|
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
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
IP
|
$5,885.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$4,119.50 |
| Max. Negotiated Rate |
$5,885.00 |
| Rate for Payer: Aetna Commercial |
$5,296.50
|
| Rate for Payer: ASR ASR |
$5,708.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,562.64
|
| Rate for Payer: BCN Commercial |
$4,562.64
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cofinity Commercial |
$5,531.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,708.00
|
| Rate for Payer: Healthscope Commercial |
$5,885.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,708.45
|
| Rate for Payer: Mclaren Commercial |
$5,296.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,002.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,119.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,178.80
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$5,885.00
|
|
|
Service Code
|
HCPCS 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 |
$2,485.99
|
| Rate for Payer: Cofinity Commercial |
$2,313.35
|
| 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
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$356.07 |
| Max. Negotiated Rate |
$1,116.92 |
| Rate for Payer: Aetna Commercial |
$915.15
|
| Rate for Payer: Aetna Medicare |
$682.95
|
| Rate for Payer: BCBS Complete |
$468.77
|
| Rate for Payer: BCBS MAPPO |
$682.95
|
| Rate for Payer: BCBS Trust/PPO |
$356.07
|
| Rate for Payer: BCN Commercial |
$1,010.10
|
| Rate for Payer: BCN Medicare Advantage |
$682.95
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$983.45
|
| Rate for Payer: Cofinity Commercial |
$915.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$682.95
|
| Rate for Payer: Healthscope Commercial |
$819.54
|
| Rate for Payer: Healthscope Whirlpool |
$819.54
|
| Rate for Payer: Meridian Medicaid |
$468.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$717.10
|
| Rate for Payer: PACE SWMI |
$682.95
|
| Rate for Payer: PHP Medicare Advantage |
$682.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.92
|
| Rate for Payer: Priority Health Medicare |
$682.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.92
|
| Rate for Payer: UHC Medicare Advantage |
$703.44
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$4,557.12 |
| Rate for Payer: Aetna Commercial |
$667.29
|
| Rate for Payer: Aetna Medicare |
$497.98
|
| Rate for Payer: BCBS Complete |
$344.42
|
| Rate for Payer: BCBS MAPPO |
$497.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,557.12
|
| Rate for Payer: BCN Commercial |
$739.37
|
| Rate for Payer: BCN Medicare Advantage |
$497.98
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cofinity Commercial |
$717.09
|
| Rate for Payer: Cofinity Commercial |
$667.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.98
|
| Rate for Payer: Healthscope Commercial |
$597.58
|
| Rate for Payer: Healthscope Whirlpool |
$597.58
|
| Rate for Payer: Meridian Medicaid |
$344.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$522.88
|
| Rate for Payer: PACE SWMI |
$497.98
|
| Rate for Payer: PHP Medicare Advantage |
$497.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.56
|
| Rate for Payer: Priority Health Medicare |
$497.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.56
|
| Rate for Payer: UHC Medicare Advantage |
$512.92
|
|
|
PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,045.00
|
|
|
Service Code
|
HCPCS 37224
|
| Min. Negotiated Rate |
$275.62 |
| Max. Negotiated Rate |
$4,307.21 |
| Rate for Payer: Aetna Commercial |
$584.29
|
| Rate for Payer: Aetna Medicare |
$436.04
|
| Rate for Payer: BCBS Complete |
$289.40
|
| Rate for Payer: BCBS MAPPO |
$436.04
|
| Rate for Payer: BCBS Trust/PPO |
$622.87
|
| Rate for Payer: BCN Commercial |
$4,307.21
|
| Rate for Payer: BCN Medicare Advantage |
$436.04
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cofinity Commercial |
$584.29
|
| Rate for Payer: Cofinity Commercial |
$627.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.04
|
| Rate for Payer: Healthscope Commercial |
$523.25
|
| Rate for Payer: Healthscope Whirlpool |
$523.25
|
| Rate for Payer: Meridian Medicaid |
$289.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$457.84
|
| Rate for Payer: PACE SWMI |
$436.04
|
| Rate for Payer: PHP Medicare Advantage |
$436.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$687.29
|
| Rate for Payer: Priority Health Medicare |
$436.04
|
| Rate for Payer: Priority Health Narrow Network |
$687.29
|
| Rate for Payer: UHC Medicare Advantage |
$449.12
|
|
|
PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,272.00
|
|
|
Service Code
|
HCPCS 37225
|
| Min. Negotiated Rate |
$370.83 |
| Max. Negotiated Rate |
$12,917.21 |
| Rate for Payer: Aetna Commercial |
$785.04
|
| Rate for Payer: Aetna Medicare |
$585.85
|
| Rate for Payer: BCBS Complete |
$389.37
|
| Rate for Payer: BCBS MAPPO |
$585.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.41
|
| Rate for Payer: BCN Commercial |
$12,917.21
|
| Rate for Payer: BCN Medicare Advantage |
$585.85
|
| Rate for Payer: Cash Price |
$1,817.60
|
| Rate for Payer: Cash Price |
$1,817.60
|
| Rate for Payer: Cofinity Commercial |
$843.62
|
| Rate for Payer: Cofinity Commercial |
$785.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.85
|
| Rate for Payer: Healthscope Commercial |
$703.02
|
| Rate for Payer: Healthscope Whirlpool |
$703.02
|
| Rate for Payer: Meridian Medicaid |
$389.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$615.14
|
| Rate for Payer: PACE SWMI |
$585.85
|
| Rate for Payer: PHP Medicare Advantage |
$585.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,590.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$924.54
|
| Rate for Payer: Priority Health Medicare |
$585.85
|
| Rate for Payer: Priority Health Narrow Network |
$924.54
|
| Rate for Payer: UHC Medicare Advantage |
$603.43
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 37226
|
| Min. Negotiated Rate |
$321.42 |
| Max. Negotiated Rate |
$12,021.96 |
| Rate for Payer: Aetna Commercial |
$682.70
|
| Rate for Payer: Aetna Medicare |
$509.48
|
| Rate for Payer: BCBS Complete |
$337.49
|
| Rate for Payer: BCBS MAPPO |
$509.48
|
| Rate for Payer: BCBS Trust/PPO |
$496.60
|
| Rate for Payer: BCN Commercial |
$12,021.96
|
| Rate for Payer: BCN Medicare Advantage |
$509.48
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Cofinity Commercial |
$733.65
|
| Rate for Payer: Cofinity Commercial |
$682.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.48
|
| Rate for Payer: Healthscope Commercial |
$611.38
|
| Rate for Payer: Healthscope Whirlpool |
$611.38
|
| Rate for Payer: Meridian Medicaid |
$337.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$534.95
|
| Rate for Payer: PACE SWMI |
$509.48
|
| Rate for Payer: PHP Medicare Advantage |
$509.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$802.73
|
| Rate for Payer: Priority Health Medicare |
$509.48
|
| Rate for Payer: Priority Health Narrow Network |
$802.73
|
| Rate for Payer: UHC Medicare Advantage |
$524.76
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 37227
|
| Min. Negotiated Rate |
$443.68 |
| Max. Negotiated Rate |
$16,544.66 |
| Rate for Payer: Aetna Commercial |
$942.73
|
| Rate for Payer: Aetna Medicare |
$703.53
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$703.53
|
| Rate for Payer: BCBS Trust/PPO |
$690.49
|
| Rate for Payer: BCN Commercial |
$16,544.66
|
| Rate for Payer: BCN Medicare Advantage |
$703.53
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$942.73
|
| Rate for Payer: Cofinity Commercial |
$1,013.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.53
|
| Rate for Payer: Healthscope Commercial |
$844.24
|
| Rate for Payer: Healthscope Whirlpool |
$844.24
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$738.71
|
| Rate for Payer: PACE SWMI |
$703.53
|
| Rate for Payer: PHP Medicare Advantage |
$703.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,349.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.13
|
| Rate for Payer: Priority Health Medicare |
$703.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.13
|
| Rate for Payer: UHC Medicare Advantage |
$724.64
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$131.21 |
| Max. Negotiated Rate |
$1,876.52 |
| Rate for Payer: Aetna Commercial |
$278.71
|
| Rate for Payer: Aetna Medicare |
$207.99
|
| Rate for Payer: BCBS Complete |
$137.77
|
| Rate for Payer: BCBS MAPPO |
$207.99
|
| Rate for Payer: BCBS Trust/PPO |
$374.83
|
| Rate for Payer: BCN Commercial |
$1,876.52
|
| Rate for Payer: BCN Medicare Advantage |
$207.99
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cofinity Commercial |
$278.71
|
| Rate for Payer: Cofinity Commercial |
$299.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.99
|
| Rate for Payer: Healthscope Commercial |
$249.59
|
| Rate for Payer: Healthscope Whirlpool |
$249.59
|
| Rate for Payer: Meridian Medicaid |
$137.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.39
|
| Rate for Payer: PACE SWMI |
$207.99
|
| Rate for Payer: PHP Medicare Advantage |
$207.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.16
|
| Rate for Payer: Priority Health Medicare |
$207.99
|
| Rate for Payer: Priority Health Narrow Network |
$327.16
|
| Rate for Payer: UHC Medicare Advantage |
$214.23
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY
|
Professional
|
Both
|
$1,982.00
|
|
|
Service Code
|
HCPCS 37221
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$4,542.26 |
| Rate for Payer: Aetna Commercial |
$648.31
|
| Rate for Payer: Aetna Medicare |
$483.81
|
| Rate for Payer: BCBS Complete |
$320.71
|
| Rate for Payer: BCBS MAPPO |
$483.81
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$4,542.26
|
| Rate for Payer: BCN Medicare Advantage |
$483.81
|
| Rate for Payer: Cash Price |
$1,585.60
|
| Rate for Payer: Cash Price |
$1,585.60
|
| Rate for Payer: Cofinity Commercial |
$648.31
|
| Rate for Payer: Cofinity Commercial |
$696.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.81
|
| Rate for Payer: Healthscope Commercial |
$580.57
|
| Rate for Payer: Healthscope Whirlpool |
$580.57
|
| Rate for Payer: Meridian Medicaid |
$320.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$508.00
|
| Rate for Payer: PACE SWMI |
$483.81
|
| Rate for Payer: PHP Medicare Advantage |
$483.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,387.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.29
|
| Rate for Payer: Priority Health Medicare |
$483.81
|
| Rate for Payer: Priority Health Narrow Network |
$762.29
|
| Rate for Payer: UHC Medicare Advantage |
$498.32
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,279.00
|
|
|
Service Code
|
HCPCS 37228
|
| Min. Negotiated Rate |
$335.05 |
| Max. Negotiated Rate |
$6,115.79 |
| Rate for Payer: Aetna Commercial |
$712.02
|
| Rate for Payer: Aetna Medicare |
$531.36
|
| Rate for Payer: BCBS Complete |
$351.80
|
| Rate for Payer: BCBS MAPPO |
$531.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.15
|
| Rate for Payer: BCN Commercial |
$6,115.79
|
| Rate for Payer: BCN Medicare Advantage |
$531.36
|
| Rate for Payer: Cash Price |
$1,023.20
|
| Rate for Payer: Cash Price |
$1,023.20
|
| Rate for Payer: Cofinity Commercial |
$765.16
|
| Rate for Payer: Cofinity Commercial |
$712.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.36
|
| Rate for Payer: Healthscope Commercial |
$637.63
|
| Rate for Payer: Healthscope Whirlpool |
$637.63
|
| Rate for Payer: Meridian Medicaid |
$351.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$557.93
|
| Rate for Payer: PACE SWMI |
$531.36
|
| Rate for Payer: PHP Medicare Advantage |
$531.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$335.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.29
|
| Rate for Payer: Priority Health Medicare |
$531.36
|
| Rate for Payer: Priority Health Narrow Network |
$837.29
|
| Rate for Payer: UHC Medicare Advantage |
$547.30
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
|
Professional
|
Both
|
$4,266.00
|
|
|
Service Code
|
HCPCS 37232
|
| Min. Negotiated Rate |
$123.33 |
| Max. Negotiated Rate |
$2,986.20 |
| Rate for Payer: Aetna Commercial |
$261.19
|
| Rate for Payer: Aetna Medicare |
$194.92
|
| Rate for Payer: BCBS Complete |
$129.50
|
| Rate for Payer: BCBS MAPPO |
$194.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.35
|
| Rate for Payer: BCN Commercial |
$1,206.05
|
| Rate for Payer: BCN Medicare Advantage |
$194.92
|
| Rate for Payer: Cash Price |
$3,412.80
|
| Rate for Payer: Cash Price |
$3,412.80
|
| Rate for Payer: Cofinity Commercial |
$280.68
|
| Rate for Payer: Cofinity Commercial |
$261.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.92
|
| Rate for Payer: Healthscope Commercial |
$233.90
|
| Rate for Payer: Healthscope Whirlpool |
$233.90
|
| Rate for Payer: Meridian Medicaid |
$129.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.67
|
| Rate for Payer: PACE SWMI |
$194.92
|
| Rate for Payer: PHP Medicare Advantage |
$194.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,986.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.47
|
| Rate for Payer: Priority Health Medicare |
$194.92
|
| Rate for Payer: Priority Health Narrow Network |
$307.47
|
| Rate for Payer: UHC Medicare Advantage |
$200.77
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,679.00
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$13,126.37 |
| Rate for Payer: Aetna Commercial |
$910.84
|
| Rate for Payer: Aetna Medicare |
$679.73
|
| Rate for Payer: BCBS Complete |
$450.66
|
| Rate for Payer: BCBS MAPPO |
$679.73
|
| Rate for Payer: BCBS Trust/PPO |
$476.53
|
| Rate for Payer: BCN Commercial |
$13,126.37
|
| Rate for Payer: BCN Medicare Advantage |
$679.73
|
| Rate for Payer: Cash Price |
$2,143.20
|
| Rate for Payer: Cash Price |
$2,143.20
|
| Rate for Payer: Cofinity Commercial |
$978.81
|
| Rate for Payer: Cofinity Commercial |
$910.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.73
|
| Rate for Payer: Healthscope Commercial |
$815.68
|
| Rate for Payer: Healthscope Whirlpool |
$815.68
|
| Rate for Payer: Meridian Medicaid |
$450.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$713.72
|
| Rate for Payer: PACE SWMI |
$679.73
|
| Rate for Payer: PHP Medicare Advantage |
$679.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,875.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.95
|
| Rate for Payer: Priority Health Medicare |
$679.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,072.95
|
| Rate for Payer: UHC Medicare Advantage |
$700.12
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$199.37 |
| Max. Negotiated Rate |
$1,531.51 |
| Rate for Payer: Aetna Commercial |
$423.17
|
| Rate for Payer: Aetna Medicare |
$315.80
|
| Rate for Payer: BCBS Complete |
$209.34
|
| Rate for Payer: BCBS MAPPO |
$315.80
|
| Rate for Payer: BCBS Trust/PPO |
$495.55
|
| Rate for Payer: BCN Commercial |
$1,531.51
|
| Rate for Payer: BCN Medicare Advantage |
$315.80
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cofinity Commercial |
$423.17
|
| Rate for Payer: Cofinity Commercial |
$454.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.80
|
| Rate for Payer: Healthscope Commercial |
$378.96
|
| Rate for Payer: Healthscope Whirlpool |
$378.96
|
| Rate for Payer: Meridian Medicaid |
$209.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$331.59
|
| Rate for Payer: PACE SWMI |
$315.80
|
| Rate for Payer: PHP Medicare Advantage |
$315.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.44
|
| Rate for Payer: Priority Health Medicare |
$315.80
|
| Rate for Payer: Priority Health Narrow Network |
$498.44
|
| Rate for Payer: UHC Medicare Advantage |
$325.27
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$429.41 |
| Max. Negotiated Rate |
$13,145.42 |
| Rate for Payer: Aetna Commercial |
$909.70
|
| Rate for Payer: Aetna Medicare |
$678.88
|
| Rate for Payer: BCBS Complete |
$450.88
|
| Rate for Payer: BCBS MAPPO |
$678.88
|
| Rate for Payer: BCBS Trust/PPO |
$709.51
|
| Rate for Payer: BCN Commercial |
$13,145.42
|
| Rate for Payer: BCN Medicare Advantage |
$678.88
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cofinity Commercial |
$977.59
|
| Rate for Payer: Cofinity Commercial |
$909.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.88
|
| Rate for Payer: Healthscope Commercial |
$814.66
|
| Rate for Payer: Healthscope Whirlpool |
$814.66
|
| Rate for Payer: Meridian Medicaid |
$450.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$712.82
|
| Rate for Payer: PACE SWMI |
$678.88
|
| Rate for Payer: PHP Medicare Advantage |
$678.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.37
|
| Rate for Payer: Priority Health Medicare |
$678.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.37
|
| Rate for Payer: UHC Medicare Advantage |
$699.25
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$5,352.48 |
| Rate for Payer: Aetna Commercial |
$368.26
|
| Rate for Payer: Aetna Medicare |
$274.82
|
| Rate for Payer: BCBS Complete |
$182.94
|
| Rate for Payer: BCBS MAPPO |
$274.82
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$5,352.48
|
| Rate for Payer: BCN Medicare Advantage |
$274.82
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$395.74
|
| Rate for Payer: Cofinity Commercial |
$368.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.82
|
| Rate for Payer: Healthscope Commercial |
$329.78
|
| Rate for Payer: Healthscope Whirlpool |
$329.78
|
| Rate for Payer: Meridian Medicaid |
$182.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$288.56
|
| Rate for Payer: PACE SWMI |
$274.82
|
| Rate for Payer: PHP Medicare Advantage |
$274.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.08
|
| Rate for Payer: Priority Health Medicare |
$274.82
|
| Rate for Payer: Priority Health Narrow Network |
$434.08
|
| Rate for Payer: UHC Medicare Advantage |
$283.06
|
|
|
PR RHINOPLASTY EXTERNAL
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 00536
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,240.00 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: BCBS Complete |
$1,240.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$782.41 |
| Max. Negotiated Rate |
$2,150.18 |
| Rate for Payer: Aetna Commercial |
$1,906.97
|
| Rate for Payer: Aetna Medicare |
$1,423.11
|
| Rate for Payer: BCBS Complete |
$979.59
|
| Rate for Payer: BCBS MAPPO |
$1,423.11
|
| Rate for Payer: BCBS Trust/PPO |
$782.41
|
| Rate for Payer: BCN Commercial |
$2,150.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.11
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cofinity Commercial |
$2,049.28
|
| Rate for Payer: Cofinity Commercial |
$1,906.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.11
|
| Rate for Payer: Healthscope Commercial |
$1,707.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,707.73
|
| Rate for Payer: Meridian Medicaid |
$979.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.27
|
| Rate for Payer: PACE SWMI |
$1,423.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$932.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,037.40
|
| Rate for Payer: Priority Health Medicare |
$1,423.11
|
| Rate for Payer: Priority Health Narrow Network |
$2,037.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.80
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$1,990.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$859.24 |
| Max. Negotiated Rate |
$1,983.05 |
| Rate for Payer: Aetna Commercial |
$1,747.29
|
| Rate for Payer: Aetna Medicare |
$1,303.95
|
| Rate for Payer: BCBS Complete |
$902.20
|
| Rate for Payer: BCBS MAPPO |
$1,303.95
|
| Rate for Payer: BCBS Trust/PPO |
$987.39
|
| Rate for Payer: BCN Commercial |
$1,983.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.95
|
| Rate for Payer: Cash Price |
$1,592.00
|
| Rate for Payer: Cash Price |
$1,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,747.29
|
| Rate for Payer: Cofinity Commercial |
$1,877.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.95
|
| Rate for Payer: Healthscope Commercial |
$1,564.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,564.74
|
| Rate for Payer: Meridian Medicaid |
$902.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,369.15
|
| Rate for Payer: PACE SWMI |
$1,303.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,393.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.03
|
| Rate for Payer: Priority Health Medicare |
$1,303.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,879.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,343.07
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,431.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$858.49 |
| Max. Negotiated Rate |
$2,584.13 |
| Rate for Payer: Aetna Commercial |
$2,293.56
|
| Rate for Payer: Aetna Medicare |
$1,711.61
|
| Rate for Payer: BCBS Complete |
$1,176.85
|
| Rate for Payer: BCBS MAPPO |
$1,711.61
|
| Rate for Payer: BCBS Trust/PPO |
$858.49
|
| Rate for Payer: BCN Commercial |
$2,584.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,711.61
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Cofinity Commercial |
$2,464.72
|
| Rate for Payer: Cofinity Commercial |
$2,293.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,711.61
|
| Rate for Payer: Healthscope Commercial |
$2,053.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,053.93
|
| Rate for Payer: Meridian Medicaid |
$1,176.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,797.19
|
| Rate for Payer: PACE SWMI |
$1,711.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,711.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,120.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,448.59
|
| Rate for Payer: Priority Health Medicare |
$1,711.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,448.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,762.96
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$1,222.67 |
| Rate for Payer: Aetna Commercial |
$1,090.73
|
| Rate for Payer: Aetna Medicare |
$813.98
|
| Rate for Payer: BCBS Complete |
$558.01
|
| Rate for Payer: BCBS MAPPO |
$813.98
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: BCN Commercial |
$1,222.67
|
| Rate for Payer: BCN Medicare Advantage |
$813.98
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,090.73
|
| Rate for Payer: Cofinity Commercial |
$1,172.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.98
|
| Rate for Payer: Healthscope Commercial |
$976.78
|
| Rate for Payer: Healthscope Whirlpool |
$976.78
|
| Rate for Payer: Meridian Medicaid |
$558.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$854.68
|
| Rate for Payer: PACE SWMI |
$813.98
|
| Rate for Payer: PHP Medicare Advantage |
$813.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,158.54
|
| Rate for Payer: Priority Health Medicare |
$813.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,158.54
|
| Rate for Payer: UHC Medicare Advantage |
$838.40
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,847.15
|
| Rate for Payer: Aetna Commercial |
$1,847.15
|
| Rate for Payer: Aetna Medicare |
$1,378.47
|
| Rate for Payer: Aetna Medicare |
$1,378.47
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS MAPPO |
$1,378.47
|
| Rate for Payer: BCBS MAPPO |
$1,378.47
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.47
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cofinity Commercial |
$1,985.00
|
| Rate for Payer: Cofinity Commercial |
$1,847.15
|
| Rate for Payer: Cofinity Commercial |
$1,985.00
|
| Rate for Payer: Cofinity Commercial |
$1,847.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.47
|
| Rate for Payer: Healthscope Commercial |
$1,654.16
|
| Rate for Payer: Healthscope Commercial |
$1,654.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,654.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,654.16
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,447.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,447.39
|
| Rate for Payer: PACE SWMI |
$1,378.47
|
| Rate for Payer: PACE SWMI |
$1,378.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,116.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health Medicare |
$1,378.47
|
| Rate for Payer: Priority Health Medicare |
$1,378.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,983.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,983.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.82
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$788.95 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,600.75
|
| Rate for Payer: Aetna Medicare |
$1,194.59
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$1,194.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.35
|
| Rate for Payer: BCN Commercial |
$1,821.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,194.59
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,720.21
|
| Rate for Payer: Cofinity Commercial |
$1,600.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,194.59
|
| Rate for Payer: Healthscope Commercial |
$1,433.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,433.51
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,254.32
|
| Rate for Payer: PACE SWMI |
$1,194.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,194.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,726.23
|
| Rate for Payer: Priority Health Medicare |
$1,194.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,726.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,230.43
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$91.88
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
