|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$79.33 |
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Medicare |
$55.09
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$55.09
|
| Rate for Payer: BCN Medicare Advantage |
$55.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$79.33
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.09
|
| Rate for Payer: Healthscope Commercial |
$66.11
|
| Rate for Payer: Healthscope Whirlpool |
$66.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.84
|
| Rate for Payer: Nomi Health Commercial |
$66.11
|
| Rate for Payer: PACE SWMI |
$55.09
|
| Rate for Payer: PHP Medicare Advantage |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$55.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.09
|
| Rate for Payer: UHC Medicare Advantage |
$55.09
|
| Rate for Payer: UHCCP DNSP |
$55.09
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Commercial |
$106.85
|
| Rate for Payer: Aetna Medicare |
$79.74
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$79.74
|
| Rate for Payer: BCN Medicare Advantage |
$79.74
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$114.83
|
| Rate for Payer: Cofinity Commercial |
$106.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$95.69
|
| Rate for Payer: Healthscope Whirlpool |
$95.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.73
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: PACE SWMI |
$79.74
|
| Rate for Payer: PHP Medicare Advantage |
$79.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health Medicare |
$79.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.74
|
| Rate for Payer: UHC Medicare Advantage |
$79.74
|
| Rate for Payer: UHCCP DNSP |
$79.74
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna Medicare |
$70.93
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$70.93
|
| Rate for Payer: BCN Medicare Advantage |
$70.93
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Cofinity Commercial |
$102.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.93
|
| Rate for Payer: Healthscope Commercial |
$85.12
|
| Rate for Payer: Healthscope Whirlpool |
$85.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.48
|
| Rate for Payer: Nomi Health Commercial |
$85.12
|
| Rate for Payer: PACE SWMI |
$70.93
|
| Rate for Payer: PHP Medicare Advantage |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Medicare |
$70.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.93
|
| Rate for Payer: UHC Medicare Advantage |
$70.93
|
| Rate for Payer: UHCCP DNSP |
$70.93
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$10.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.78
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.78
|
| Rate for Payer: Healthscope Commercial |
$12.94
|
| Rate for Payer: Healthscope Whirlpool |
$12.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: PACE SWMI |
$10.78
|
| Rate for Payer: PHP Medicare Advantage |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$10.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.78
|
| Rate for Payer: UHCCP DNSP |
$10.78
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Commercial |
$30.31
|
| Rate for Payer: Aetna Medicare |
$22.62
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$22.62
|
| Rate for Payer: BCN Medicare Advantage |
$22.62
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$30.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.62
|
| Rate for Payer: Healthscope Commercial |
$27.14
|
| Rate for Payer: Healthscope Whirlpool |
$27.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.75
|
| Rate for Payer: Nomi Health Commercial |
$27.14
|
| Rate for Payer: PACE SWMI |
$22.62
|
| Rate for Payer: PHP Medicare Advantage |
$22.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$22.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.62
|
| Rate for Payer: UHC Medicare Advantage |
$22.62
|
| Rate for Payer: UHCCP DNSP |
$22.62
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$11.58
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$11.58
|
| Rate for Payer: BCN Medicare Advantage |
$11.58
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.58
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Healthscope Whirlpool |
$13.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.16
|
| Rate for Payer: Nomi Health Commercial |
$13.90
|
| Rate for Payer: PACE SWMI |
$11.58
|
| Rate for Payer: PHP Medicare Advantage |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Medicare |
$11.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$11.58
|
| Rate for Payer: UHCCP DNSP |
$11.58
|
|
|
PR MONALISA TOUCH, SERIES, UP TO 7 VISITS, LICHEN SCLEROSUS
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 00560
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Medicare |
$1,071.00
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
|
|
PR MONOVISC INJ PER DOSE
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS J7327
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$916.69 |
| Rate for Payer: Aetna Commercial |
$853.03
|
| Rate for Payer: Aetna Medicare |
$636.59
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$636.59
|
| Rate for Payer: BCN Medicare Advantage |
$636.59
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$916.69
|
| Rate for Payer: Cofinity Commercial |
$853.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.59
|
| Rate for Payer: Healthscope Commercial |
$763.91
|
| Rate for Payer: Healthscope Whirlpool |
$763.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.42
|
| Rate for Payer: Nomi Health Commercial |
$763.91
|
| Rate for Payer: PACE SWMI |
$636.59
|
| Rate for Payer: PHP Medicare Advantage |
$636.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$636.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$636.59
|
| Rate for Payer: UHC Medicare Advantage |
$636.59
|
| Rate for Payer: UHCCP DNSP |
$636.59
|
|
|
PR MORPHINE SULFATE INJECTION
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2270
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$2.18
|
| Rate for Payer: BCN Medicare Advantage |
$2.18
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Whirlpool |
$2.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: PACE SWMI |
$2.18
|
| Rate for Payer: PHP Medicare Advantage |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.18
|
| Rate for Payer: UHC Medicare Advantage |
$2.18
|
| Rate for Payer: UHCCP DNSP |
$2.18
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$29.19 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Commercial |
$39.11
|
| Rate for Payer: Aetna Medicare |
$29.19
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$29.19
|
| Rate for Payer: BCN Medicare Advantage |
$29.19
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$35.03
|
| Rate for Payer: Healthscope Whirlpool |
$35.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.65
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: PACE SWMI |
$29.19
|
| Rate for Payer: PHP Medicare Advantage |
$29.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Medicare |
$29.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.19
|
| Rate for Payer: UHC Medicare Advantage |
$29.19
|
| Rate for Payer: UHCCP DNSP |
$29.19
|
|
|
PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 90733
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
|
|
PR MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 97157
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 90849
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Commercial |
$38.67
|
| Rate for Payer: Aetna Medicare |
$28.86
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$28.86
|
| Rate for Payer: BCN Medicare Advantage |
$28.86
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$41.56
|
| Rate for Payer: Cofinity Commercial |
$38.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$34.63
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.30
|
| Rate for Payer: Nomi Health Commercial |
$34.63
|
| Rate for Payer: PACE SWMI |
$28.86
|
| Rate for Payer: PHP Medicare Advantage |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$28.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.86
|
| Rate for Payer: UHC Medicare Advantage |
$28.86
|
| Rate for Payer: UHCCP DNSP |
$28.86
|
|
|
PR MUSCLE-SKIN FLAP,HEAD/NECK
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 15732
|
| Min. Negotiated Rate |
$1,298.80 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Medicare |
$1,623.50
|
| Rate for Payer: BCBS Complete |
$1,298.80
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
|
|
PR MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 24301
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$1,044.94 |
| Rate for Payer: Aetna Commercial |
$972.37
|
| Rate for Payer: Aetna Medicare |
$725.65
|
| Rate for Payer: BCBS Complete |
$456.00
|
| Rate for Payer: BCBS MAPPO |
$725.65
|
| Rate for Payer: BCN Medicare Advantage |
$725.65
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cofinity Commercial |
$972.37
|
| Rate for Payer: Cofinity Commercial |
$1,044.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.65
|
| Rate for Payer: Healthscope Commercial |
$870.78
|
| Rate for Payer: Healthscope Whirlpool |
$870.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$761.93
|
| Rate for Payer: Nomi Health Commercial |
$870.78
|
| Rate for Payer: PACE SWMI |
$725.65
|
| Rate for Payer: PHP Medicare Advantage |
$725.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.00
|
| Rate for Payer: Priority Health Medicare |
$725.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$725.65
|
| Rate for Payer: UHC Medicare Advantage |
$725.65
|
| Rate for Payer: UHCCP DNSP |
$725.65
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE
|
Professional
|
Both
|
$3,065.00
|
|
|
Service Code
|
HCPCS 23397
|
| Min. Negotiated Rate |
$1,096.18 |
| Max. Negotiated Rate |
$1,992.25 |
| Rate for Payer: Aetna Commercial |
$1,468.88
|
| Rate for Payer: Aetna Medicare |
$1,096.18
|
| Rate for Payer: BCBS Complete |
$1,226.00
|
| Rate for Payer: BCBS MAPPO |
$1,096.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.18
|
| Rate for Payer: Cash Price |
$2,452.00
|
| Rate for Payer: Cash Price |
$2,452.00
|
| Rate for Payer: Cofinity Commercial |
$1,578.50
|
| Rate for Payer: Cofinity Commercial |
$1,468.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.18
|
| Rate for Payer: Healthscope Commercial |
$1,315.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,315.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,150.99
|
| Rate for Payer: Nomi Health Commercial |
$1,315.42
|
| Rate for Payer: PACE SWMI |
$1,096.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,992.25
|
| Rate for Payer: Priority Health Medicare |
$1,096.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.18
|
| Rate for Payer: UHCCP DNSP |
$1,096.18
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 23395
|
| Min. Negotiated Rate |
$1,236.16 |
| Max. Negotiated Rate |
$2,219.10 |
| Rate for Payer: Aetna Commercial |
$1,656.45
|
| Rate for Payer: Aetna Medicare |
$1,236.16
|
| Rate for Payer: BCBS Complete |
$1,365.60
|
| Rate for Payer: BCBS MAPPO |
$1,236.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,236.16
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cofinity Commercial |
$1,780.07
|
| Rate for Payer: Cofinity Commercial |
$1,656.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,236.16
|
| Rate for Payer: Healthscope Commercial |
$1,483.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,483.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,297.97
|
| Rate for Payer: Nomi Health Commercial |
$1,483.39
|
| Rate for Payer: PACE SWMI |
$1,236.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,236.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,219.10
|
| Rate for Payer: Priority Health Medicare |
$1,236.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,236.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,236.16
|
| Rate for Payer: UHCCP DNSP |
$1,236.16
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 15738
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$1,741.03 |
| Rate for Payer: Aetna Commercial |
$1,620.13
|
| Rate for Payer: Aetna Medicare |
$1,209.05
|
| Rate for Payer: BCBS Complete |
$990.00
|
| Rate for Payer: BCBS MAPPO |
$1,209.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,209.05
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,741.03
|
| Rate for Payer: Cofinity Commercial |
$1,620.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,209.05
|
| Rate for Payer: Healthscope Commercial |
$1,450.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,450.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,269.50
|
| Rate for Payer: Nomi Health Commercial |
$1,450.86
|
| Rate for Payer: PACE SWMI |
$1,209.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,209.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health Medicare |
$1,209.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,209.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,209.05
|
| Rate for Payer: UHCCP DNSP |
$1,209.05
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Facility
|
OP
|
$4,600.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
15734
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$5,534.23 |
| Rate for Payer: Aetna Commercial |
$4,140.00
|
| Rate for Payer: Aetna Medicare |
$3,570.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: ASR ASR |
$4,462.00
|
| Rate for Payer: ASR Commercial |
$4,462.00
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,766.94
|
| Rate for Payer: BCN Commercial |
$3,566.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$4,324.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,680.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$4,600.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,462.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,570.47
|
| Rate for Payer: Mclaren Commercial |
$4,140.00
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,910.00
|
| Rate for Payer: Nomi Health Commercial |
$3,772.00
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$3,927.52
|
| Rate for Payer: PHP Medicaid |
$1,913.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,030.52
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health Narrow Network |
$3,224.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,048.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$5,534.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP DNSP |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 15734
|
| Min. Negotiated Rate |
$1,443.85 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna Commercial |
$1,934.76
|
| Rate for Payer: Aetna Medicare |
$1,443.85
|
| Rate for Payer: BCBS Complete |
$1,840.00
|
| Rate for Payer: BCBS MAPPO |
$1,443.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,443.85
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$2,079.14
|
| Rate for Payer: Cofinity Commercial |
$1,934.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,443.85
|
| Rate for Payer: Healthscope Commercial |
$1,732.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,732.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.04
|
| Rate for Payer: Nomi Health Commercial |
$1,732.62
|
| Rate for Payer: PACE SWMI |
$1,443.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,443.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: Priority Health Medicare |
$1,443.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,443.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,443.85
|
| Rate for Payer: UHCCP DNSP |
$1,443.85
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 15734
|
| Hospital Charge Code |
15734
|
| Min. Negotiated Rate |
$1,443.85 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna Commercial |
$1,934.76
|
| Rate for Payer: Aetna Medicare |
$1,443.85
|
| Rate for Payer: BCBS Complete |
$1,840.00
|
| Rate for Payer: BCBS MAPPO |
$1,443.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,443.85
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$2,079.14
|
| Rate for Payer: Cofinity Commercial |
$1,934.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,443.85
|
| Rate for Payer: Healthscope Commercial |
$1,732.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,732.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.04
|
| Rate for Payer: Nomi Health Commercial |
$1,732.62
|
| Rate for Payer: PACE SWMI |
$1,443.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,443.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: Priority Health Medicare |
$1,443.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,443.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,443.85
|
| Rate for Payer: UHCCP DNSP |
$1,443.85
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Facility
|
IP
|
$4,600.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
15734
|
| Min. Negotiated Rate |
$2,990.00 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Aetna Commercial |
$4,140.00
|
| Rate for Payer: ASR ASR |
$4,462.00
|
| Rate for Payer: ASR Commercial |
$4,462.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,748.54
|
| Rate for Payer: BCN Commercial |
$3,566.38
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$4,324.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,680.00
|
| Rate for Payer: Healthscope Commercial |
$4,600.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,462.00
|
| Rate for Payer: Mclaren Commercial |
$4,140.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,910.00
|
| Rate for Payer: Nomi Health Commercial |
$3,772.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,048.00
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 15736
|
| Min. Negotiated Rate |
$922.40 |
| Max. Negotiated Rate |
$1,671.61 |
| Rate for Payer: Aetna Commercial |
$1,555.53
|
| Rate for Payer: Aetna Medicare |
$1,160.84
|
| Rate for Payer: BCBS Complete |
$922.40
|
| Rate for Payer: BCBS MAPPO |
$1,160.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.84
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cofinity Commercial |
$1,671.61
|
| Rate for Payer: Cofinity Commercial |
$1,555.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.84
|
| Rate for Payer: Healthscope Commercial |
$1,393.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,393.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,218.88
|
| Rate for Payer: Nomi Health Commercial |
$1,393.01
|
| Rate for Payer: PACE SWMI |
$1,160.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.90
|
| Rate for Payer: Priority Health Medicare |
$1,160.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,160.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,160.84
|
| Rate for Payer: UHCCP DNSP |
$1,160.84
|
|
