|
PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF
|
Professional
|
Both
|
$2,568.00
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$772.98 |
| Max. Negotiated Rate |
$1,921.96 |
| Rate for Payer: Aetna Commercial |
$1,639.03
|
| Rate for Payer: Aetna Medicare |
$1,223.16
|
| Rate for Payer: BCBS Complete |
$811.63
|
| Rate for Payer: BCBS MAPPO |
$1,223.16
|
| Rate for Payer: BCBS Trust/PPO |
$926.64
|
| Rate for Payer: BCN Commercial |
$1,765.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,223.16
|
| Rate for Payer: Cash Price |
$2,054.40
|
| Rate for Payer: Cash Price |
$2,054.40
|
| Rate for Payer: Cofinity Commercial |
$1,639.03
|
| Rate for Payer: Cofinity Commercial |
$1,761.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,223.16
|
| Rate for Payer: Healthscope Commercial |
$1,467.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,467.79
|
| Rate for Payer: Meridian Medicaid |
$811.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,284.32
|
| Rate for Payer: PACE SWMI |
$1,223.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,223.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,921.96
|
| Rate for Payer: Priority Health Medicare |
$1,223.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,921.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,259.85
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$1,858.66 |
| Rate for Payer: Aetna Commercial |
$1,580.89
|
| Rate for Payer: Aetna Medicare |
$1,179.77
|
| Rate for Payer: BCBS Complete |
$782.78
|
| Rate for Payer: BCBS MAPPO |
$1,179.77
|
| Rate for Payer: BCBS Trust/PPO |
$876.98
|
| Rate for Payer: BCN Commercial |
$1,707.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,179.77
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cofinity Commercial |
$1,698.87
|
| Rate for Payer: Cofinity Commercial |
$1,580.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,179.77
|
| Rate for Payer: Healthscope Commercial |
$1,415.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,415.72
|
| Rate for Payer: Meridian Medicaid |
$782.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,238.76
|
| Rate for Payer: PACE SWMI |
$1,179.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,179.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,621.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,858.66
|
| Rate for Payer: Priority Health Medicare |
$1,179.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,858.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.16
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$5,278.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$163.77 |
| Max. Negotiated Rate |
$3,694.60 |
| Rate for Payer: Aetna Commercial |
$2,182.20
|
| Rate for Payer: Aetna Medicare |
$1,628.51
|
| Rate for Payer: BCBS Complete |
$1,096.11
|
| Rate for Payer: BCBS MAPPO |
$1,628.51
|
| Rate for Payer: BCBS Trust/PPO |
$163.77
|
| Rate for Payer: BCN Commercial |
$2,385.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,628.51
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cash Price |
$4,222.40
|
| Rate for Payer: Cofinity Commercial |
$2,182.20
|
| Rate for Payer: Cofinity Commercial |
$2,345.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,628.51
|
| Rate for Payer: Healthscope Commercial |
$1,954.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,954.21
|
| Rate for Payer: Meridian Medicaid |
$1,096.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,709.94
|
| Rate for Payer: PACE SWMI |
$1,628.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,628.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,043.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,694.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,869.89
|
| Rate for Payer: Priority Health Medicare |
$1,628.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,869.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,677.37
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,536.00
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$249.89 |
| Max. Negotiated Rate |
$1,775.20 |
| Rate for Payer: Aetna Commercial |
$1,329.87
|
| Rate for Payer: Aetna Medicare |
$992.44
|
| Rate for Payer: BCBS Complete |
$672.74
|
| Rate for Payer: BCBS MAPPO |
$992.44
|
| Rate for Payer: BCBS Trust/PPO |
$249.89
|
| Rate for Payer: BCN Commercial |
$1,462.12
|
| Rate for Payer: BCN Medicare Advantage |
$992.44
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Cash Price |
$2,028.80
|
| Rate for Payer: Cofinity Commercial |
$1,429.11
|
| Rate for Payer: Cofinity Commercial |
$1,329.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.44
|
| Rate for Payer: Healthscope Commercial |
$1,190.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,190.93
|
| Rate for Payer: Meridian Medicaid |
$672.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,042.06
|
| Rate for Payer: PACE SWMI |
$992.44
|
| Rate for Payer: PHP Medicare Advantage |
$992.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.22
|
| Rate for Payer: Priority Health Medicare |
$992.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,022.21
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$1,047.18 |
| Rate for Payer: Aetna Commercial |
$789.18
|
| Rate for Payer: Aetna Medicare |
$588.94
|
| Rate for Payer: BCBS Complete |
$402.12
|
| Rate for Payer: BCBS MAPPO |
$588.94
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: BCN Medicare Advantage |
$588.94
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cofinity Commercial |
$848.07
|
| Rate for Payer: Cofinity Commercial |
$789.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.94
|
| Rate for Payer: Healthscope Commercial |
$706.73
|
| Rate for Payer: Healthscope Whirlpool |
$706.73
|
| Rate for Payer: Meridian Medicaid |
$402.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.39
|
| Rate for Payer: PACE SWMI |
$588.94
|
| Rate for Payer: PHP Medicare Advantage |
$588.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,047.18
|
| Rate for Payer: Priority Health Medicare |
$588.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.18
|
| Rate for Payer: UHC Medicare Advantage |
$606.61
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,047.00
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$576.17 |
| Max. Negotiated Rate |
$2,832.90 |
| Rate for Payer: Aetna Commercial |
$1,182.16
|
| Rate for Payer: Aetna Medicare |
$882.21
|
| Rate for Payer: BCBS Complete |
$604.98
|
| Rate for Payer: BCBS MAPPO |
$882.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$1,305.75
|
| Rate for Payer: BCN Medicare Advantage |
$882.21
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cofinity Commercial |
$1,182.16
|
| Rate for Payer: Cofinity Commercial |
$1,270.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.21
|
| Rate for Payer: Healthscope Commercial |
$1,058.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.65
|
| Rate for Payer: Meridian Medicaid |
$604.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$926.32
|
| Rate for Payer: PACE SWMI |
$882.21
|
| Rate for Payer: PHP Medicare Advantage |
$882.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,832.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.96
|
| Rate for Payer: Priority Health Medicare |
$882.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,512.96
|
| Rate for Payer: UHC Medicare Advantage |
$908.68
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$4,723.00
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$3,306.10 |
| Rate for Payer: Aetna Commercial |
$594.30
|
| Rate for Payer: Aetna Medicare |
$443.51
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$443.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.26
|
| Rate for Payer: BCN Commercial |
$1,321.38
|
| Rate for Payer: BCN Medicare Advantage |
$443.51
|
| Rate for Payer: Cash Price |
$3,778.40
|
| Rate for Payer: Cash Price |
$3,778.40
|
| Rate for Payer: Cofinity Commercial |
$594.30
|
| Rate for Payer: Cofinity Commercial |
$638.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.51
|
| Rate for Payer: Healthscope Commercial |
$532.21
|
| Rate for Payer: Healthscope Whirlpool |
$532.21
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$465.69
|
| Rate for Payer: PACE SWMI |
$443.51
|
| Rate for Payer: PHP Medicare Advantage |
$443.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,306.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$759.31
|
| Rate for Payer: Priority Health Medicare |
$443.51
|
| Rate for Payer: Priority Health Narrow Network |
$759.31
|
| Rate for Payer: UHC Medicare Advantage |
$456.82
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$1,789.00
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$574.89 |
| Max. Negotiated Rate |
$1,898.71 |
| Rate for Payer: Aetna Commercial |
$1,216.01
|
| Rate for Payer: Aetna Medicare |
$907.47
|
| Rate for Payer: BCBS Complete |
$603.63
|
| Rate for Payer: BCBS MAPPO |
$907.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.71
|
| Rate for Payer: BCN Commercial |
$1,316.01
|
| Rate for Payer: BCN Medicare Advantage |
$907.47
|
| Rate for Payer: Cash Price |
$1,431.20
|
| Rate for Payer: Cash Price |
$1,431.20
|
| Rate for Payer: Cofinity Commercial |
$1,306.76
|
| Rate for Payer: Cofinity Commercial |
$1,216.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.47
|
| Rate for Payer: Healthscope Commercial |
$1,088.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.96
|
| Rate for Payer: Meridian Medicaid |
$603.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$952.84
|
| Rate for Payer: PACE SWMI |
$907.47
|
| Rate for Payer: PHP Medicare Advantage |
$907.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,432.56
|
| Rate for Payer: Priority Health Medicare |
$907.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,432.56
|
| Rate for Payer: UHC Medicare Advantage |
$934.69
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$2,077.00
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$642.62 |
| Max. Negotiated Rate |
$1,789.35 |
| Rate for Payer: Aetna Commercial |
$1,349.66
|
| Rate for Payer: Aetna Medicare |
$1,007.21
|
| Rate for Payer: BCBS Complete |
$674.75
|
| Rate for Payer: BCBS MAPPO |
$1,007.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.35
|
| Rate for Payer: BCN Commercial |
$1,460.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.21
|
| Rate for Payer: Cash Price |
$1,661.60
|
| Rate for Payer: Cash Price |
$1,661.60
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$1,450.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.21
|
| Rate for Payer: Healthscope Commercial |
$1,208.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,208.65
|
| Rate for Payer: Meridian Medicaid |
$674.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,057.57
|
| Rate for Payer: PACE SWMI |
$1,007.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,590.02
|
| Rate for Payer: Priority Health Medicare |
$1,007.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,590.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.43
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$653.91 |
| Max. Negotiated Rate |
$2,276.44 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Medicare |
$1,000.96
|
| Rate for Payer: BCBS Complete |
$686.61
|
| Rate for Payer: BCBS MAPPO |
$1,000.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.44
|
| Rate for Payer: BCN Commercial |
$1,503.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.96
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cofinity Commercial |
$1,441.38
|
| Rate for Payer: Cofinity Commercial |
$1,341.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.96
|
| Rate for Payer: Healthscope Commercial |
$1,201.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,201.15
|
| Rate for Payer: Meridian Medicaid |
$686.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,051.01
|
| Rate for Payer: PACE SWMI |
$1,000.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$653.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,450.21
|
| Rate for Payer: Priority Health Medicare |
$1,000.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,450.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,030.99
|
|
|
PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY
|
Professional
|
Both
|
$2,195.00
|
|
|
Service Code
|
HCPCS 69604
|
| Min. Negotiated Rate |
$714.62 |
| Max. Negotiated Rate |
$1,642.45 |
| Rate for Payer: Aetna Commercial |
$1,462.88
|
| Rate for Payer: Aetna Medicare |
$1,091.70
|
| Rate for Payer: BCBS Complete |
$750.35
|
| Rate for Payer: BCBS MAPPO |
$1,091.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.15
|
| Rate for Payer: BCN Commercial |
$1,642.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cofinity Commercial |
$1,462.88
|
| Rate for Payer: Cofinity Commercial |
$1,572.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.70
|
| Rate for Payer: Healthscope Commercial |
$1,310.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,310.04
|
| Rate for Payer: Meridian Medicaid |
$750.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,146.28
|
| Rate for Payer: PACE SWMI |
$1,091.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$714.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,584.58
|
| Rate for Payer: Priority Health Medicare |
$1,091.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,584.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,124.45
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,757.65 |
| Rate for Payer: Aetna Commercial |
$994.29
|
| Rate for Payer: Aetna Medicare |
$742.01
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS MAPPO |
$742.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.65
|
| Rate for Payer: BCN Commercial |
$1,081.45
|
| Rate for Payer: BCN Medicare Advantage |
$742.01
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,068.49
|
| Rate for Payer: Cofinity Commercial |
$994.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$742.01
|
| Rate for Payer: Healthscope Commercial |
$890.41
|
| Rate for Payer: Healthscope Whirlpool |
$890.41
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$779.11
|
| Rate for Payer: PACE SWMI |
$742.01
|
| Rate for Payer: PHP Medicare Advantage |
$742.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,177.22
|
| Rate for Payer: Priority Health Medicare |
$742.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,177.22
|
| Rate for Payer: UHC Medicare Advantage |
$764.27
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$505.02 |
| Max. Negotiated Rate |
$1,600.90 |
| Rate for Payer: Aetna Commercial |
$1,062.82
|
| Rate for Payer: Aetna Medicare |
$793.15
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS MAPPO |
$793.15
|
| Rate for Payer: BCBS Trust/PPO |
$902.86
|
| Rate for Payer: BCN Commercial |
$1,155.23
|
| Rate for Payer: BCN Medicare Advantage |
$793.15
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,142.14
|
| Rate for Payer: Cofinity Commercial |
$1,062.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.15
|
| Rate for Payer: Healthscope Commercial |
$951.78
|
| Rate for Payer: Healthscope Whirlpool |
$951.78
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$832.81
|
| Rate for Payer: PACE SWMI |
$793.15
|
| Rate for Payer: PHP Medicare Advantage |
$793.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,600.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,257.54
|
| Rate for Payer: Priority Health Medicare |
$793.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,257.54
|
| Rate for Payer: UHC Medicare Advantage |
$816.94
|
|
|
PR REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 63688
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$1,248.10 |
| Rate for Payer: Aetna Commercial |
$494.06
|
| Rate for Payer: Aetna Medicare |
$368.70
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS MAPPO |
$368.70
|
| Rate for Payer: BCBS Trust/PPO |
$917.66
|
| Rate for Payer: BCN Commercial |
$547.80
|
| Rate for Payer: BCN Medicare Advantage |
$368.70
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cofinity Commercial |
$494.06
|
| Rate for Payer: Cofinity Commercial |
$530.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.70
|
| Rate for Payer: Healthscope Commercial |
$442.44
|
| Rate for Payer: Healthscope Whirlpool |
$442.44
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$387.14
|
| Rate for Payer: PACE SWMI |
$368.70
|
| Rate for Payer: PHP Medicare Advantage |
$368.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.74
|
| Rate for Payer: Priority Health Medicare |
$368.70
|
| Rate for Payer: Priority Health Narrow Network |
$634.74
|
| Rate for Payer: UHC Medicare Advantage |
$379.76
|
|
|
PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS
|
Professional
|
Both
|
$3,122.00
|
|
|
Service Code
|
HCPCS 61880
|
| Min. Negotiated Rate |
$384.25 |
| Max. Negotiated Rate |
$2,185.40 |
| Rate for Payer: Aetna Commercial |
$786.73
|
| Rate for Payer: Aetna Medicare |
$587.11
|
| Rate for Payer: BCBS Complete |
$403.46
|
| Rate for Payer: BCBS MAPPO |
$587.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.32
|
| Rate for Payer: BCN Commercial |
$871.31
|
| Rate for Payer: BCN Medicare Advantage |
$587.11
|
| Rate for Payer: Cash Price |
$2,497.60
|
| Rate for Payer: Cash Price |
$2,497.60
|
| Rate for Payer: Cofinity Commercial |
$845.44
|
| Rate for Payer: Cofinity Commercial |
$786.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.11
|
| Rate for Payer: Healthscope Commercial |
$704.53
|
| Rate for Payer: Healthscope Whirlpool |
$704.53
|
| Rate for Payer: Meridian Medicaid |
$403.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$616.47
|
| Rate for Payer: PACE SWMI |
$587.11
|
| Rate for Payer: PHP Medicare Advantage |
$587.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,185.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.58
|
| Rate for Payer: Priority Health Medicare |
$587.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.58
|
| Rate for Payer: UHC Medicare Advantage |
$604.72
|
|
|
PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR
|
Professional
|
Both
|
$1,027.00
|
|
|
Service Code
|
HCPCS 61888
|
| Min. Negotiated Rate |
$259.22 |
| Max. Negotiated Rate |
$1,422.71 |
| Rate for Payer: Aetna Commercial |
$535.73
|
| Rate for Payer: Aetna Medicare |
$399.80
|
| Rate for Payer: BCBS Complete |
$272.18
|
| Rate for Payer: BCBS MAPPO |
$399.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$818.26
|
| Rate for Payer: BCN Medicare Advantage |
$399.80
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cofinity Commercial |
$535.73
|
| Rate for Payer: Cofinity Commercial |
$575.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.80
|
| Rate for Payer: Healthscope Commercial |
$479.76
|
| Rate for Payer: Healthscope Whirlpool |
$479.76
|
| Rate for Payer: Meridian Medicaid |
$272.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.79
|
| Rate for Payer: PACE SWMI |
$399.80
|
| Rate for Payer: PHP Medicare Advantage |
$399.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.43
|
| Rate for Payer: Priority Health Medicare |
$399.80
|
| Rate for Payer: Priority Health Narrow Network |
$683.43
|
| Rate for Payer: UHC Medicare Advantage |
$411.79
|
|
|
PR REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 64585
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$918.40 |
| Rate for Payer: Aetna Commercial |
$186.93
|
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.50
|
| Rate for Payer: BCBS Trust/PPO |
$390.41
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$139.50
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Cofinity Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.50
|
| Rate for Payer: Healthscope Commercial |
$167.40
|
| Rate for Payer: Healthscope Whirlpool |
$167.40
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.48
|
| Rate for Payer: PACE SWMI |
$139.50
|
| Rate for Payer: PHP Medicare Advantage |
$139.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.21
|
| Rate for Payer: Priority Health Medicare |
$139.50
|
| Rate for Payer: Priority Health Narrow Network |
$241.21
|
| Rate for Payer: UHC Medicare Advantage |
$143.68
|
|
|
PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 57295
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$1,461.28 |
| Rate for Payer: Aetna Commercial |
$663.85
|
| Rate for Payer: Aetna Medicare |
$495.41
|
| Rate for Payer: BCBS Complete |
$339.06
|
| Rate for Payer: BCBS MAPPO |
$495.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.28
|
| Rate for Payer: BCN Commercial |
$1,021.64
|
| Rate for Payer: BCN Medicare Advantage |
$495.41
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cofinity Commercial |
$713.39
|
| Rate for Payer: Cofinity Commercial |
$663.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.41
|
| Rate for Payer: Healthscope Commercial |
$594.49
|
| Rate for Payer: Healthscope Whirlpool |
$594.49
|
| Rate for Payer: Meridian Medicaid |
$339.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$520.18
|
| Rate for Payer: PACE SWMI |
$495.41
|
| Rate for Payer: PHP Medicare Advantage |
$495.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$713.45
|
| Rate for Payer: Priority Health Medicare |
$495.41
|
| Rate for Payer: Priority Health Narrow Network |
$713.45
|
| Rate for Payer: UHC Medicare Advantage |
$510.27
|
|
|
PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 64583
|
| Min. Negotiated Rate |
$315.92 |
| Max. Negotiated Rate |
$1,462.56 |
| Rate for Payer: Aetna Commercial |
$1,142.63
|
| Rate for Payer: Aetna Medicare |
$852.71
|
| Rate for Payer: BCBS Complete |
$580.15
|
| Rate for Payer: BCBS MAPPO |
$852.71
|
| Rate for Payer: BCBS Trust/PPO |
$315.92
|
| Rate for Payer: BCN Commercial |
$1,262.26
|
| Rate for Payer: BCN Medicare Advantage |
$852.71
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$1,227.90
|
| Rate for Payer: Cofinity Commercial |
$1,142.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.71
|
| Rate for Payer: Healthscope Commercial |
$1,023.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,023.25
|
| Rate for Payer: Meridian Medicaid |
$580.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$895.35
|
| Rate for Payer: PACE SWMI |
$852.71
|
| Rate for Payer: PHP Medicare Advantage |
$852.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,462.56
|
| Rate for Payer: Priority Health Medicare |
$852.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,462.56
|
| Rate for Payer: UHC Medicare Advantage |
$878.29
|
|
|
PR REVJ/RPLMNT CH WAL RESPIR ELTRD & CONJ PULSE GEN
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 0467T
|
| Min. Negotiated Rate |
$320.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS Complete |
$320.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
|
|
PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$4,478.00
|
|
|
Service Code
|
HCPCS 27486
|
| Min. Negotiated Rate |
$899.71 |
| Max. Negotiated Rate |
$3,134.60 |
| Rate for Payer: Aetna Commercial |
$1,852.75
|
| Rate for Payer: Aetna Medicare |
$1,382.65
|
| Rate for Payer: BCBS Complete |
$944.70
|
| Rate for Payer: BCBS MAPPO |
$1,382.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,429.05
|
| Rate for Payer: BCN Commercial |
$2,050.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,382.65
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,852.75
|
| Rate for Payer: Cofinity Commercial |
$1,991.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,382.65
|
| Rate for Payer: Healthscope Commercial |
$1,659.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,659.18
|
| Rate for Payer: Meridian Medicaid |
$944.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,451.78
|
| Rate for Payer: PACE SWMI |
$1,382.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,382.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$899.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,134.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,142.69
|
| Rate for Payer: Priority Health Medicare |
$1,382.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,142.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,424.13
|
|
|
PR REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$2,978.08
|
|
|
Service Code
|
HCPCS 27137
|
| Min. Negotiated Rate |
$936.99 |
| Max. Negotiated Rate |
$2,232.56 |
| Rate for Payer: Aetna Commercial |
$1,934.41
|
| Rate for Payer: Aetna Medicare |
$1,443.59
|
| Rate for Payer: BCBS Complete |
$983.84
|
| Rate for Payer: BCBS MAPPO |
$1,443.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,779.31
|
| Rate for Payer: BCN Commercial |
$2,136.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,443.59
|
| Rate for Payer: Cash Price |
$2,382.46
|
| Rate for Payer: Cash Price |
$2,382.46
|
| Rate for Payer: Cofinity Commercial |
$2,078.77
|
| Rate for Payer: Cofinity Commercial |
$1,934.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,443.59
|
| Rate for Payer: Healthscope Commercial |
$1,732.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,732.31
|
| Rate for Payer: Meridian Medicaid |
$983.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,515.77
|
| Rate for Payer: PACE SWMI |
$1,443.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,443.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$936.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,084.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,232.56
|
| Rate for Payer: Priority Health Medicare |
$1,443.59
|
| Rate for Payer: Priority Health Narrow Network |
$2,232.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,486.90
|
|
|
PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,880.62
|
|
|
Service Code
|
HCPCS 27134
|
| Min. Negotiated Rate |
$409.96 |
| Max. Negotiated Rate |
$3,054.10 |
| Rate for Payer: Aetna Commercial |
$2,515.94
|
| Rate for Payer: Aetna Medicare |
$1,877.57
|
| Rate for Payer: BCBS Complete |
$1,275.70
|
| Rate for Payer: BCBS MAPPO |
$1,877.57
|
| Rate for Payer: BCBS Trust/PPO |
$409.96
|
| Rate for Payer: BCN Commercial |
$3,054.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,877.57
|
| Rate for Payer: Cash Price |
$3,104.50
|
| Rate for Payer: Cash Price |
$3,104.50
|
| Rate for Payer: Cofinity Commercial |
$2,515.94
|
| Rate for Payer: Cofinity Commercial |
$2,703.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,877.57
|
| Rate for Payer: Healthscope Commercial |
$2,253.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,253.08
|
| Rate for Payer: Meridian Medicaid |
$1,275.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,971.45
|
| Rate for Payer: PACE SWMI |
$1,877.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,877.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,214.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,716.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,898.45
|
| Rate for Payer: Priority Health Medicare |
$1,877.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,898.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,933.90
|
|
|
PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$3,095.16
|
|
|
Service Code
|
HCPCS 27138
|
| Min. Negotiated Rate |
$573.73 |
| Max. Negotiated Rate |
$2,318.86 |
| Rate for Payer: Aetna Commercial |
$2,009.79
|
| Rate for Payer: Aetna Medicare |
$1,499.84
|
| Rate for Payer: BCBS Complete |
$1,021.63
|
| Rate for Payer: BCBS MAPPO |
$1,499.84
|
| Rate for Payer: BCBS Trust/PPO |
$573.73
|
| Rate for Payer: BCN Commercial |
$2,219.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,499.84
|
| Rate for Payer: Cash Price |
$2,476.13
|
| Rate for Payer: Cash Price |
$2,476.13
|
| Rate for Payer: Cofinity Commercial |
$2,159.77
|
| Rate for Payer: Cofinity Commercial |
$2,009.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,499.84
|
| Rate for Payer: Healthscope Commercial |
$1,799.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,799.81
|
| Rate for Payer: Meridian Medicaid |
$1,021.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,574.83
|
| Rate for Payer: PACE SWMI |
$1,499.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,499.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$972.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,166.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,318.86
|
| Rate for Payer: Priority Health Medicare |
$1,499.84
|
| Rate for Payer: Priority Health Narrow Network |
$2,318.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,544.84
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$5,885.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$861.66 |
| Max. Negotiated Rate |
$4,119.50 |
| Rate for Payer: Aetna Commercial |
$2,313.35
|
| Rate for Payer: Aetna Medicare |
$1,726.38
|
| Rate for Payer: BCBS Complete |
$1,176.62
|
| Rate for Payer: BCBS MAPPO |
$1,726.38
|
| Rate for Payer: BCBS Trust/PPO |
$861.66
|
| Rate for Payer: BCN Commercial |
$2,813.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,726.38
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cofinity Commercial |
$2,313.35
|
| Rate for Payer: Cofinity Commercial |
$2,485.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,726.38
|
| Rate for Payer: Healthscope Commercial |
$2,071.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,071.66
|
| Rate for Payer: Meridian Medicaid |
$1,176.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,812.70
|
| Rate for Payer: PACE SWMI |
$1,726.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,726.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,120.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,119.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,670.19
|
| Rate for Payer: Priority Health Medicare |
$1,726.38
|
| Rate for Payer: Priority Health Narrow Network |
$2,670.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,778.17
|
|
