|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$2,376.00
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$910.06 |
| Max. Negotiated Rate |
$1,544.40 |
| Rate for Payer: Aetna Commercial |
$1,219.48
|
| Rate for Payer: Aetna Medicare |
$910.06
|
| Rate for Payer: BCBS Complete |
$950.40
|
| Rate for Payer: BCBS MAPPO |
$910.06
|
| Rate for Payer: BCN Medicare Advantage |
$910.06
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cofinity Commercial |
$1,310.49
|
| Rate for Payer: Cofinity Commercial |
$1,219.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.06
|
| Rate for Payer: Healthscope Commercial |
$1,092.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.56
|
| Rate for Payer: Nomi Health Commercial |
$1,092.07
|
| Rate for Payer: PACE SWMI |
$910.06
|
| Rate for Payer: PHP Medicare Advantage |
$910.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.40
|
| Rate for Payer: Priority Health Medicare |
$910.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$910.06
|
| Rate for Payer: UHC Medicare Advantage |
$910.06
|
| Rate for Payer: UHCCP DNSP |
$910.06
|
|
|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$622.95 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$834.75
|
| Rate for Payer: Aetna Medicare |
$622.95
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$622.95
|
| Rate for Payer: BCN Medicare Advantage |
$622.95
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$897.05
|
| Rate for Payer: Cofinity Commercial |
$834.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.95
|
| Rate for Payer: Healthscope Commercial |
$747.54
|
| Rate for Payer: Healthscope Whirlpool |
$747.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.10
|
| Rate for Payer: Nomi Health Commercial |
$747.54
|
| Rate for Payer: PACE SWMI |
$622.95
|
| Rate for Payer: PHP Medicare Advantage |
$622.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$622.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.95
|
| Rate for Payer: UHC Medicare Advantage |
$622.95
|
| Rate for Payer: UHCCP DNSP |
$622.95
|
|
|
PR REAORT VALV W CP BYPASS
|
Professional
|
Both
|
$8,044.00
|
|
|
Service Code
|
HCPCS 33400
|
| Min. Negotiated Rate |
$3,217.60 |
| Max. Negotiated Rate |
$5,228.60 |
| Rate for Payer: Aetna Medicare |
$4,022.00
|
| Rate for Payer: BCBS Complete |
$3,217.60
|
| Rate for Payer: Cash Price |
$6,435.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,228.60
|
|
|
PR RECMPL WND LID,NOS,EAR <1 CM
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 13150
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$391.95 |
| Rate for Payer: Aetna Medicare |
$301.50
|
| Rate for Payer: BCBS Complete |
$241.20
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.95
|
|
|
PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX
|
Professional
|
Both
|
$3,465.00
|
|
|
Service Code
|
HCPCS 69310
|
| Min. Negotiated Rate |
$1,033.61 |
| Max. Negotiated Rate |
$2,252.25 |
| Rate for Payer: Aetna Commercial |
$1,385.04
|
| Rate for Payer: Aetna Medicare |
$1,033.61
|
| Rate for Payer: BCBS Complete |
$1,386.00
|
| Rate for Payer: BCBS MAPPO |
$1,033.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,033.61
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,488.40
|
| Rate for Payer: Cofinity Commercial |
$1,385.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,033.61
|
| Rate for Payer: Healthscope Commercial |
$1,240.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,240.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,085.29
|
| Rate for Payer: Nomi Health Commercial |
$1,240.33
|
| Rate for Payer: PACE SWMI |
$1,033.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,033.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.25
|
| Rate for Payer: Priority Health Medicare |
$1,033.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,033.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,033.61
|
| Rate for Payer: UHCCP DNSP |
$1,033.61
|
|
|
PR RECONSTRUCTION NAIL BED W/GRAFT
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 11762
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Aetna Commercial |
$239.89
|
| Rate for Payer: Aetna Medicare |
$179.02
|
| Rate for Payer: BCBS Complete |
$178.80
|
| Rate for Payer: BCBS MAPPO |
$179.02
|
| Rate for Payer: BCN Medicare Advantage |
$179.02
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cofinity Commercial |
$257.79
|
| Rate for Payer: Cofinity Commercial |
$239.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.02
|
| Rate for Payer: Healthscope Commercial |
$214.82
|
| Rate for Payer: Healthscope Whirlpool |
$214.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.97
|
| Rate for Payer: Nomi Health Commercial |
$214.82
|
| Rate for Payer: PACE SWMI |
$179.02
|
| Rate for Payer: PHP Medicare Advantage |
$179.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.55
|
| Rate for Payer: Priority Health Medicare |
$179.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.02
|
| Rate for Payer: UHC Medicare Advantage |
$179.02
|
| Rate for Payer: UHCCP DNSP |
$179.02
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,986.00
|
|
|
Service Code
|
HCPCS 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Aetna Commercial |
$1,260.56
|
| Rate for Payer: Aetna Medicare |
$940.72
|
| Rate for Payer: BCBS Complete |
$1,594.40
|
| Rate for Payer: BCBS MAPPO |
$940.72
|
| Rate for Payer: BCN Medicare Advantage |
$940.72
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$1,354.64
|
| Rate for Payer: Cofinity Commercial |
$1,260.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.72
|
| Rate for Payer: Healthscope Commercial |
$1,128.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,128.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.76
|
| Rate for Payer: Nomi Health Commercial |
$1,128.86
|
| Rate for Payer: PACE SWMI |
$940.72
|
| Rate for Payer: PHP Medicare Advantage |
$940.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health Medicare |
$940.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.72
|
| Rate for Payer: UHC Medicare Advantage |
$940.72
|
| Rate for Payer: UHCCP DNSP |
$940.72
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
OP
|
$3,986.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$2,590.90 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$3,587.40
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$3,866.42
|
| Rate for Payer: ASR Commercial |
$3,866.42
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,264.14
|
| Rate for Payer: BCN Commercial |
$3,090.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$3,746.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,188.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$3,986.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,866.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$3,587.40
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,388.10
|
| Rate for Payer: Nomi Health Commercial |
$3,268.52
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,492.53
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$2,794.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,507.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,986.00
|
|
|
Service Code
|
HCPCS 23420
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Aetna Commercial |
$1,260.56
|
| Rate for Payer: Aetna Medicare |
$940.72
|
| Rate for Payer: BCBS Complete |
$1,594.40
|
| Rate for Payer: BCBS MAPPO |
$940.72
|
| Rate for Payer: BCN Medicare Advantage |
$940.72
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$1,354.64
|
| Rate for Payer: Cofinity Commercial |
$1,260.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.72
|
| Rate for Payer: Healthscope Commercial |
$1,128.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,128.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.76
|
| Rate for Payer: Nomi Health Commercial |
$1,128.86
|
| Rate for Payer: PACE SWMI |
$940.72
|
| Rate for Payer: PHP Medicare Advantage |
$940.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health Medicare |
$940.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.72
|
| Rate for Payer: UHC Medicare Advantage |
$940.72
|
| Rate for Payer: UHCCP DNSP |
$940.72
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$2,590.90 |
| Max. Negotiated Rate |
$3,986.00 |
| Rate for Payer: Aetna Commercial |
$3,587.40
|
| Rate for Payer: ASR ASR |
$3,866.42
|
| Rate for Payer: ASR Commercial |
$3,866.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,248.19
|
| Rate for Payer: BCN Commercial |
$3,090.35
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$3,746.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,188.80
|
| Rate for Payer: Healthscope Commercial |
$3,986.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,866.42
|
| Rate for Payer: Mclaren Commercial |
$3,587.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,388.10
|
| Rate for Payer: Nomi Health Commercial |
$3,268.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,507.68
|
|
|
PR RECONSTRUCTION TOE POLYDACTYLY
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 28344
|
| Min. Negotiated Rate |
$266.99 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$357.77
|
| Rate for Payer: Aetna Medicare |
$266.99
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$266.99
|
| Rate for Payer: BCN Medicare Advantage |
$266.99
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$384.47
|
| Rate for Payer: Cofinity Commercial |
$357.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.99
|
| Rate for Payer: Healthscope Commercial |
$320.39
|
| Rate for Payer: Healthscope Whirlpool |
$320.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$320.39
|
| Rate for Payer: PACE SWMI |
$266.99
|
| Rate for Payer: PHP Medicare Advantage |
$266.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$266.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.99
|
| Rate for Payer: UHC Medicare Advantage |
$266.99
|
| Rate for Payer: UHCCP DNSP |
$266.99
|
|
|
PR RECONSTRUCTION VENA CAVA ANY METHOD
|
Professional
|
Both
|
$2,399.00
|
|
|
Service Code
|
HCPCS 34502
|
| Min. Negotiated Rate |
$959.60 |
| Max. Negotiated Rate |
$2,130.94 |
| Rate for Payer: Aetna Commercial |
$1,982.96
|
| Rate for Payer: Aetna Medicare |
$1,479.82
|
| Rate for Payer: BCBS Complete |
$959.60
|
| Rate for Payer: BCBS MAPPO |
$1,479.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.82
|
| Rate for Payer: Cash Price |
$1,919.20
|
| Rate for Payer: Cash Price |
$1,919.20
|
| Rate for Payer: Cofinity Commercial |
$2,130.94
|
| Rate for Payer: Cofinity Commercial |
$1,982.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.82
|
| Rate for Payer: Healthscope Commercial |
$1,775.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,775.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.81
|
| Rate for Payer: Nomi Health Commercial |
$1,775.78
|
| Rate for Payer: PACE SWMI |
$1,479.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,559.35
|
| Rate for Payer: Priority Health Medicare |
$1,479.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,479.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,479.82
|
| Rate for Payer: UHCCP DNSP |
$1,479.82
|
|
|
PR RECTAL SESATION TONE & COMPLIANCE TEST
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 91120
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$612.27 |
| Rate for Payer: Aetna Commercial |
$569.75
|
| Rate for Payer: Aetna Commercial |
$569.75
|
| Rate for Payer: Aetna Medicare |
$425.19
|
| Rate for Payer: Aetna Medicare |
$425.19
|
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$425.19
|
| Rate for Payer: BCBS MAPPO |
$425.19
|
| Rate for Payer: BCN Medicare Advantage |
$425.19
|
| Rate for Payer: BCN Medicare Advantage |
$425.19
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$569.75
|
| Rate for Payer: Cofinity Commercial |
$612.27
|
| Rate for Payer: Cofinity Commercial |
$569.75
|
| Rate for Payer: Cofinity Commercial |
$612.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.19
|
| Rate for Payer: Healthscope Commercial |
$510.23
|
| Rate for Payer: Healthscope Commercial |
$510.23
|
| Rate for Payer: Healthscope Whirlpool |
$510.23
|
| Rate for Payer: Healthscope Whirlpool |
$510.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.45
|
| Rate for Payer: Nomi Health Commercial |
$510.23
|
| Rate for Payer: Nomi Health Commercial |
$510.23
|
| Rate for Payer: PACE SWMI |
$425.19
|
| Rate for Payer: PACE SWMI |
$425.19
|
| Rate for Payer: PHP Medicare Advantage |
$425.19
|
| Rate for Payer: PHP Medicare Advantage |
$425.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$425.19
|
| Rate for Payer: Priority Health Medicare |
$425.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.19
|
| Rate for Payer: UHC Medicare Advantage |
$425.19
|
| Rate for Payer: UHC Medicare Advantage |
$425.19
|
| Rate for Payer: UHCCP DNSP |
$425.19
|
| Rate for Payer: UHCCP DNSP |
$425.19
|
|
|
PR RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 0184T
|
| Min. Negotiated Rate |
$717.20 |
| Max. Negotiated Rate |
$1,165.45 |
| Rate for Payer: Aetna Medicare |
$896.50
|
| Rate for Payer: BCBS Complete |
$717.20
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.45
|
|
|
PR REGION IV LOCAL ANESTH,UPPER/LOWER EXT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS 01995
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR REIMPLANTATION ANOMALOUS PULMONARY ARTERY
|
Professional
|
Both
|
$6,703.00
|
|
|
Service Code
|
HCPCS 33788
|
| Min. Negotiated Rate |
$1,472.16 |
| Max. Negotiated Rate |
$4,356.95 |
| Rate for Payer: Aetna Commercial |
$1,972.69
|
| Rate for Payer: Aetna Medicare |
$1,472.16
|
| Rate for Payer: BCBS Complete |
$2,681.20
|
| Rate for Payer: BCBS MAPPO |
$1,472.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,472.16
|
| Rate for Payer: Cash Price |
$5,362.40
|
| Rate for Payer: Cash Price |
$5,362.40
|
| Rate for Payer: Cofinity Commercial |
$2,119.91
|
| Rate for Payer: Cofinity Commercial |
$1,972.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,472.16
|
| Rate for Payer: Healthscope Commercial |
$1,766.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,766.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,545.77
|
| Rate for Payer: Nomi Health Commercial |
$1,766.59
|
| Rate for Payer: PACE SWMI |
$1,472.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,472.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,356.95
|
| Rate for Payer: Priority Health Medicare |
$1,472.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,472.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.16
|
| Rate for Payer: UHCCP DNSP |
$1,472.16
|
|
|
PR REINSERTION SPINAL FIXATION DEVICE
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 22849
|
| Min. Negotiated Rate |
$1,275.97 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,709.80
|
| Rate for Payer: Aetna Medicare |
$1,275.97
|
| Rate for Payer: BCBS Complete |
$2,000.00
|
| Rate for Payer: BCBS MAPPO |
$1,275.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.97
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,837.40
|
| Rate for Payer: Cofinity Commercial |
$1,709.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.97
|
| Rate for Payer: Healthscope Commercial |
$1,531.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,531.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,339.77
|
| Rate for Payer: Nomi Health Commercial |
$1,531.16
|
| Rate for Payer: PACE SWMI |
$1,275.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.00
|
| Rate for Payer: Priority Health Medicare |
$1,275.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,275.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,275.97
|
| Rate for Payer: UHCCP DNSP |
$1,275.97
|
|
|
PR RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
HCPCS 26593
|
| Min. Negotiated Rate |
$417.20 |
| Max. Negotiated Rate |
$864.95 |
| Rate for Payer: Aetna Commercial |
$804.88
|
| Rate for Payer: Aetna Medicare |
$600.66
|
| Rate for Payer: BCBS Complete |
$417.20
|
| Rate for Payer: BCBS MAPPO |
$600.66
|
| Rate for Payer: BCN Medicare Advantage |
$600.66
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cash Price |
$834.40
|
| Rate for Payer: Cofinity Commercial |
$864.95
|
| Rate for Payer: Cofinity Commercial |
$804.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.66
|
| Rate for Payer: Healthscope Commercial |
$720.79
|
| Rate for Payer: Healthscope Whirlpool |
$720.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.69
|
| Rate for Payer: Nomi Health Commercial |
$720.79
|
| Rate for Payer: PACE SWMI |
$600.66
|
| Rate for Payer: PHP Medicare Advantage |
$600.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$677.95
|
| Rate for Payer: Priority Health Medicare |
$600.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.66
|
| Rate for Payer: UHC Medicare Advantage |
$600.66
|
| Rate for Payer: UHCCP DNSP |
$600.66
|
|
|
PR RELEASE/RECESSION HAMSTRING PROXIMAL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 27097
|
| Min. Negotiated Rate |
$661.61 |
| Max. Negotiated Rate |
$1,511.90 |
| Rate for Payer: Aetna Commercial |
$886.56
|
| Rate for Payer: Aetna Medicare |
$661.61
|
| Rate for Payer: BCBS Complete |
$930.40
|
| Rate for Payer: BCBS MAPPO |
$661.61
|
| Rate for Payer: BCN Medicare Advantage |
$661.61
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cofinity Commercial |
$952.72
|
| Rate for Payer: Cofinity Commercial |
$886.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.61
|
| Rate for Payer: Healthscope Commercial |
$793.93
|
| Rate for Payer: Healthscope Whirlpool |
$793.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.69
|
| Rate for Payer: Nomi Health Commercial |
$793.93
|
| Rate for Payer: PACE SWMI |
$661.61
|
| Rate for Payer: PHP Medicare Advantage |
$661.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.90
|
| Rate for Payer: Priority Health Medicare |
$661.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.61
|
| Rate for Payer: UHC Medicare Advantage |
$661.61
|
| Rate for Payer: UHCCP DNSP |
$661.61
|
|
|
PR RELEASE TARSAL TUNNEL
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 28035
|
| Min. Negotiated Rate |
$347.15 |
| Max. Negotiated Rate |
$899.60 |
| Rate for Payer: Aetna Commercial |
$465.18
|
| Rate for Payer: Aetna Medicare |
$347.15
|
| Rate for Payer: BCBS Complete |
$553.60
|
| Rate for Payer: BCBS MAPPO |
$347.15
|
| Rate for Payer: BCN Medicare Advantage |
$347.15
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Cofinity Commercial |
$499.90
|
| Rate for Payer: Cofinity Commercial |
$465.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.15
|
| Rate for Payer: Healthscope Commercial |
$416.58
|
| Rate for Payer: Healthscope Whirlpool |
$416.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.51
|
| Rate for Payer: Nomi Health Commercial |
$416.58
|
| Rate for Payer: PACE SWMI |
$347.15
|
| Rate for Payer: PHP Medicare Advantage |
$347.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.60
|
| Rate for Payer: Priority Health Medicare |
$347.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.15
|
| Rate for Payer: UHC Medicare Advantage |
$347.15
|
| Rate for Payer: UHCCP DNSP |
$347.15
|
|
|
PR RELEASE THENAR MUSCLE
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26508
|
| Min. Negotiated Rate |
$629.51 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$843.54
|
| Rate for Payer: Aetna Medicare |
$629.51
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$629.51
|
| Rate for Payer: BCN Medicare Advantage |
$629.51
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$906.49
|
| Rate for Payer: Cofinity Commercial |
$843.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$629.51
|
| Rate for Payer: Healthscope Commercial |
$755.41
|
| Rate for Payer: Healthscope Whirlpool |
$755.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.99
|
| Rate for Payer: Nomi Health Commercial |
$755.41
|
| Rate for Payer: PACE SWMI |
$629.51
|
| Rate for Payer: PHP Medicare Advantage |
$629.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$629.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$629.51
|
| Rate for Payer: UHC Medicare Advantage |
$629.51
|
| Rate for Payer: UHCCP DNSP |
$629.51
|
|
|
PR RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 33223
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$882.05 |
| Rate for Payer: Aetna Commercial |
$519.12
|
| Rate for Payer: Aetna Medicare |
$387.40
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS MAPPO |
$387.40
|
| Rate for Payer: BCN Medicare Advantage |
$387.40
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$557.86
|
| Rate for Payer: Cofinity Commercial |
$519.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.40
|
| Rate for Payer: Healthscope Commercial |
$464.88
|
| Rate for Payer: Healthscope Whirlpool |
$464.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.77
|
| Rate for Payer: Nomi Health Commercial |
$464.88
|
| Rate for Payer: PACE SWMI |
$387.40
|
| Rate for Payer: PHP Medicare Advantage |
$387.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.05
|
| Rate for Payer: Priority Health Medicare |
$387.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.40
|
| Rate for Payer: UHC Medicare Advantage |
$387.40
|
| Rate for Payer: UHCCP DNSP |
$387.40
|
|
|
PR RELOCATION OF SKIN POCKET FOR PACEMAKER
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 33222
|
| Min. Negotiated Rate |
$324.53 |
| Max. Negotiated Rate |
$748.15 |
| Rate for Payer: Aetna Commercial |
$434.87
|
| Rate for Payer: Aetna Medicare |
$324.53
|
| Rate for Payer: BCBS Complete |
$460.40
|
| Rate for Payer: BCBS MAPPO |
$324.53
|
| Rate for Payer: BCN Medicare Advantage |
$324.53
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cofinity Commercial |
$467.32
|
| Rate for Payer: Cofinity Commercial |
$434.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.53
|
| Rate for Payer: Healthscope Commercial |
$389.44
|
| Rate for Payer: Healthscope Whirlpool |
$389.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$389.44
|
| Rate for Payer: PACE SWMI |
$324.53
|
| Rate for Payer: PHP Medicare Advantage |
$324.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.15
|
| Rate for Payer: Priority Health Medicare |
$324.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.53
|
| Rate for Payer: UHC Medicare Advantage |
$324.53
|
| Rate for Payer: UHCCP DNSP |
$324.53
|
|
|
PR REM INTERROG ICPMS <30 D PHYS/QHP
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 93297
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$78.90 |
| Rate for Payer: Aetna Commercial |
$73.42
|
| Rate for Payer: Aetna Medicare |
$54.79
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$54.79
|
| Rate for Payer: BCN Medicare Advantage |
$54.79
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$78.90
|
| Rate for Payer: Cofinity Commercial |
$73.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.79
|
| Rate for Payer: Healthscope Commercial |
$65.75
|
| Rate for Payer: Healthscope Whirlpool |
$65.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.53
|
| Rate for Payer: Nomi Health Commercial |
$65.75
|
| Rate for Payer: PACE SWMI |
$54.79
|
| Rate for Payer: PHP Medicare Advantage |
$54.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$54.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.79
|
| Rate for Payer: UHC Medicare Advantage |
$54.79
|
| Rate for Payer: UHCCP DNSP |
$54.79
|
|
|
PR REM INTERROG ICPMS/SCRMS <30 D TECH REVIEW
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
HCPCS 93299
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$150.80 |
| Rate for Payer: Aetna Medicare |
$116.00
|
| Rate for Payer: BCBS Complete |
$92.80
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
|
