|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$1,048.40 |
| Max. Negotiated Rate |
$1,883.68 |
| Rate for Payer: Aetna Commercial |
$1,752.87
|
| Rate for Payer: Aetna Medicare |
$1,308.11
|
| Rate for Payer: BCBS Complete |
$1,048.40
|
| Rate for Payer: BCBS MAPPO |
$1,308.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.11
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,883.68
|
| Rate for Payer: Cofinity Commercial |
$1,752.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.11
|
| Rate for Payer: Healthscope Commercial |
$1,569.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.52
|
| Rate for Payer: Nomi Health Commercial |
$1,569.73
|
| Rate for Payer: PACE SWMI |
$1,308.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health Medicare |
$1,308.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.11
|
| Rate for Payer: UHCCP DNSP |
$1,308.11
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$1,032.40 |
| Max. Negotiated Rate |
$1,839.27 |
| Rate for Payer: Aetna Commercial |
$1,711.54
|
| Rate for Payer: Aetna Medicare |
$1,277.27
|
| Rate for Payer: BCBS Complete |
$1,032.40
|
| Rate for Payer: BCBS MAPPO |
$1,277.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.27
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$1,839.27
|
| Rate for Payer: Cofinity Commercial |
$1,711.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.27
|
| Rate for Payer: Healthscope Commercial |
$1,532.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.13
|
| Rate for Payer: Nomi Health Commercial |
$1,532.72
|
| Rate for Payer: PACE SWMI |
$1,277.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.65
|
| Rate for Payer: Priority Health Medicare |
$1,277.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,277.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,277.27
|
| Rate for Payer: UHCCP DNSP |
$1,277.27
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$1,128.40 |
| Max. Negotiated Rate |
$1,904.57 |
| Rate for Payer: Aetna Commercial |
$1,772.31
|
| Rate for Payer: Aetna Medicare |
$1,322.62
|
| Rate for Payer: BCBS Complete |
$1,128.40
|
| Rate for Payer: BCBS MAPPO |
$1,322.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,322.62
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,904.57
|
| Rate for Payer: Cofinity Commercial |
$1,772.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,322.62
|
| Rate for Payer: Healthscope Commercial |
$1,587.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,587.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,388.75
|
| Rate for Payer: Nomi Health Commercial |
$1,587.14
|
| Rate for Payer: PACE SWMI |
$1,322.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,322.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.65
|
| Rate for Payer: Priority Health Medicare |
$1,322.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,322.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,322.62
|
| Rate for Payer: UHCCP DNSP |
$1,322.62
|
|
|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$588.99 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Aetna Medicare |
$588.99
|
| Rate for Payer: BCBS Complete |
$852.80
|
| Rate for Payer: BCBS MAPPO |
$588.99
|
| Rate for Payer: BCN Medicare Advantage |
$588.99
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cofinity Commercial |
$848.15
|
| Rate for Payer: Cofinity Commercial |
$789.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.99
|
| Rate for Payer: Healthscope Commercial |
$706.79
|
| Rate for Payer: Healthscope Whirlpool |
$706.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.44
|
| Rate for Payer: Nomi Health Commercial |
$706.79
|
| Rate for Payer: PACE SWMI |
$588.99
|
| Rate for Payer: PHP Medicare Advantage |
$588.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health Medicare |
$588.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.99
|
| Rate for Payer: UHC Medicare Advantage |
$588.99
|
| Rate for Payer: UHCCP DNSP |
$588.99
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$1,018.08 |
| Max. Negotiated Rate |
$1,907.10 |
| Rate for Payer: Aetna Commercial |
$1,364.23
|
| Rate for Payer: Aetna Medicare |
$1,018.08
|
| Rate for Payer: BCBS Complete |
$1,173.60
|
| Rate for Payer: BCBS MAPPO |
$1,018.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.08
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cofinity Commercial |
$1,466.04
|
| Rate for Payer: Cofinity Commercial |
$1,364.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.08
|
| Rate for Payer: Healthscope Commercial |
$1,221.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.98
|
| Rate for Payer: Nomi Health Commercial |
$1,221.70
|
| Rate for Payer: PACE SWMI |
$1,018.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health Medicare |
$1,018.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.08
|
| Rate for Payer: UHCCP DNSP |
$1,018.08
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$680.98 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$912.51
|
| Rate for Payer: Aetna Medicare |
$680.98
|
| Rate for Payer: BCBS Complete |
$852.80
|
| Rate for Payer: BCBS MAPPO |
$680.98
|
| Rate for Payer: BCN Medicare Advantage |
$680.98
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cofinity Commercial |
$980.61
|
| Rate for Payer: Cofinity Commercial |
$912.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.98
|
| Rate for Payer: Healthscope Commercial |
$817.18
|
| Rate for Payer: Healthscope Whirlpool |
$817.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.03
|
| Rate for Payer: Nomi Health Commercial |
$817.18
|
| Rate for Payer: PACE SWMI |
$680.98
|
| Rate for Payer: PHP Medicare Advantage |
$680.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health Medicare |
$680.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.98
|
| Rate for Payer: UHC Medicare Advantage |
$680.98
|
| Rate for Payer: UHCCP DNSP |
$680.98
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$766.61 |
| Max. Negotiated Rate |
$1,466.40 |
| Rate for Payer: Aetna Commercial |
$1,027.26
|
| Rate for Payer: Aetna Medicare |
$766.61
|
| Rate for Payer: BCBS Complete |
$902.40
|
| Rate for Payer: BCBS MAPPO |
$766.61
|
| Rate for Payer: BCN Medicare Advantage |
$766.61
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cofinity Commercial |
$1,103.92
|
| Rate for Payer: Cofinity Commercial |
$1,027.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.61
|
| Rate for Payer: Healthscope Commercial |
$919.93
|
| Rate for Payer: Healthscope Whirlpool |
$919.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.94
|
| Rate for Payer: Nomi Health Commercial |
$919.93
|
| Rate for Payer: PACE SWMI |
$766.61
|
| Rate for Payer: PHP Medicare Advantage |
$766.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health Medicare |
$766.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.61
|
| Rate for Payer: UHC Medicare Advantage |
$766.61
|
| Rate for Payer: UHCCP DNSP |
$766.61
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$3,976.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$1,308.02 |
| Max. Negotiated Rate |
$2,584.40 |
| Rate for Payer: Aetna Commercial |
$1,752.75
|
| Rate for Payer: Aetna Medicare |
$1,308.02
|
| Rate for Payer: BCBS Complete |
$1,590.40
|
| Rate for Payer: BCBS MAPPO |
$1,308.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.02
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cofinity Commercial |
$1,883.55
|
| Rate for Payer: Cofinity Commercial |
$1,752.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.02
|
| Rate for Payer: Healthscope Commercial |
$1,569.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.42
|
| Rate for Payer: Nomi Health Commercial |
$1,569.62
|
| Rate for Payer: PACE SWMI |
$1,308.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,584.40
|
| Rate for Payer: Priority Health Medicare |
$1,308.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.02
|
| Rate for Payer: UHCCP DNSP |
$1,308.02
|
|
|
PR GEL-ONE
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$529.26 |
| Max. Negotiated Rate |
$888.55 |
| Rate for Payer: Aetna Commercial |
$709.21
|
| Rate for Payer: Aetna Medicare |
$529.26
|
| Rate for Payer: BCBS Complete |
$546.80
|
| Rate for Payer: BCBS MAPPO |
$529.26
|
| Rate for Payer: BCN Medicare Advantage |
$529.26
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cofinity Commercial |
$762.13
|
| Rate for Payer: Cofinity Commercial |
$709.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.26
|
| Rate for Payer: Healthscope Commercial |
$635.11
|
| Rate for Payer: Healthscope Whirlpool |
$635.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.72
|
| Rate for Payer: Nomi Health Commercial |
$635.11
|
| Rate for Payer: PACE SWMI |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: Priority Health Medicare |
$529.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.26
|
| Rate for Payer: UHC Medicare Advantage |
$529.26
|
| Rate for Payer: UHCCP DNSP |
$529.26
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$1,948.59 |
| Rate for Payer: Aetna Commercial |
$1,813.27
|
| Rate for Payer: Aetna Commercial |
$1,813.27
|
| Rate for Payer: Aetna Medicare |
$1,353.19
|
| Rate for Payer: Aetna Medicare |
$1,353.19
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS Complete |
$1,366.80
|
| Rate for Payer: BCBS MAPPO |
$1,353.19
|
| Rate for Payer: BCBS MAPPO |
$1,353.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.19
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cofinity Commercial |
$1,813.27
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Cofinity Commercial |
$1,813.27
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.19
|
| Rate for Payer: Healthscope Commercial |
$1,623.83
|
| Rate for Payer: Healthscope Commercial |
$1,623.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,623.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,623.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.85
|
| Rate for Payer: Nomi Health Commercial |
$1,623.83
|
| Rate for Payer: Nomi Health Commercial |
$1,623.83
|
| Rate for Payer: PACE SWMI |
$1,353.19
|
| Rate for Payer: PACE SWMI |
$1,353.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.05
|
| Rate for Payer: Priority Health Medicare |
$1,353.19
|
| Rate for Payer: Priority Health Medicare |
$1,353.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,353.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,353.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,353.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,353.19
|
| Rate for Payer: UHCCP DNSP |
$1,353.19
|
| Rate for Payer: UHCCP DNSP |
$1,353.19
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$622.62 |
| Max. Negotiated Rate |
$1,051.70 |
| Rate for Payer: Aetna Commercial |
$834.31
|
| Rate for Payer: Aetna Medicare |
$622.62
|
| Rate for Payer: BCBS Complete |
$647.20
|
| Rate for Payer: BCBS MAPPO |
$622.62
|
| Rate for Payer: BCN Medicare Advantage |
$622.62
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cofinity Commercial |
$896.57
|
| Rate for Payer: Cofinity Commercial |
$834.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.62
|
| Rate for Payer: Healthscope Commercial |
$747.14
|
| Rate for Payer: Healthscope Whirlpool |
$747.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$653.75
|
| Rate for Payer: Nomi Health Commercial |
$747.14
|
| Rate for Payer: PACE SWMI |
$622.62
|
| Rate for Payer: PHP Medicare Advantage |
$622.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.70
|
| Rate for Payer: Priority Health Medicare |
$622.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.62
|
| Rate for Payer: UHC Medicare Advantage |
$622.62
|
| Rate for Payer: UHCCP DNSP |
$622.62
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,388.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$955.20 |
| Max. Negotiated Rate |
$1,756.41 |
| Rate for Payer: Aetna Commercial |
$1,634.44
|
| Rate for Payer: Aetna Medicare |
$1,219.73
|
| Rate for Payer: BCBS Complete |
$955.20
|
| Rate for Payer: BCBS MAPPO |
$1,219.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,219.73
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cofinity Commercial |
$1,756.41
|
| Rate for Payer: Cofinity Commercial |
$1,634.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,219.73
|
| Rate for Payer: Healthscope Commercial |
$1,463.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,463.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,280.72
|
| Rate for Payer: Nomi Health Commercial |
$1,463.68
|
| Rate for Payer: PACE SWMI |
$1,219.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,219.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.20
|
| Rate for Payer: Priority Health Medicare |
$1,219.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,219.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,219.73
|
| Rate for Payer: UHCCP DNSP |
$1,219.73
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$1,409.70 |
| Rate for Payer: Aetna Commercial |
$1,311.81
|
| Rate for Payer: Aetna Medicare |
$978.96
|
| Rate for Payer: BCBS Complete |
$760.00
|
| Rate for Payer: BCBS MAPPO |
$978.96
|
| Rate for Payer: BCN Medicare Advantage |
$978.96
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,409.70
|
| Rate for Payer: Cofinity Commercial |
$1,311.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.96
|
| Rate for Payer: Healthscope Commercial |
$1,174.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.91
|
| Rate for Payer: Nomi Health Commercial |
$1,174.75
|
| Rate for Payer: PACE SWMI |
$978.96
|
| Rate for Payer: PHP Medicare Advantage |
$978.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.00
|
| Rate for Payer: Priority Health Medicare |
$978.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.96
|
| Rate for Payer: UHC Medicare Advantage |
$978.96
|
| Rate for Payer: UHCCP DNSP |
$978.96
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$3,945.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$1,578.00 |
| Max. Negotiated Rate |
$2,918.02 |
| Rate for Payer: Aetna Commercial |
$2,715.38
|
| Rate for Payer: Aetna Medicare |
$2,026.40
|
| Rate for Payer: BCBS Complete |
$1,578.00
|
| Rate for Payer: BCBS MAPPO |
$2,026.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,026.40
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cofinity Commercial |
$2,918.02
|
| Rate for Payer: Cofinity Commercial |
$2,715.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,026.40
|
| Rate for Payer: Healthscope Commercial |
$2,431.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,431.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,127.72
|
| Rate for Payer: Nomi Health Commercial |
$2,431.68
|
| Rate for Payer: PACE SWMI |
$2,026.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,026.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,564.25
|
| Rate for Payer: Priority Health Medicare |
$2,026.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,026.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,026.40
|
| Rate for Payer: UHCCP DNSP |
$2,026.40
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$4,098.00
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$2,956.38 |
| Rate for Payer: Aetna Commercial |
$2,751.07
|
| Rate for Payer: Aetna Medicare |
$2,053.04
|
| Rate for Payer: BCBS Complete |
$1,639.20
|
| Rate for Payer: BCBS MAPPO |
$2,053.04
|
| Rate for Payer: BCN Medicare Advantage |
$2,053.04
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cofinity Commercial |
$2,956.38
|
| Rate for Payer: Cofinity Commercial |
$2,751.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,053.04
|
| Rate for Payer: Healthscope Commercial |
$2,463.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,463.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,155.69
|
| Rate for Payer: Nomi Health Commercial |
$2,463.65
|
| Rate for Payer: PACE SWMI |
$2,053.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,053.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.70
|
| Rate for Payer: Priority Health Medicare |
$2,053.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,053.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,053.04
|
| Rate for Payer: UHCCP DNSP |
$2,053.04
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$25.23
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$18.83
|
| Rate for Payer: BCN Medicare Advantage |
$18.83
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$25.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Healthscope Whirlpool |
$22.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.77
|
| Rate for Payer: Nomi Health Commercial |
$22.60
|
| Rate for Payer: PACE SWMI |
$18.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Medicare |
$18.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.83
|
| Rate for Payer: UHC Medicare Advantage |
$18.83
|
| Rate for Payer: UHCCP DNSP |
$18.83
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,703.00
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$662.35 |
| Max. Negotiated Rate |
$1,106.95 |
| Rate for Payer: Aetna Commercial |
$887.55
|
| Rate for Payer: Aetna Medicare |
$662.35
|
| Rate for Payer: BCBS Complete |
$681.20
|
| Rate for Payer: BCBS MAPPO |
$662.35
|
| Rate for Payer: BCN Medicare Advantage |
$662.35
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cofinity Commercial |
$953.78
|
| Rate for Payer: Cofinity Commercial |
$887.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.35
|
| Rate for Payer: Healthscope Commercial |
$794.82
|
| Rate for Payer: Healthscope Whirlpool |
$794.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.47
|
| Rate for Payer: Nomi Health Commercial |
$794.82
|
| Rate for Payer: PACE SWMI |
$662.35
|
| Rate for Payer: PHP Medicare Advantage |
$662.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.95
|
| Rate for Payer: Priority Health Medicare |
$662.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.35
|
| Rate for Payer: UHC Medicare Advantage |
$662.35
|
| Rate for Payer: UHCCP DNSP |
$662.35
|
|
|
PR GRAFT DERMA-FAT-FASCIA
|
Professional
|
Both
|
$1,469.00
|
|
|
Service Code
|
HCPCS 15770
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$954.85 |
| Rate for Payer: Aetna Commercial |
$859.15
|
| Rate for Payer: Aetna Medicare |
$641.16
|
| Rate for Payer: BCBS Complete |
$587.60
|
| Rate for Payer: BCBS MAPPO |
$641.16
|
| Rate for Payer: BCN Medicare Advantage |
$641.16
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cofinity Commercial |
$923.27
|
| Rate for Payer: Cofinity Commercial |
$859.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.16
|
| Rate for Payer: Healthscope Commercial |
$769.39
|
| Rate for Payer: Healthscope Whirlpool |
$769.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.22
|
| Rate for Payer: Nomi Health Commercial |
$769.39
|
| Rate for Payer: PACE SWMI |
$641.16
|
| Rate for Payer: PHP Medicare Advantage |
$641.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.85
|
| Rate for Payer: Priority Health Medicare |
$641.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.16
|
| Rate for Payer: UHC Medicare Advantage |
$641.16
|
| Rate for Payer: UHCCP DNSP |
$641.16
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Aetna Commercial |
$724.54
|
| Rate for Payer: Aetna Medicare |
$540.70
|
| Rate for Payer: BCBS Complete |
$490.00
|
| Rate for Payer: BCBS MAPPO |
$540.70
|
| Rate for Payer: BCN Medicare Advantage |
$540.70
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$778.61
|
| Rate for Payer: Cofinity Commercial |
$724.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.70
|
| Rate for Payer: Healthscope Commercial |
$648.84
|
| Rate for Payer: Healthscope Whirlpool |
$648.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.74
|
| Rate for Payer: Nomi Health Commercial |
$648.84
|
| Rate for Payer: PACE SWMI |
$540.70
|
| Rate for Payer: PHP Medicare Advantage |
$540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.25
|
| Rate for Payer: Priority Health Medicare |
$540.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.70
|
| Rate for Payer: UHC Medicare Advantage |
$540.70
|
| Rate for Payer: UHCCP DNSP |
$540.70
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$467.20 |
| Max. Negotiated Rate |
$759.20 |
| Rate for Payer: Aetna Commercial |
$642.37
|
| Rate for Payer: Aetna Medicare |
$479.38
|
| Rate for Payer: BCBS Complete |
$467.20
|
| Rate for Payer: BCBS MAPPO |
$479.38
|
| Rate for Payer: BCN Medicare Advantage |
$479.38
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$690.31
|
| Rate for Payer: Cofinity Commercial |
$642.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.38
|
| Rate for Payer: Healthscope Commercial |
$575.26
|
| Rate for Payer: Healthscope Whirlpool |
$575.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.35
|
| Rate for Payer: Nomi Health Commercial |
$575.26
|
| Rate for Payer: PACE SWMI |
$479.38
|
| Rate for Payer: PHP Medicare Advantage |
$479.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health Medicare |
$479.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.38
|
| Rate for Payer: UHC Medicare Advantage |
$479.38
|
| Rate for Payer: UHCCP DNSP |
$479.38
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$462.80 |
| Max. Negotiated Rate |
$752.05 |
| Rate for Payer: Aetna Commercial |
$656.55
|
| Rate for Payer: Aetna Medicare |
$489.96
|
| Rate for Payer: BCBS Complete |
$462.80
|
| Rate for Payer: BCBS MAPPO |
$489.96
|
| Rate for Payer: BCN Medicare Advantage |
$489.96
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cofinity Commercial |
$705.54
|
| Rate for Payer: Cofinity Commercial |
$656.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.96
|
| Rate for Payer: Healthscope Commercial |
$587.95
|
| Rate for Payer: Healthscope Whirlpool |
$587.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.46
|
| Rate for Payer: Nomi Health Commercial |
$587.95
|
| Rate for Payer: PACE SWMI |
$489.96
|
| Rate for Payer: PHP Medicare Advantage |
$489.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.05
|
| Rate for Payer: Priority Health Medicare |
$489.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.96
|
| Rate for Payer: UHC Medicare Advantage |
$489.96
|
| Rate for Payer: UHCCP DNSP |
$489.96
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Aetna Commercial |
$185.62
|
| Rate for Payer: Aetna Medicare |
$138.52
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS MAPPO |
$138.52
|
| Rate for Payer: BCN Medicare Advantage |
$138.52
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$199.47
|
| Rate for Payer: Cofinity Commercial |
$185.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.52
|
| Rate for Payer: Healthscope Commercial |
$166.22
|
| Rate for Payer: Healthscope Whirlpool |
$166.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.45
|
| Rate for Payer: Nomi Health Commercial |
$166.22
|
| Rate for Payer: PACE SWMI |
$138.52
|
| Rate for Payer: PHP Medicare Advantage |
$138.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health Medicare |
$138.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.52
|
| Rate for Payer: UHC Medicare Advantage |
$138.52
|
| Rate for Payer: UHCCP DNSP |
$138.52
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$191.61
|
| Rate for Payer: Aetna Medicare |
$142.99
|
| Rate for Payer: BCBS Complete |
$146.80
|
| Rate for Payer: BCBS MAPPO |
$142.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.99
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$205.91
|
| Rate for Payer: Cofinity Commercial |
$191.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.99
|
| Rate for Payer: Healthscope Commercial |
$171.59
|
| Rate for Payer: Healthscope Whirlpool |
$171.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.14
|
| Rate for Payer: Nomi Health Commercial |
$171.59
|
| Rate for Payer: PACE SWMI |
$142.99
|
| Rate for Payer: PHP Medicare Advantage |
$142.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health Medicare |
$142.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.99
|
| Rate for Payer: UHC Medicare Advantage |
$142.99
|
| Rate for Payer: UHCCP DNSP |
$142.99
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$661.92 |
| Rate for Payer: Aetna Commercial |
$615.96
|
| Rate for Payer: Aetna Medicare |
$459.67
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS MAPPO |
$459.67
|
| Rate for Payer: BCN Medicare Advantage |
$459.67
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$661.92
|
| Rate for Payer: Cofinity Commercial |
$615.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.67
|
| Rate for Payer: Healthscope Commercial |
$551.60
|
| Rate for Payer: Healthscope Whirlpool |
$551.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.65
|
| Rate for Payer: Nomi Health Commercial |
$551.60
|
| Rate for Payer: PACE SWMI |
$459.67
|
| Rate for Payer: PHP Medicare Advantage |
$459.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health Medicare |
$459.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.67
|
| Rate for Payer: UHC Medicare Advantage |
$459.67
|
| Rate for Payer: UHCCP DNSP |
$459.67
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Aetna Medicare |
$601.01
|
| Rate for Payer: BCBS Complete |
$480.00
|
| Rate for Payer: BCBS MAPPO |
$601.01
|
| Rate for Payer: BCN Medicare Advantage |
$601.01
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$865.45
|
| Rate for Payer: Cofinity Commercial |
$805.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.01
|
| Rate for Payer: Healthscope Commercial |
$721.21
|
| Rate for Payer: Healthscope Whirlpool |
$721.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$631.06
|
| Rate for Payer: Nomi Health Commercial |
$721.21
|
| Rate for Payer: PACE SWMI |
$601.01
|
| Rate for Payer: PHP Medicare Advantage |
$601.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.00
|
| Rate for Payer: Priority Health Medicare |
$601.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.01
|
| Rate for Payer: UHC Medicare Advantage |
$601.01
|
| Rate for Payer: UHCCP DNSP |
$601.01
|
|
