare |
$490.60
|
| Rate for Payer: Priority Health Narrow Network |
$921.99
|
| Rate for Payer: Railroad Medicare Medicare |
$490.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.60
|
| Rate for Payer: UHC Exchange |
$971.32
|
| Rate for Payer: UHC Medicaid |
$322.70
|
| Rate for Payer: UHCCP DNSP |
$490.60
|
| Rate for Payer: UHCCP Medicaid |
$322.70
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$289.68 |
| Max. Negotiated Rate |
$902.25 |
| Rate for Payer: Aetna Commercial |
$592.51
|
| Rate for Payer: Aetna Medicare |
$442.17
|
| Rate for Payer: BCBS Complete |
$304.16
|
| Rate for Payer: BCBS MAPPO |
$442.17
|
| Rate for Payer: BCN Commercial |
$760.42
|
| Rate for Payer: BCN Medicare Advantage |
$442.17
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$636.72
|
| Rate for Payer: Cofinity Commercial |
$592.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.17
|
| Rate for Payer: Healthscope Commercial |
$530.60
|
| Rate for Payer: Healthscope Whirlpool |
$530.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.28
|
| Rate for Payer: Meridian Medicaid |
$304.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$486.39
|
| Rate for Payer: Nomi Health Commercial |
$530.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$902.25
|
| Rate for Payer: PACE SWMI |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$442.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$695.98
|
| Rate for Payer: Priority Health Medicare |
$442.17
|
| Rate for Payer: Priority Health Narrow Network |
$695.98
|
| Rate for Payer: Railroad Medicare Medicare |
$442.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$442.17
|
| Rate for Payer: UHC Exchange |
$841.76
|
| Rate for Payer: UHC Medicaid |
$289.68
|
| Rate for Payer: UHCCP DNSP |
$442.17
|
| Rate for Payer: UHCCP Medicaid |
$289.68
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,192.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$894.00 |
| Rate for Payer: Aetna Commercial |
$616.88
|
| Rate for Payer: Aetna Medicare |
$460.36
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS MAPPO |
$460.36
|
| Rate for Payer: BCN Commercial |
$777.35
|
| Rate for Payer: BCN Medicare Advantage |
$460.36
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Cofinity Commercial |
$662.92
|
| Rate for Payer: Cofinity Commercial |
$616.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.36
|
| Rate for Payer: Healthscope Commercial |
$552.43
|
| Rate for Payer: Healthscope Whirlpool |
$552.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.38
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.40
|
| Rate for Payer: Nomi Health Commercial |
$552.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$894.00
|
| Rate for Payer: PACE SWMI |
$460.36
|
| Rate for Payer: PHP Medicare Advantage |
$460.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$711.48
|
| Rate for Payer: Priority Health Medicare |
$460.36
|
| Rate for Payer: Priority Health Narrow Network |
$711.48
|
| Rate for Payer: Railroad Medicare Medicare |
$460.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$460.36
|
| Rate for Payer: UHC Exchange |
$832.61
|
| Rate for Payer: UHC Medicaid |
$302.03
|
| Rate for Payer: UHCCP DNSP |
$460.36
|
| Rate for Payer: UHCCP Medicaid |
$302.03
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna Medicare |
$120.93
|
| Rate for Payer: BCBS Complete |
$81.41
|
| Rate for Payer: BCBS MAPPO |
$120.93
|
| Rate for Payer: BCN Commercial |
$215.63
|
| Rate for Payer: BCN Medicare Advantage |
$120.93
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$174.14
|
| Rate for Payer: Cofinity Commercial |
$162.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.93
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Healthscope Whirlpool |
$145.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.98
|
| Rate for Payer: Meridian Medicaid |
$81.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.02
|
| Rate for Payer: Nomi Health Commercial |
$145.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.25
|
| Rate for Payer: PACE SWMI |
$120.93
|
| Rate for Payer: PHP Medicare Advantage |
$120.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$197.35
|
| Rate for Payer: Priority Health Medicare |
$120.93
|
| Rate for Payer: Priority Health Narrow Network |
$197.35
|
| Rate for Payer: Railroad Medicare Medicare |
$120.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$120.93
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicaid |
$77.53
|
| Rate for Payer: UHCCP DNSP |
$120.93
|
| Rate for Payer: UHCCP Medicaid |
$77.53
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$168.32
|
| Rate for Payer: Aetna Medicare |
$125.61
|
| Rate for Payer: BCBS Complete |
$84.54
|
| Rate for Payer: BCBS MAPPO |
$125.61
|
| Rate for Payer: BCN Commercial |
$222.60
|
| Rate for Payer: BCN Medicare Advantage |
$125.61
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$180.88
|
| Rate for Payer: Cofinity Commercial |
$168.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.61
|
| Rate for Payer: Healthscope Commercial |
$150.73
|
| Rate for Payer: Healthscope Whirlpool |
$150.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.89
|
| Rate for Payer: Meridian Medicaid |
$84.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.17
|
| Rate for Payer: Nomi Health Commercial |
$150.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$125.61
|
| Rate for Payer: PHP Medicare Advantage |
$125.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$125.61
|
| Rate for Payer: Priority Health Narrow Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$125.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.61
|
| Rate for Payer: UHC Exchange |
$249.46
|
| Rate for Payer: UHC Medicaid |
$80.51
|
| Rate for Payer: UHCCP DNSP |
$125.61
|
| Rate for Payer: UHCCP Medicaid |
$80.51
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$289.89 |
| Max. Negotiated Rate |
$838.04 |
| Rate for Payer: Aetna Commercial |
$594.36
|
| Rate for Payer: Aetna Medicare |
$443.55
|
| Rate for Payer: BCBS Complete |
$304.38
|
| Rate for Payer: BCBS MAPPO |
$443.55
|
| Rate for Payer: BCN Commercial |
$726.55
|
| Rate for Payer: BCN Medicare Advantage |
$443.55
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cofinity Commercial |
$638.71
|
| Rate for Payer: Cofinity Commercial |
$594.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.55
|
| Rate for Payer: Healthscope Commercial |
$532.26
|
| Rate for Payer: Healthscope Whirlpool |
$532.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.73
|
| Rate for Payer: Meridian Medicaid |
$304.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$487.90
|
| Rate for Payer: Nomi Health Commercial |
$532.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.00
|
| Rate for Payer: PACE SWMI |
$443.55
|
| Rate for Payer: PHP Medicare Advantage |
$443.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$664.99
|
| Rate for Payer: Priority Health Medicare |
$443.55
|
| Rate for Payer: Priority Health Narrow Network |
$664.99
|
| Rate for Payer: Railroad Medicare Medicare |
$443.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$443.55
|
| Rate for Payer: UHC Exchange |
$838.04
|
| Rate for Payer: UHC Medicaid |
$289.89
|
| Rate for Payer: UHCCP DNSP |
$443.55
|
| Rate for Payer: UHCCP Medicaid |
$289.89
|
|
