|
PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY
|
Professional
|
Both
|
$5,729.00
|
|
|
Service Code
|
HCPCS 62120
|
| Min. Negotiated Rate |
$1,110.49 |
| Max. Negotiated Rate |
$4,010.30 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Aetna Medicare |
$2,070.67
|
| Rate for Payer: BCBS Complete |
$1,413.69
|
| Rate for Payer: BCBS MAPPO |
$2,070.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.49
|
| Rate for Payer: BCN Commercial |
$3,072.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,070.67
|
| Rate for Payer: Cash Price |
$4,583.20
|
| Rate for Payer: Cash Price |
$4,583.20
|
| Rate for Payer: Cofinity Commercial |
$2,981.76
|
| Rate for Payer: Cofinity Commercial |
$2,774.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,070.67
|
| Rate for Payer: Healthscope Commercial |
$2,484.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,484.80
|
| Rate for Payer: Meridian Medicaid |
$1,413.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.20
|
| Rate for Payer: PACE SWMI |
$2,070.67
|
| Rate for Payer: PHP Medicare Advantage |
$2,070.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,346.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,010.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,559.85
|
| Rate for Payer: Priority Health Medicare |
$2,070.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,559.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,132.79
|
|
|
PR RPR EPIGASTRIC HERNIA INCARCERATED
|
Professional
|
Both
|
$1,459.00
|
|
|
Service Code
|
HCPCS 49572
|
| Min. Negotiated Rate |
$583.60 |
| Max. Negotiated Rate |
$1,021.30 |
| Rate for Payer: BCBS Complete |
$583.60
|
| Rate for Payer: Cash Price |
$1,167.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.30
|
|
|
PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
HCPCS 49570
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$803.60 |
| Rate for Payer: BCBS Complete |
$459.20
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.60
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$235.15 |
| Max. Negotiated Rate |
$1,815.77 |
| Rate for Payer: Aetna Commercial |
$477.71
|
| Rate for Payer: Aetna Medicare |
$356.50
|
| Rate for Payer: BCBS Complete |
$246.91
|
| Rate for Payer: BCBS MAPPO |
$356.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.77
|
| Rate for Payer: BCN Commercial |
$535.10
|
| Rate for Payer: BCN Medicare Advantage |
$356.50
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$513.36
|
| Rate for Payer: Cofinity Commercial |
$477.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.50
|
| Rate for Payer: Healthscope Commercial |
$427.80
|
| Rate for Payer: Healthscope Whirlpool |
$427.80
|
| Rate for Payer: Meridian Medicaid |
$246.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.32
|
| Rate for Payer: PACE SWMI |
$356.50
|
| Rate for Payer: PHP Medicare Advantage |
$356.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.15
|
| Rate for Payer: Priority Health Medicare |
$356.50
|
| Rate for Payer: Priority Health Narrow Network |
$559.15
|
| Rate for Payer: UHC Medicare Advantage |
$367.20
|
|
|
PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 27665
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$1,815.77 |
| Rate for Payer: Aetna Commercial |
$553.08
|
| Rate for Payer: Aetna Medicare |
$412.75
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS MAPPO |
$412.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.77
|
| Rate for Payer: BCN Commercial |
$619.16
|
| Rate for Payer: BCN Medicare Advantage |
$412.75
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$594.36
|
| Rate for Payer: Cofinity Commercial |
$553.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.75
|
| Rate for Payer: Healthscope Commercial |
$495.30
|
| Rate for Payer: Healthscope Whirlpool |
$495.30
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$433.39
|
| Rate for Payer: PACE SWMI |
$412.75
|
| Rate for Payer: PHP Medicare Advantage |
$412.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$646.99
|
| Rate for Payer: Priority Health Medicare |
$412.75
|
| Rate for Payer: Priority Health Narrow Network |
$646.99
|
| Rate for Payer: UHC Medicare Advantage |
$425.13
|
|
|
PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 27659
|
| Min. Negotiated Rate |
$305.66 |
| Max. Negotiated Rate |
$1,861.44 |
| Rate for Payer: Aetna Commercial |
$619.28
|
| Rate for Payer: Aetna Medicare |
$462.15
|
| Rate for Payer: BCBS Complete |
$320.94
|
| Rate for Payer: BCBS MAPPO |
$462.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,861.44
|
| Rate for Payer: BCN Commercial |
$689.52
|
| Rate for Payer: BCN Medicare Advantage |
$462.15
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$665.50
|
| Rate for Payer: Cofinity Commercial |
$619.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.15
|
| Rate for Payer: Healthscope Commercial |
$554.58
|
| Rate for Payer: Healthscope Whirlpool |
$554.58
|
| Rate for Payer: Meridian Medicaid |
$320.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$485.26
|
| Rate for Payer: PACE SWMI |
$462.15
|
| Rate for Payer: PHP Medicare Advantage |
$462.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$720.53
|
| Rate for Payer: Priority Health Medicare |
$462.15
|
| Rate for Payer: Priority Health Narrow Network |
$720.53
|
| Rate for Payer: UHC Medicare Advantage |
$476.01
|
|
|
PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$5,448.00
|
|
|
Service Code
|
HCPCS 46740
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$3,813.60 |
| Rate for Payer: Aetna Commercial |
$2,882.21
|
| Rate for Payer: Aetna Medicare |
$2,150.90
|
| Rate for Payer: BCBS Complete |
$1,457.98
|
| Rate for Payer: BCBS MAPPO |
$2,150.90
|
| Rate for Payer: BCBS Trust/PPO |
$93.51
|
| Rate for Payer: BCN Commercial |
$3,167.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,150.90
|
| Rate for Payer: Cash Price |
$4,358.40
|
| Rate for Payer: Cash Price |
$4,358.40
|
| Rate for Payer: Cofinity Commercial |
$2,882.21
|
| Rate for Payer: Cofinity Commercial |
$3,097.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,150.90
|
| Rate for Payer: Healthscope Commercial |
$2,581.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,581.08
|
| Rate for Payer: Meridian Medicaid |
$1,457.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,258.44
|
| Rate for Payer: PACE SWMI |
$2,150.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,150.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,388.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,813.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,811.24
|
| Rate for Payer: Priority Health Medicare |
$2,150.90
|
| Rate for Payer: Priority Health Narrow Network |
$3,811.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,215.43
|
|
|
PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL
|
Professional
|
Both
|
$5,046.00
|
|
|
Service Code
|
HCPCS 46742
|
| Min. Negotiated Rate |
$477.58 |
| Max. Negotiated Rate |
$4,399.21 |
| Rate for Payer: Aetna Commercial |
$3,332.78
|
| Rate for Payer: Aetna Medicare |
$2,487.15
|
| Rate for Payer: BCBS Complete |
$1,682.52
|
| Rate for Payer: BCBS MAPPO |
$2,487.15
|
| Rate for Payer: BCBS Trust/PPO |
$477.58
|
| Rate for Payer: BCN Commercial |
$3,656.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,487.15
|
| Rate for Payer: Cash Price |
$4,036.80
|
| Rate for Payer: Cash Price |
$4,036.80
|
| Rate for Payer: Cofinity Commercial |
$3,581.50
|
| Rate for Payer: Cofinity Commercial |
$3,332.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,487.15
|
| Rate for Payer: Healthscope Commercial |
$2,984.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,984.58
|
| Rate for Payer: Meridian Medicaid |
$1,682.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,611.51
|
| Rate for Payer: PACE SWMI |
$2,487.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,487.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,602.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,532.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,399.21
|
| Rate for Payer: Priority Health Medicare |
$2,487.15
|
| Rate for Payer: Priority Health Narrow Network |
$4,399.21
|
| Rate for Payer: UHC Medicare Advantage |
$2,561.76
|
|
|
PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$3,803.00
|
|
|
Service Code
|
HCPCS 46730
|
| Min. Negotiated Rate |
$105.13 |
| Max. Negotiated Rate |
$3,495.49 |
| Rate for Payer: Aetna Commercial |
$2,640.86
|
| Rate for Payer: Aetna Medicare |
$1,970.79
|
| Rate for Payer: BCBS Complete |
$1,336.98
|
| Rate for Payer: BCBS MAPPO |
$1,970.79
|
| Rate for Payer: BCBS Trust/PPO |
$105.13
|
| Rate for Payer: BCN Commercial |
$2,905.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,970.79
|
| Rate for Payer: Cash Price |
$3,042.40
|
| Rate for Payer: Cash Price |
$3,042.40
|
| Rate for Payer: Cofinity Commercial |
$2,837.94
|
| Rate for Payer: Cofinity Commercial |
$2,640.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,970.79
|
| Rate for Payer: Healthscope Commercial |
$2,364.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,364.95
|
| Rate for Payer: Meridian Medicaid |
$1,336.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,069.33
|
| Rate for Payer: PACE SWMI |
$1,970.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,970.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,273.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,662.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,495.49
|
| Rate for Payer: Priority Health Medicare |
$1,970.79
|
| Rate for Payer: Priority Health Narrow Network |
$3,495.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,029.91
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS 54340
|
| Min. Negotiated Rate |
$364.02 |
| Max. Negotiated Rate |
$2,917.27 |
| Rate for Payer: Aetna Commercial |
$744.49
|
| Rate for Payer: Aetna Medicare |
$555.59
|
| Rate for Payer: BCBS Complete |
$382.22
|
| Rate for Payer: BCBS MAPPO |
$555.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,917.27
|
| Rate for Payer: BCN Commercial |
$822.94
|
| Rate for Payer: BCN Medicare Advantage |
$555.59
|
| Rate for Payer: Cash Price |
$1,556.80
|
| Rate for Payer: Cash Price |
$1,556.80
|
| Rate for Payer: Cofinity Commercial |
$744.49
|
| Rate for Payer: Cofinity Commercial |
$800.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.59
|
| Rate for Payer: Healthscope Commercial |
$666.71
|
| Rate for Payer: Healthscope Whirlpool |
$666.71
|
| Rate for Payer: Meridian Medicaid |
$382.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$583.37
|
| Rate for Payer: PACE SWMI |
$555.59
|
| Rate for Payer: PHP Medicare Advantage |
$555.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.96
|
| Rate for Payer: Priority Health Medicare |
$555.59
|
| Rate for Payer: Priority Health Narrow Network |
$909.96
|
| Rate for Payer: UHC Medicare Advantage |
$572.26
|
|
|
PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR
|
Professional
|
Both
|
$7,400.00
|
|
|
Service Code
|
HCPCS 33660
|
| Min. Negotiated Rate |
$1,101.42 |
| Max. Negotiated Rate |
$5,180.00 |
| Rate for Payer: Aetna Commercial |
$2,315.96
|
| Rate for Payer: Aetna Medicare |
$1,728.33
|
| Rate for Payer: BCBS Complete |
$1,156.49
|
| Rate for Payer: BCBS MAPPO |
$1,728.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.09
|
| Rate for Payer: BCN Commercial |
$2,516.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,728.33
|
| Rate for Payer: Cash Price |
$5,920.00
|
| Rate for Payer: Cash Price |
$5,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,488.80
|
| Rate for Payer: Cofinity Commercial |
$2,315.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,728.33
|
| Rate for Payer: Healthscope Commercial |
$2,074.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,074.00
|
| Rate for Payer: Meridian Medicaid |
$1,156.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,814.75
|
| Rate for Payer: PACE SWMI |
$1,728.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,728.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,101.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,180.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,739.05
|
| Rate for Payer: Priority Health Medicare |
$1,728.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,739.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,780.18
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,122.80 |
| Max. Negotiated Rate |
$1,604.00 |
| Rate for Payer: Aetna Commercial |
$1,443.60
|
| Rate for Payer: ASR ASR |
$1,555.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,243.58
|
| Rate for Payer: BCN Commercial |
$1,243.58
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,507.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,283.20
|
| Rate for Payer: Healthscope Commercial |
$1,604.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,555.88
|
| Rate for Payer: Mclaren Commercial |
$1,443.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,363.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,411.52
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,122.80 |
| Max. Negotiated Rate |
$3,844.02 |
| Rate for Payer: Aetna Commercial |
$1,443.60
|
| Rate for Payer: Aetna Medicare |
$3,075.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: ASR ASR |
$1,555.88
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,243.58
|
| Rate for Payer: BCN Commercial |
$1,243.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,507.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,283.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Healthscope Commercial |
$1,604.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,555.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,075.22
|
| Rate for Payer: Mclaren Commercial |
$1,443.60
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,363.40
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Commercial |
$3,382.74
|
| Rate for Payer: PHP Medicaid |
$1,682.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,459.64
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,138.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,411.52
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$369.34 |
| Max. Negotiated Rate |
$1,122.80 |
| Rate for Payer: Aetna Commercial |
$765.68
|
| Rate for Payer: Aetna Medicare |
$571.40
|
| Rate for Payer: BCBS Complete |
$387.81
|
| Rate for Payer: BCBS MAPPO |
$571.40
|
| Rate for Payer: BCBS Trust/PPO |
$515.62
|
| Rate for Payer: BCN Commercial |
$842.48
|
| Rate for Payer: BCN Medicare Advantage |
$571.40
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$765.68
|
| Rate for Payer: Cofinity Commercial |
$822.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.40
|
| Rate for Payer: Healthscope Commercial |
$685.68
|
| Rate for Payer: Healthscope Whirlpool |
$685.68
|
| Rate for Payer: Meridian Medicaid |
$387.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$599.97
|
| Rate for Payer: PACE SWMI |
$571.40
|
| Rate for Payer: PHP Medicare Advantage |
$571.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,013.67
|
| Rate for Payer: Priority Health Medicare |
$571.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.67
|
| Rate for Payer: UHC Medicare Advantage |
$588.54
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$369.34 |
| Max. Negotiated Rate |
$1,122.80 |
| Rate for Payer: Aetna Commercial |
$765.68
|
| Rate for Payer: Aetna Medicare |
$571.40
|
| Rate for Payer: BCBS Complete |
$387.81
|
| Rate for Payer: BCBS MAPPO |
$571.40
|
| Rate for Payer: BCBS Trust/PPO |
$515.62
|
| Rate for Payer: BCN Commercial |
$842.48
|
| Rate for Payer: BCN Medicare Advantage |
$571.40
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cash Price |
$1,283.20
|
| Rate for Payer: Cofinity Commercial |
$765.68
|
| Rate for Payer: Cofinity Commercial |
$822.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.40
|
| Rate for Payer: Healthscope Commercial |
$685.68
|
| Rate for Payer: Healthscope Whirlpool |
$685.68
|
| Rate for Payer: Meridian Medicaid |
$387.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$599.97
|
| Rate for Payer: PACE SWMI |
$571.40
|
| Rate for Payer: PHP Medicare Advantage |
$571.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,013.67
|
| Rate for Payer: Priority Health Medicare |
$571.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.67
|
| Rate for Payer: UHC Medicare Advantage |
$588.54
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$204.05 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$418.05
|
| Rate for Payer: Aetna Medicare |
$311.98
|
| Rate for Payer: BCBS Complete |
$214.25
|
| Rate for Payer: BCBS MAPPO |
$311.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.00
|
| Rate for Payer: BCN Commercial |
$734.48
|
| Rate for Payer: BCN Medicare Advantage |
$311.98
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cofinity Commercial |
$449.25
|
| Rate for Payer: Cofinity Commercial |
$418.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.98
|
| Rate for Payer: Healthscope Commercial |
$374.38
|
| Rate for Payer: Healthscope Whirlpool |
$374.38
|
| Rate for Payer: Meridian Medicaid |
$214.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.58
|
| Rate for Payer: PACE SWMI |
$311.98
|
| Rate for Payer: PHP Medicare Advantage |
$311.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.08
|
| Rate for Payer: Priority Health Medicare |
$311.98
|
| Rate for Payer: Priority Health Narrow Network |
$390.08
|
| Rate for Payer: UHC Medicare Advantage |
$321.34
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$1,744.97 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Medicare |
$150.30
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS MAPPO |
$150.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.97
|
| Rate for Payer: BCN Commercial |
$420.26
|
| Rate for Payer: BCN Medicare Advantage |
$150.30
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$216.43
|
| Rate for Payer: Cofinity Commercial |
$201.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.30
|
| Rate for Payer: Healthscope Commercial |
$180.36
|
| Rate for Payer: Healthscope Whirlpool |
$180.36
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.82
|
| Rate for Payer: PACE SWMI |
$150.30
|
| Rate for Payer: PHP Medicare Advantage |
$150.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.06
|
| Rate for Payer: Priority Health Medicare |
$150.30
|
| Rate for Payer: Priority Health Narrow Network |
$271.06
|
| Rate for Payer: UHC Medicare Advantage |
$154.81
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$744.10 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna Medicare |
$205.72
|
| Rate for Payer: BCBS Complete |
$140.68
|
| Rate for Payer: BCBS MAPPO |
$205.72
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: BCN Commercial |
$484.76
|
| Rate for Payer: BCN Medicare Advantage |
$205.72
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Cofinity Commercial |
$275.66
|
| Rate for Payer: Cofinity Commercial |
$296.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.72
|
| Rate for Payer: Healthscope Commercial |
$246.86
|
| Rate for Payer: Healthscope Whirlpool |
$246.86
|
| Rate for Payer: Meridian Medicaid |
$140.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.01
|
| Rate for Payer: PACE SWMI |
$205.72
|
| Rate for Payer: PHP Medicare Advantage |
$205.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.24
|
| Rate for Payer: Priority Health Medicare |
$205.72
|
| Rate for Payer: Priority Health Narrow Network |
$369.24
|
| Rate for Payer: UHC Medicare Advantage |
$211.89
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$3,342.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$726.33 |
| Max. Negotiated Rate |
$2,339.40 |
| Rate for Payer: Aetna Commercial |
$1,516.88
|
| Rate for Payer: Aetna Medicare |
$1,132.00
|
| Rate for Payer: BCBS Complete |
$762.65
|
| Rate for Payer: BCBS MAPPO |
$1,132.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.86
|
| Rate for Payer: BCN Commercial |
$1,659.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,132.00
|
| Rate for Payer: Cash Price |
$2,673.60
|
| Rate for Payer: Cash Price |
$2,673.60
|
| Rate for Payer: Cofinity Commercial |
$1,630.08
|
| Rate for Payer: Cofinity Commercial |
$1,516.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,132.00
|
| Rate for Payer: Healthscope Commercial |
$1,358.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,358.40
|
| Rate for Payer: Meridian Medicaid |
$762.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,188.60
|
| Rate for Payer: PACE SWMI |
$1,132.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,132.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,339.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,996.17
|
| Rate for Payer: Priority Health Medicare |
$1,132.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,996.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,165.96
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$8,940.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$2,106.86 |
| Max. Negotiated Rate |
$8,595.58 |
| Rate for Payer: Aetna Commercial |
$6,563.25
|
| Rate for Payer: Aetna Medicare |
$4,897.95
|
| Rate for Payer: BCBS Complete |
$3,280.05
|
| Rate for Payer: BCBS MAPPO |
$4,897.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.86
|
| Rate for Payer: BCN Commercial |
$7,143.98
|
| Rate for Payer: BCN Medicare Advantage |
$4,897.95
|
| Rate for Payer: Cash Price |
$7,152.00
|
| Rate for Payer: Cash Price |
$7,152.00
|
| Rate for Payer: Cofinity Commercial |
$7,053.05
|
| Rate for Payer: Cofinity Commercial |
$6,563.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,897.95
|
| Rate for Payer: Healthscope Commercial |
$5,877.54
|
| Rate for Payer: Healthscope Whirlpool |
$5,877.54
|
| Rate for Payer: Meridian Medicaid |
$3,280.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,142.85
|
| Rate for Payer: PACE SWMI |
$4,897.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,897.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,123.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,258.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,595.58
|
| Rate for Payer: Priority Health Medicare |
$4,897.95
|
| Rate for Payer: Priority Health Narrow Network |
$8,595.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,044.89
|
|
|
PR RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$233.45 |
| Max. Negotiated Rate |
$765.27 |
| Rate for Payer: Aetna Commercial |
$472.36
|
| Rate for Payer: Aetna Medicare |
$352.51
|
| Rate for Payer: BCBS Complete |
$245.12
|
| Rate for Payer: BCBS MAPPO |
$352.51
|
| Rate for Payer: BCBS Trust/PPO |
$649.28
|
| Rate for Payer: BCN Commercial |
$765.27
|
| Rate for Payer: BCN Medicare Advantage |
$352.51
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$507.61
|
| Rate for Payer: Cofinity Commercial |
$472.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.51
|
| Rate for Payer: Healthscope Commercial |
$423.01
|
| Rate for Payer: Healthscope Whirlpool |
$423.01
|
| Rate for Payer: Meridian Medicaid |
$245.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$370.14
|
| Rate for Payer: PACE SWMI |
$352.51
|
| Rate for Payer: PHP Medicare Advantage |
$352.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.96
|
| Rate for Payer: Priority Health Medicare |
$352.51
|
| Rate for Payer: Priority Health Narrow Network |
$637.96
|
| Rate for Payer: UHC Medicare Advantage |
$363.09
|
|
|
PR RPR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$709.07 |
| Rate for Payer: Aetna Commercial |
$411.67
|
| Rate for Payer: Aetna Medicare |
$307.22
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS MAPPO |
$307.22
|
| Rate for Payer: BCBS Trust/PPO |
$462.26
|
| Rate for Payer: BCN Commercial |
$709.07
|
| Rate for Payer: BCN Medicare Advantage |
$307.22
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$442.40
|
| Rate for Payer: Cofinity Commercial |
$411.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.22
|
| Rate for Payer: Healthscope Commercial |
$368.66
|
| Rate for Payer: Healthscope Whirlpool |
$368.66
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$322.58
|
| Rate for Payer: PACE SWMI |
$307.22
|
| Rate for Payer: PHP Medicare Advantage |
$307.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.63
|
| Rate for Payer: Priority Health Medicare |
$307.22
|
| Rate for Payer: Priority Health Narrow Network |
$555.63
|
| Rate for Payer: UHC Medicare Advantage |
$316.44
|
|
|
PR RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$861.54 |
| Rate for Payer: Aetna Commercial |
$556.97
|
| Rate for Payer: Aetna Medicare |
$415.65
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS MAPPO |
$415.65
|
| Rate for Payer: BCBS Trust/PPO |
$842.64
|
| Rate for Payer: BCN Commercial |
$861.54
|
| Rate for Payer: BCN Medicare Advantage |
$415.65
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$598.54
|
| Rate for Payer: Cofinity Commercial |
$556.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.65
|
| Rate for Payer: Healthscope Commercial |
$498.78
|
| Rate for Payer: Healthscope Whirlpool |
$498.78
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$436.43
|
| Rate for Payer: PACE SWMI |
$415.65
|
| Rate for Payer: PHP Medicare Advantage |
$415.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.43
|
| Rate for Payer: Priority Health Medicare |
$415.65
|
| Rate for Payer: Priority Health Narrow Network |
$751.43
|
| Rate for Payer: UHC Medicare Advantage |
$428.12
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$231.40 |
| Max. Negotiated Rate |
$982.51 |
| Rate for Payer: Aetna Commercial |
$736.44
|
| Rate for Payer: Aetna Medicare |
$549.58
|
| Rate for Payer: BCBS Complete |
$375.28
|
| Rate for Payer: BCBS MAPPO |
$549.58
|
| Rate for Payer: BCBS Trust/PPO |
$231.40
|
| Rate for Payer: BCN Commercial |
$816.58
|
| Rate for Payer: BCN Medicare Advantage |
$549.58
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$736.44
|
| Rate for Payer: Cofinity Commercial |
$791.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.58
|
| Rate for Payer: Healthscope Commercial |
$659.50
|
| Rate for Payer: Healthscope Whirlpool |
$659.50
|
| Rate for Payer: Meridian Medicaid |
$375.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$577.06
|
| Rate for Payer: PACE SWMI |
$549.58
|
| Rate for Payer: PHP Medicare Advantage |
$549.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.51
|
| Rate for Payer: Priority Health Medicare |
$549.58
|
| Rate for Payer: Priority Health Narrow Network |
$982.51
|
| Rate for Payer: UHC Medicare Advantage |
$566.07
|
|
|
PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA
|
Professional
|
Both
|
$2,933.00
|
|
|
Service Code
|
HCPCS 46716
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$2,174.92 |
| Rate for Payer: Aetna Commercial |
$1,633.96
|
| Rate for Payer: Aetna Medicare |
$1,219.37
|
| Rate for Payer: BCBS Complete |
$833.32
|
| Rate for Payer: BCBS MAPPO |
$1,219.37
|
| Rate for Payer: BCBS Trust/PPO |
$117.81
|
| Rate for Payer: BCN Commercial |
$1,807.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,219.37
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cash Price |
$2,346.40
|
| Rate for Payer: Cofinity Commercial |
$1,633.96
|
| Rate for Payer: Cofinity Commercial |
$1,755.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,219.37
|
| Rate for Payer: Healthscope Commercial |
$1,463.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,463.24
|
| Rate for Payer: Meridian Medicaid |
$833.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,280.34
|
| Rate for Payer: PACE SWMI |
$1,219.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,219.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,174.92
|
| Rate for Payer: Priority Health Medicare |
$1,219.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,174.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,255.95
|
|
