|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$2,148.00
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$707.39 |
| Max. Negotiated Rate |
$1,396.20 |
| Rate for Payer: Aetna Commercial |
$947.90
|
| Rate for Payer: Aetna Medicare |
$707.39
|
| Rate for Payer: BCBS Complete |
$859.20
|
| Rate for Payer: BCBS MAPPO |
$707.39
|
| Rate for Payer: BCN Medicare Advantage |
$707.39
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cofinity Commercial |
$947.90
|
| Rate for Payer: Cofinity Commercial |
$1,018.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.39
|
| Rate for Payer: Healthscope Commercial |
$848.87
|
| Rate for Payer: Healthscope Whirlpool |
$848.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.76
|
| Rate for Payer: Nomi Health Commercial |
$848.87
|
| Rate for Payer: PACE SWMI |
$707.39
|
| Rate for Payer: PHP Medicare Advantage |
$707.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.20
|
| Rate for Payer: Priority Health Medicare |
$707.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.39
|
| Rate for Payer: UHC Medicare Advantage |
$707.39
|
| Rate for Payer: UHCCP DNSP |
$707.39
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$2,041.00
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$816.40 |
| Max. Negotiated Rate |
$1,383.39 |
| Rate for Payer: Aetna Commercial |
$1,287.32
|
| Rate for Payer: Aetna Medicare |
$960.69
|
| Rate for Payer: BCBS Complete |
$816.40
|
| Rate for Payer: BCBS MAPPO |
$960.69
|
| Rate for Payer: BCN Medicare Advantage |
$960.69
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cofinity Commercial |
$1,383.39
|
| Rate for Payer: Cofinity Commercial |
$1,287.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$960.69
|
| Rate for Payer: Healthscope Commercial |
$1,152.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,152.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,008.72
|
| Rate for Payer: Nomi Health Commercial |
$1,152.83
|
| Rate for Payer: PACE SWMI |
$960.69
|
| Rate for Payer: PHP Medicare Advantage |
$960.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health Medicare |
$960.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$960.69
|
| Rate for Payer: UHC Medicare Advantage |
$960.69
|
| Rate for Payer: UHCCP DNSP |
$960.69
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$833.94 |
| Max. Negotiated Rate |
$1,678.30 |
| Rate for Payer: Aetna Commercial |
$1,117.48
|
| Rate for Payer: Aetna Medicare |
$833.94
|
| Rate for Payer: BCBS Complete |
$1,032.80
|
| Rate for Payer: BCBS MAPPO |
$833.94
|
| Rate for Payer: BCN Medicare Advantage |
$833.94
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cofinity Commercial |
$1,200.87
|
| Rate for Payer: Cofinity Commercial |
$1,117.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$833.94
|
| Rate for Payer: Healthscope Commercial |
$1,000.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.64
|
| Rate for Payer: Nomi Health Commercial |
$1,000.73
|
| Rate for Payer: PACE SWMI |
$833.94
|
| Rate for Payer: PHP Medicare Advantage |
$833.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health Medicare |
$833.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$833.94
|
| Rate for Payer: UHC Medicare Advantage |
$833.94
|
| Rate for Payer: UHCCP DNSP |
$833.94
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$836.00 |
| Max. Negotiated Rate |
$1,411.66 |
| Rate for Payer: Aetna Commercial |
$1,313.63
|
| Rate for Payer: Aetna Medicare |
$980.32
|
| Rate for Payer: BCBS Complete |
$836.00
|
| Rate for Payer: BCBS MAPPO |
$980.32
|
| Rate for Payer: BCN Medicare Advantage |
$980.32
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cofinity Commercial |
$1,411.66
|
| Rate for Payer: Cofinity Commercial |
$1,313.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.32
|
| Rate for Payer: Healthscope Commercial |
$1,176.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,029.34
|
| Rate for Payer: Nomi Health Commercial |
$1,176.38
|
| Rate for Payer: PACE SWMI |
$980.32
|
| Rate for Payer: PHP Medicare Advantage |
$980.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,358.50
|
| Rate for Payer: Priority Health Medicare |
$980.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$980.32
|
| Rate for Payer: UHC Medicare Advantage |
$980.32
|
| Rate for Payer: UHCCP DNSP |
$980.32
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS
|
Professional
|
Both
|
$2,251.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$695.73 |
| Max. Negotiated Rate |
$1,463.15 |
| Rate for Payer: Aetna Commercial |
$932.28
|
| Rate for Payer: Aetna Medicare |
$695.73
|
| Rate for Payer: BCBS Complete |
$900.40
|
| Rate for Payer: BCBS MAPPO |
$695.73
|
| Rate for Payer: BCN Medicare Advantage |
$695.73
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cofinity Commercial |
$932.28
|
| Rate for Payer: Cofinity Commercial |
$1,001.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.73
|
| Rate for Payer: Healthscope Commercial |
$834.88
|
| Rate for Payer: Healthscope Whirlpool |
$834.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.52
|
| Rate for Payer: Nomi Health Commercial |
$834.88
|
| Rate for Payer: PACE SWMI |
$695.73
|
| Rate for Payer: PHP Medicare Advantage |
$695.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.15
|
| Rate for Payer: Priority Health Medicare |
$695.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.73
|
| Rate for Payer: UHC Medicare Advantage |
$695.73
|
| Rate for Payer: UHCCP DNSP |
$695.73
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.91
|
| Rate for Payer: Healthscope Whirlpool |
$9.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP DNSP |
$8.26
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,657.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$1,462.80 |
| Max. Negotiated Rate |
$2,415.04 |
| Rate for Payer: Aetna Commercial |
$2,247.33
|
| Rate for Payer: Aetna Medicare |
$1,677.11
|
| Rate for Payer: BCBS Complete |
$1,462.80
|
| Rate for Payer: BCBS MAPPO |
$1,677.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,677.11
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cofinity Commercial |
$2,415.04
|
| Rate for Payer: Cofinity Commercial |
$2,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,677.11
|
| Rate for Payer: Healthscope Commercial |
$2,012.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,012.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,760.97
|
| Rate for Payer: Nomi Health Commercial |
$2,012.53
|
| Rate for Payer: PACE SWMI |
$1,677.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,677.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,377.05
|
| Rate for Payer: Priority Health Medicare |
$1,677.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,677.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,677.11
|
| Rate for Payer: UHCCP DNSP |
$1,677.11
|
|
|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$821.66 |
| Max. Negotiated Rate |
$2,171.65 |
| Rate for Payer: Aetna Commercial |
$1,101.02
|
| Rate for Payer: Aetna Medicare |
$821.66
|
| Rate for Payer: BCBS Complete |
$1,336.40
|
| Rate for Payer: BCBS MAPPO |
$821.66
|
| Rate for Payer: BCN Medicare Advantage |
$821.66
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,101.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.66
|
| Rate for Payer: Healthscope Commercial |
$985.99
|
| Rate for Payer: Healthscope Whirlpool |
$985.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.74
|
| Rate for Payer: Nomi Health Commercial |
$985.99
|
| Rate for Payer: PACE SWMI |
$821.66
|
| Rate for Payer: PHP Medicare Advantage |
$821.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health Medicare |
$821.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.66
|
| Rate for Payer: UHC Medicare Advantage |
$821.66
|
| Rate for Payer: UHCCP DNSP |
$821.66
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$1,665.95 |
| Rate for Payer: Aetna Commercial |
$1,496.67
|
| Rate for Payer: Aetna Medicare |
$1,116.92
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: BCBS MAPPO |
$1,116.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.92
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,608.36
|
| Rate for Payer: Cofinity Commercial |
$1,496.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.92
|
| Rate for Payer: Healthscope Commercial |
$1,340.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,340.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.77
|
| Rate for Payer: Nomi Health Commercial |
$1,340.30
|
| Rate for Payer: PACE SWMI |
$1,116.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health Medicare |
$1,116.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.92
|
| Rate for Payer: UHCCP DNSP |
$1,116.92
|
|
|
PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES
|
Professional
|
Both
|
$3,269.00
|
|
|
Service Code
|
HCPCS 55821
|
| Min. Negotiated Rate |
$801.00 |
| Max. Negotiated Rate |
$2,124.85 |
| Rate for Payer: Aetna Commercial |
$1,073.34
|
| Rate for Payer: Aetna Medicare |
$801.00
|
| Rate for Payer: BCBS Complete |
$1,307.60
|
| Rate for Payer: BCBS MAPPO |
$801.00
|
| Rate for Payer: BCN Medicare Advantage |
$801.00
|
| Rate for Payer: Cash Price |
$2,615.20
|
| Rate for Payer: Cash Price |
$2,615.20
|
| Rate for Payer: Cofinity Commercial |
$1,153.44
|
| Rate for Payer: Cofinity Commercial |
$1,073.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.00
|
| Rate for Payer: Healthscope Commercial |
$961.20
|
| Rate for Payer: Healthscope Whirlpool |
$961.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.05
|
| Rate for Payer: Nomi Health Commercial |
$961.20
|
| Rate for Payer: PACE SWMI |
$801.00
|
| Rate for Payer: PHP Medicare Advantage |
$801.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.85
|
| Rate for Payer: Priority Health Medicare |
$801.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.00
|
| Rate for Payer: UHC Medicare Advantage |
$801.00
|
| Rate for Payer: UHCCP DNSP |
$801.00
|
|
|
PR PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 55700
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$123.40
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS MAPPO |
$123.40
|
| Rate for Payer: BCN Medicare Advantage |
$123.40
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$177.70
|
| Rate for Payer: Cofinity Commercial |
$165.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.40
|
| Rate for Payer: Healthscope Commercial |
$148.08
|
| Rate for Payer: Healthscope Whirlpool |
$148.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.57
|
| Rate for Payer: Nomi Health Commercial |
$148.08
|
| Rate for Payer: PACE SWMI |
$123.40
|
| Rate for Payer: PHP Medicare Advantage |
$123.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.60
|
| Rate for Payer: Priority Health Medicare |
$123.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.40
|
| Rate for Payer: UHC Medicare Advantage |
$123.40
|
| Rate for Payer: UHCCP DNSP |
$123.40
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 55725
|
| Min. Negotiated Rate |
$428.00 |
| Max. Negotiated Rate |
$821.32 |
| Rate for Payer: Aetna Commercial |
$764.28
|
| Rate for Payer: Aetna Medicare |
$570.36
|
| Rate for Payer: BCBS Complete |
$428.00
|
| Rate for Payer: BCBS MAPPO |
$570.36
|
| Rate for Payer: BCN Medicare Advantage |
$570.36
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$821.32
|
| Rate for Payer: Cofinity Commercial |
$764.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.36
|
| Rate for Payer: Healthscope Commercial |
$684.43
|
| Rate for Payer: Healthscope Whirlpool |
$684.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.88
|
| Rate for Payer: Nomi Health Commercial |
$684.43
|
| Rate for Payer: PACE SWMI |
$570.36
|
| Rate for Payer: PHP Medicare Advantage |
$570.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.50
|
| Rate for Payer: Priority Health Medicare |
$570.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.36
|
| Rate for Payer: UHC Medicare Advantage |
$570.36
|
| Rate for Payer: UHCCP DNSP |
$570.36
|
|
|
PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 55842
|
| Min. Negotiated Rate |
$1,114.05 |
| Max. Negotiated Rate |
$2,738.45 |
| Rate for Payer: Aetna Commercial |
$1,492.83
|
| Rate for Payer: Aetna Medicare |
$1,114.05
|
| Rate for Payer: BCBS Complete |
$1,685.20
|
| Rate for Payer: BCBS MAPPO |
$1,114.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.05
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cofinity Commercial |
$1,604.23
|
| Rate for Payer: Cofinity Commercial |
$1,492.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.05
|
| Rate for Payer: Healthscope Commercial |
$1,336.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,336.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,169.75
|
| Rate for Payer: Nomi Health Commercial |
$1,336.86
|
| Rate for Payer: PACE SWMI |
$1,114.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health Medicare |
$1,114.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,114.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,114.05
|
| Rate for Payer: UHCCP DNSP |
$1,114.05
|
|
|
PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM
|
Professional
|
Both
|
$2,838.00
|
|
|
Service Code
|
HCPCS 55845
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$1,869.55 |
| Rate for Payer: Aetna Commercial |
$1,739.72
|
| Rate for Payer: Aetna Medicare |
$1,298.30
|
| Rate for Payer: BCBS Complete |
$1,135.20
|
| Rate for Payer: BCBS MAPPO |
$1,298.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,298.30
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cofinity Commercial |
$1,869.55
|
| Rate for Payer: Cofinity Commercial |
$1,739.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,298.30
|
| Rate for Payer: Healthscope Commercial |
$1,557.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,557.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,363.21
|
| Rate for Payer: Nomi Health Commercial |
$1,557.96
|
| Rate for Payer: PACE SWMI |
$1,298.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,298.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.70
|
| Rate for Payer: Priority Health Medicare |
$1,298.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,298.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,298.30
|
| Rate for Payer: UHCCP DNSP |
$1,298.30
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 23335
|
| Min. Negotiated Rate |
$786.80 |
| Max. Negotiated Rate |
$1,754.45 |
| Rate for Payer: Aetna Commercial |
$1,632.62
|
| Rate for Payer: Aetna Medicare |
$1,218.37
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCBS MAPPO |
$1,218.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.37
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$1,754.45
|
| Rate for Payer: Cofinity Commercial |
$1,632.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.37
|
| Rate for Payer: Healthscope Commercial |
$1,462.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,462.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.29
|
| Rate for Payer: Nomi Health Commercial |
$1,462.04
|
| Rate for Payer: PACE SWMI |
$1,218.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.55
|
| Rate for Payer: Priority Health Medicare |
$1,218.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.37
|
| Rate for Payer: UHCCP DNSP |
$1,218.37
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 24160
|
| Min. Negotiated Rate |
$820.80 |
| Max. Negotiated Rate |
$1,744.14 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Medicare |
$1,211.21
|
| Rate for Payer: BCBS Complete |
$820.80
|
| Rate for Payer: BCBS MAPPO |
$1,211.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,211.21
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$1,744.14
|
| Rate for Payer: Cofinity Commercial |
$1,623.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,211.21
|
| Rate for Payer: Healthscope Commercial |
$1,453.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,453.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,271.77
|
| Rate for Payer: Nomi Health Commercial |
$1,453.45
|
| Rate for Payer: PACE SWMI |
$1,211.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,211.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.80
|
| Rate for Payer: Priority Health Medicare |
$1,211.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.21
|
| Rate for Payer: UHCCP DNSP |
$1,211.21
|
|
|
PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
|
Professional
|
Both
|
$2,533.00
|
|
|
Service Code
|
HCPCS 23334
|
| Min. Negotiated Rate |
$1,013.20 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: Aetna Commercial |
$1,371.99
|
| Rate for Payer: Aetna Medicare |
$1,023.87
|
| Rate for Payer: BCBS Complete |
$1,013.20
|
| Rate for Payer: BCBS MAPPO |
$1,023.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.87
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,474.37
|
| Rate for Payer: Cofinity Commercial |
$1,371.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.87
|
| Rate for Payer: Healthscope Commercial |
$1,228.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,228.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,075.06
|
| Rate for Payer: Nomi Health Commercial |
$1,228.64
|
| Rate for Payer: PACE SWMI |
$1,023.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.45
|
| Rate for Payer: Priority Health Medicare |
$1,023.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.87
|
| Rate for Payer: UHCCP DNSP |
$1,023.87
|
|
|
PR PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 24164
|
| Min. Negotiated Rate |
$702.11 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$940.83
|
| Rate for Payer: Aetna Medicare |
$702.11
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$702.11
|
| Rate for Payer: BCN Medicare Advantage |
$702.11
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$940.83
|
| Rate for Payer: Cofinity Commercial |
$1,011.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.11
|
| Rate for Payer: Healthscope Commercial |
$842.53
|
| Rate for Payer: Healthscope Whirlpool |
$842.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.22
|
| Rate for Payer: Nomi Health Commercial |
$842.53
|
| Rate for Payer: PACE SWMI |
$702.11
|
| Rate for Payer: PHP Medicare Advantage |
$702.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$702.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.11
|
| Rate for Payer: UHC Medicare Advantage |
$702.11
|
| Rate for Payer: UHCCP DNSP |
$702.11
|
|
|
PR PROSTHESIS SERVICE APHAKIA TEMPORARY
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92358
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
|
|
PR PROTECTOR HEEL OR ELBOW
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS E0191
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$908.70 |
| Rate for Payer: Aetna Commercial |
$195.72
|
| Rate for Payer: Aetna Medicare |
$146.06
|
| Rate for Payer: BCBS Complete |
$559.20
|
| Rate for Payer: BCBS MAPPO |
$146.06
|
| Rate for Payer: BCN Medicare Advantage |
$146.06
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cofinity Commercial |
$210.33
|
| Rate for Payer: Cofinity Commercial |
$195.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.06
|
| Rate for Payer: Healthscope Commercial |
$175.27
|
| Rate for Payer: Healthscope Whirlpool |
$175.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.36
|
| Rate for Payer: Nomi Health Commercial |
$175.27
|
| Rate for Payer: PACE SWMI |
$146.06
|
| Rate for Payer: PHP Medicare Advantage |
$146.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$908.70
|
| Rate for Payer: Priority Health Medicare |
$146.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.06
|
| Rate for Payer: UHC Medicare Advantage |
$146.06
|
| Rate for Payer: UHCCP DNSP |
$146.06
|
|
|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$2,680.00
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$1,072.00 |
| Max. Negotiated Rate |
$1,814.64 |
| Rate for Payer: Aetna Commercial |
$1,688.63
|
| Rate for Payer: Aetna Medicare |
$1,260.17
|
| Rate for Payer: BCBS Complete |
$1,072.00
|
| Rate for Payer: BCBS MAPPO |
$1,260.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,260.17
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,814.64
|
| Rate for Payer: Cofinity Commercial |
$1,688.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,260.17
|
| Rate for Payer: Healthscope Commercial |
$1,512.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,512.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,323.18
|
| Rate for Payer: Nomi Health Commercial |
$1,512.20
|
| Rate for Payer: PACE SWMI |
$1,260.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,260.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,742.00
|
| Rate for Payer: Priority Health Medicare |
$1,260.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,260.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,260.17
|
| Rate for Payer: UHCCP DNSP |
$1,260.17
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,989.00
|
|
|
Service Code
|
HCPCS 64561
|
| Min. Negotiated Rate |
$289.62 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Aetna Commercial |
$388.09
|
| Rate for Payer: Aetna Medicare |
$289.62
|
| Rate for Payer: BCBS Complete |
$795.60
|
| Rate for Payer: BCBS MAPPO |
$289.62
|
| Rate for Payer: BCN Medicare Advantage |
$289.62
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cofinity Commercial |
$417.05
|
| Rate for Payer: Cofinity Commercial |
$388.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.62
|
| Rate for Payer: Healthscope Commercial |
$347.54
|
| Rate for Payer: Healthscope Whirlpool |
$347.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.10
|
| Rate for Payer: Nomi Health Commercial |
$347.54
|
| Rate for Payer: PACE SWMI |
$289.62
|
| Rate for Payer: PHP Medicare Advantage |
$289.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.85
|
| Rate for Payer: Priority Health Medicare |
$289.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.62
|
| Rate for Payer: UHC Medicare Advantage |
$289.62
|
| Rate for Payer: UHCCP DNSP |
$289.62
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
HCPCS 64553
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$641.20 |
| Rate for Payer: Aetna Commercial |
$596.68
|
| Rate for Payer: Aetna Medicare |
$445.28
|
| Rate for Payer: BCBS Complete |
$181.60
|
| Rate for Payer: BCBS MAPPO |
$445.28
|
| Rate for Payer: BCN Medicare Advantage |
$445.28
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cofinity Commercial |
$641.20
|
| Rate for Payer: Cofinity Commercial |
$596.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.28
|
| Rate for Payer: Healthscope Commercial |
$534.34
|
| Rate for Payer: Healthscope Whirlpool |
$534.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.54
|
| Rate for Payer: Nomi Health Commercial |
$534.34
|
| Rate for Payer: PACE SWMI |
$445.28
|
| Rate for Payer: PHP Medicare Advantage |
$445.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.10
|
| Rate for Payer: Priority Health Medicare |
$445.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.28
|
| Rate for Payer: UHC Medicare Advantage |
$445.28
|
| Rate for Payer: UHCCP DNSP |
$445.28
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$447.84 |
| Rate for Payer: Aetna Commercial |
$416.74
|
| Rate for Payer: Aetna Medicare |
$311.00
|
| Rate for Payer: BCBS Complete |
$199.20
|
| Rate for Payer: BCBS MAPPO |
$311.00
|
| Rate for Payer: BCN Medicare Advantage |
$311.00
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cofinity Commercial |
$447.84
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.00
|
| Rate for Payer: Healthscope Commercial |
$373.20
|
| Rate for Payer: Healthscope Whirlpool |
$373.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.55
|
| Rate for Payer: Nomi Health Commercial |
$373.20
|
| Rate for Payer: PACE SWMI |
$311.00
|
| Rate for Payer: PHP Medicare Advantage |
$311.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.70
|
| Rate for Payer: Priority Health Medicare |
$311.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.00
|
| Rate for Payer: UHC Medicare Advantage |
$311.00
|
| Rate for Payer: UHCCP DNSP |
$311.00
|
|
