|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$410.76 |
| Rate for Payer: Aetna Commercial |
$382.24
|
| Rate for Payer: Aetna Medicare |
$285.25
|
| Rate for Payer: BCBS Complete |
$229.60
|
| Rate for Payer: BCBS MAPPO |
$285.25
|
| Rate for Payer: BCN Medicare Advantage |
$285.25
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$410.76
|
| Rate for Payer: Cofinity Commercial |
$382.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.25
|
| Rate for Payer: Healthscope Commercial |
$342.30
|
| Rate for Payer: Healthscope Whirlpool |
$342.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.51
|
| Rate for Payer: Nomi Health Commercial |
$342.30
|
| Rate for Payer: PACE SWMI |
$285.25
|
| Rate for Payer: PHP Medicare Advantage |
$285.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$285.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.25
|
| Rate for Payer: UHC Medicare Advantage |
$285.25
|
| Rate for Payer: UHCCP DNSP |
$285.25
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$693.20 |
| Max. Negotiated Rate |
$1,154.64 |
| Rate for Payer: Aetna Commercial |
$1,074.45
|
| Rate for Payer: Aetna Medicare |
$801.83
|
| Rate for Payer: BCBS Complete |
$693.20
|
| Rate for Payer: BCBS MAPPO |
$801.83
|
| Rate for Payer: BCN Medicare Advantage |
$801.83
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.64
|
| Rate for Payer: Cofinity Commercial |
$1,074.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.83
|
| Rate for Payer: Healthscope Commercial |
$962.20
|
| Rate for Payer: Healthscope Whirlpool |
$962.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.92
|
| Rate for Payer: Nomi Health Commercial |
$962.20
|
| Rate for Payer: PACE SWMI |
$801.83
|
| Rate for Payer: PHP Medicare Advantage |
$801.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health Medicare |
$801.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.83
|
| Rate for Payer: UHC Medicare Advantage |
$801.83
|
| Rate for Payer: UHCCP DNSP |
$801.83
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$29.77
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$29.77
|
| Rate for Payer: BCN Medicare Advantage |
$29.77
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.77
|
| Rate for Payer: Healthscope Commercial |
$35.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.26
|
| Rate for Payer: Nomi Health Commercial |
$35.72
|
| Rate for Payer: PACE SWMI |
$29.77
|
| Rate for Payer: PHP Medicare Advantage |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$29.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.77
|
| Rate for Payer: UHC Medicare Advantage |
$29.77
|
| Rate for Payer: UHCCP DNSP |
$29.77
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$9.80
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$8.77
|
| Rate for Payer: Healthscope Whirlpool |
$8.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$8.77
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
| Rate for Payer: UHCCP DNSP |
$7.31
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$348.81 |
| Rate for Payer: Aetna Commercial |
$324.59
|
| Rate for Payer: Aetna Medicare |
$242.23
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$242.23
|
| Rate for Payer: BCN Medicare Advantage |
$242.23
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$324.59
|
| Rate for Payer: Cofinity Commercial |
$348.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.23
|
| Rate for Payer: Healthscope Commercial |
$290.68
|
| Rate for Payer: Healthscope Whirlpool |
$290.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.34
|
| Rate for Payer: Nomi Health Commercial |
$290.68
|
| Rate for Payer: PACE SWMI |
$242.23
|
| Rate for Payer: PHP Medicare Advantage |
$242.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$242.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.23
|
| Rate for Payer: UHC Medicare Advantage |
$242.23
|
| Rate for Payer: UHCCP DNSP |
$242.23
|
|
|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$127.97 |
| Rate for Payer: Aetna Commercial |
$119.09
|
| Rate for Payer: Aetna Medicare |
$88.87
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$88.87
|
| Rate for Payer: BCN Medicare Advantage |
$88.87
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$127.97
|
| Rate for Payer: Cofinity Commercial |
$119.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.87
|
| Rate for Payer: Healthscope Commercial |
$106.64
|
| Rate for Payer: Healthscope Whirlpool |
$106.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.31
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: PACE SWMI |
$88.87
|
| Rate for Payer: PHP Medicare Advantage |
$88.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$88.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.87
|
| Rate for Payer: UHC Medicare Advantage |
$88.87
|
| Rate for Payer: UHCCP DNSP |
$88.87
|
|
|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$61.29
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$61.29
|
| Rate for Payer: BCN Medicare Advantage |
$61.29
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$88.26
|
| Rate for Payer: Cofinity Commercial |
$82.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.29
|
| Rate for Payer: Healthscope Commercial |
$73.55
|
| Rate for Payer: Healthscope Whirlpool |
$73.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.35
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: PACE SWMI |
$61.29
|
| Rate for Payer: PHP Medicare Advantage |
$61.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$61.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.29
|
| Rate for Payer: UHC Medicare Advantage |
$61.29
|
| Rate for Payer: UHCCP DNSP |
$61.29
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$103.72 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna Medicare |
$72.03
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$72.03
|
| Rate for Payer: BCN Medicare Advantage |
$72.03
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.03
|
| Rate for Payer: Healthscope Commercial |
$86.44
|
| Rate for Payer: Healthscope Whirlpool |
$86.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.63
|
| Rate for Payer: Nomi Health Commercial |
$86.44
|
| Rate for Payer: PACE SWMI |
$72.03
|
| Rate for Payer: PHP Medicare Advantage |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$72.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.03
|
| Rate for Payer: UHC Medicare Advantage |
$72.03
|
| Rate for Payer: UHCCP DNSP |
$72.03
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$1,078.91 |
| Rate for Payer: Aetna Commercial |
$1,003.98
|
| Rate for Payer: Aetna Medicare |
$749.24
|
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCBS MAPPO |
$749.24
|
| Rate for Payer: BCN Medicare Advantage |
$749.24
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$1,078.91
|
| Rate for Payer: Cofinity Commercial |
$1,003.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.24
|
| Rate for Payer: Healthscope Commercial |
$899.09
|
| Rate for Payer: Healthscope Whirlpool |
$899.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.70
|
| Rate for Payer: Nomi Health Commercial |
$899.09
|
| Rate for Payer: PACE SWMI |
$749.24
|
| Rate for Payer: PHP Medicare Advantage |
$749.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health Medicare |
$749.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$749.24
|
| Rate for Payer: UHC Medicare Advantage |
$749.24
|
| Rate for Payer: UHCCP DNSP |
$749.24
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,259.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$903.60 |
| Max. Negotiated Rate |
$1,468.35 |
| Rate for Payer: Aetna Commercial |
$1,268.04
|
| Rate for Payer: Aetna Medicare |
$946.30
|
| Rate for Payer: BCBS Complete |
$903.60
|
| Rate for Payer: BCBS MAPPO |
$946.30
|
| Rate for Payer: BCN Medicare Advantage |
$946.30
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.67
|
| Rate for Payer: Cofinity Commercial |
$1,268.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.30
|
| Rate for Payer: Healthscope Commercial |
$1,135.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.62
|
| Rate for Payer: Nomi Health Commercial |
$1,135.56
|
| Rate for Payer: PACE SWMI |
$946.30
|
| Rate for Payer: PHP Medicare Advantage |
$946.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,468.35
|
| Rate for Payer: Priority Health Medicare |
$946.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.30
|
| Rate for Payer: UHC Medicare Advantage |
$946.30
|
| Rate for Payer: UHCCP DNSP |
$946.30
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$73.55
|
| Rate for Payer: Aetna Medicare |
$54.89
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$54.89
|
| Rate for Payer: BCN Medicare Advantage |
$54.89
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Cofinity Commercial |
$73.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.89
|
| Rate for Payer: Healthscope Commercial |
$65.87
|
| Rate for Payer: Healthscope Whirlpool |
$65.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.63
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: PACE SWMI |
$54.89
|
| Rate for Payer: PHP Medicare Advantage |
$54.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$54.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.89
|
| Rate for Payer: UHC Medicare Advantage |
$54.89
|
| Rate for Payer: UHCCP DNSP |
$54.89
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$336.90 |
| Rate for Payer: Aetna Commercial |
$313.51
|
| Rate for Payer: Aetna Medicare |
$233.96
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$233.96
|
| Rate for Payer: BCN Medicare Advantage |
$233.96
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$313.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.96
|
| Rate for Payer: Healthscope Commercial |
$280.75
|
| Rate for Payer: Healthscope Whirlpool |
$280.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.66
|
| Rate for Payer: Nomi Health Commercial |
$280.75
|
| Rate for Payer: PACE SWMI |
$233.96
|
| Rate for Payer: PHP Medicare Advantage |
$233.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Medicare |
$233.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.96
|
| Rate for Payer: UHC Medicare Advantage |
$233.96
|
| Rate for Payer: UHCCP DNSP |
$233.96
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00100
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR FRAC NECK
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00102
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR FRAC SCARS PER INCH
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00104
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR FRAC THGH/ABD/BACK
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00103
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$148.86
|
| Rate for Payer: Aetna Medicare |
$111.09
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$111.09
|
| Rate for Payer: BCN Medicare Advantage |
$111.09
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Cofinity Commercial |
$159.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.09
|
| Rate for Payer: Healthscope Commercial |
$133.31
|
| Rate for Payer: Healthscope Whirlpool |
$133.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.64
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PACE SWMI |
$111.09
|
| Rate for Payer: PHP Medicare Advantage |
$111.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$111.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.09
|
| Rate for Payer: UHC Medicare Advantage |
$111.09
|
| Rate for Payer: UHCCP DNSP |
$111.09
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00101
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$369.85 |
| Rate for Payer: Aetna Commercial |
$317.37
|
| Rate for Payer: Aetna Medicare |
$236.84
|
| Rate for Payer: BCBS Complete |
$227.60
|
| Rate for Payer: BCBS MAPPO |
$236.84
|
| Rate for Payer: BCN Medicare Advantage |
$236.84
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cofinity Commercial |
$341.05
|
| Rate for Payer: Cofinity Commercial |
$317.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.84
|
| Rate for Payer: Healthscope Commercial |
$284.21
|
| Rate for Payer: Healthscope Whirlpool |
$284.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.68
|
| Rate for Payer: Nomi Health Commercial |
$284.21
|
| Rate for Payer: PACE SWMI |
$236.84
|
| Rate for Payer: PHP Medicare Advantage |
$236.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health Medicare |
$236.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.84
|
| Rate for Payer: UHC Medicare Advantage |
$236.84
|
| Rate for Payer: UHCCP DNSP |
$236.84
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$185.83 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: Aetna Medicare |
$185.83
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$185.83
|
| Rate for Payer: BCN Medicare Advantage |
$185.83
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$267.60
|
| Rate for Payer: Cofinity Commercial |
$249.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.83
|
| Rate for Payer: Healthscope Commercial |
$223.00
|
| Rate for Payer: Healthscope Whirlpool |
$223.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.12
|
| Rate for Payer: Nomi Health Commercial |
$223.00
|
| Rate for Payer: PACE SWMI |
$185.83
|
| Rate for Payer: PHP Medicare Advantage |
$185.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$185.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.83
|
| Rate for Payer: UHC Medicare Advantage |
$185.83
|
| Rate for Payer: UHCCP DNSP |
$185.83
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$601.20 |
| Max. Negotiated Rate |
$1,002.02 |
| Rate for Payer: Aetna Commercial |
$932.44
|
| Rate for Payer: Aetna Medicare |
$695.85
|
| Rate for Payer: BCBS Complete |
$601.20
|
| Rate for Payer: BCBS MAPPO |
$695.85
|
| Rate for Payer: BCN Medicare Advantage |
$695.85
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$932.44
|
| Rate for Payer: Cofinity Commercial |
$1,002.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.85
|
| Rate for Payer: Healthscope Commercial |
$835.02
|
| Rate for Payer: Healthscope Whirlpool |
$835.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.64
|
| Rate for Payer: Nomi Health Commercial |
$835.02
|
| Rate for Payer: PACE SWMI |
$695.85
|
| Rate for Payer: PHP Medicare Advantage |
$695.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health Medicare |
$695.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.85
|
| Rate for Payer: UHC Medicare Advantage |
$695.85
|
| Rate for Payer: UHCCP DNSP |
$695.85
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$615.17 |
| Max. Negotiated Rate |
$1,054.95 |
| Rate for Payer: Aetna Commercial |
$824.33
|
| Rate for Payer: Aetna Medicare |
$615.17
|
| Rate for Payer: BCBS Complete |
$649.20
|
| Rate for Payer: BCBS MAPPO |
$615.17
|
| Rate for Payer: BCN Medicare Advantage |
$615.17
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$885.84
|
| Rate for Payer: Cofinity Commercial |
$824.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.17
|
| Rate for Payer: Healthscope Commercial |
$738.20
|
| Rate for Payer: Healthscope Whirlpool |
$738.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.93
|
| Rate for Payer: Nomi Health Commercial |
$738.20
|
| Rate for Payer: PACE SWMI |
$615.17
|
| Rate for Payer: PHP Medicare Advantage |
$615.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health Medicare |
$615.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.17
|
| Rate for Payer: UHC Medicare Advantage |
$615.17
|
| Rate for Payer: UHCCP DNSP |
$615.17
|
|
