|
PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 50553
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Aetna Medicare |
$297.58
|
| Rate for Payer: BCBS Complete |
$290.40
|
| Rate for Payer: BCBS MAPPO |
$297.58
|
| Rate for Payer: BCN Medicare Advantage |
$297.58
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$428.52
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.58
|
| Rate for Payer: Healthscope Commercial |
$357.10
|
| Rate for Payer: Healthscope Whirlpool |
$357.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.46
|
| Rate for Payer: Nomi Health Commercial |
$357.10
|
| Rate for Payer: PACE SWMI |
$297.58
|
| Rate for Payer: PHP Medicare Advantage |
$297.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health Medicare |
$297.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.58
|
| Rate for Payer: UHC Medicare Advantage |
$297.58
|
| Rate for Payer: UHCCP DNSP |
$297.58
|
|
|
PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 50570
|
| Min. Negotiated Rate |
$381.60 |
| Max. Negotiated Rate |
$670.52 |
| Rate for Payer: Aetna Commercial |
$623.96
|
| Rate for Payer: Aetna Medicare |
$465.64
|
| Rate for Payer: BCBS Complete |
$381.60
|
| Rate for Payer: BCBS MAPPO |
$465.64
|
| Rate for Payer: BCN Medicare Advantage |
$465.64
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cofinity Commercial |
$670.52
|
| Rate for Payer: Cofinity Commercial |
$623.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.64
|
| Rate for Payer: Healthscope Commercial |
$558.77
|
| Rate for Payer: Healthscope Whirlpool |
$558.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.92
|
| Rate for Payer: Nomi Health Commercial |
$558.77
|
| Rate for Payer: PACE SWMI |
$465.64
|
| Rate for Payer: PHP Medicare Advantage |
$465.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.10
|
| Rate for Payer: Priority Health Medicare |
$465.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.64
|
| Rate for Payer: UHC Medicare Advantage |
$465.64
|
| Rate for Payer: UHCCP DNSP |
$465.64
|
|
|
PR REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
HCPCS 49002
|
| Min. Negotiated Rate |
$850.80 |
| Max. Negotiated Rate |
$1,457.60 |
| Rate for Payer: Aetna Commercial |
$1,356.37
|
| Rate for Payer: Aetna Medicare |
$1,012.22
|
| Rate for Payer: BCBS Complete |
$850.80
|
| Rate for Payer: BCBS MAPPO |
$1,012.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,012.22
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cofinity Commercial |
$1,457.60
|
| Rate for Payer: Cofinity Commercial |
$1,356.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,012.22
|
| Rate for Payer: Healthscope Commercial |
$1,214.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,214.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.83
|
| Rate for Payer: Nomi Health Commercial |
$1,214.66
|
| Rate for Payer: PACE SWMI |
$1,012.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,012.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.55
|
| Rate for Payer: Priority Health Medicare |
$1,012.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,012.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,012.22
|
| Rate for Payer: UHCCP DNSP |
$1,012.22
|
|
|
PR REPAIR ANAL FISTULA W/FIBRIN GLUE
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 46706
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$252.03 |
| Rate for Payer: Aetna Commercial |
$234.53
|
| Rate for Payer: Aetna Medicare |
$175.02
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: BCBS MAPPO |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$175.02
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$252.03
|
| Rate for Payer: Cofinity Commercial |
$234.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.02
|
| Rate for Payer: Healthscope Commercial |
$210.02
|
| Rate for Payer: Healthscope Whirlpool |
$210.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$210.02
|
| Rate for Payer: PACE SWMI |
$175.02
|
| Rate for Payer: PHP Medicare Advantage |
$175.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
| Rate for Payer: Priority Health Medicare |
$175.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.02
|
| Rate for Payer: UHC Medicare Advantage |
$175.02
|
| Rate for Payer: UHCCP DNSP |
$175.02
|
|
|
PR REPAIR ANORECTAL FISTULA PLUG
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 46707
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$701.68 |
| Rate for Payer: Aetna Commercial |
$652.96
|
| Rate for Payer: Aetna Medicare |
$487.28
|
| Rate for Payer: BCBS Complete |
$414.80
|
| Rate for Payer: BCBS MAPPO |
$487.28
|
| Rate for Payer: BCN Medicare Advantage |
$487.28
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cofinity Commercial |
$701.68
|
| Rate for Payer: Cofinity Commercial |
$652.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.28
|
| Rate for Payer: Healthscope Commercial |
$584.74
|
| Rate for Payer: Healthscope Whirlpool |
$584.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.64
|
| Rate for Payer: Nomi Health Commercial |
$584.74
|
| Rate for Payer: PACE SWMI |
$487.28
|
| Rate for Payer: PHP Medicare Advantage |
$487.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.05
|
| Rate for Payer: Priority Health Medicare |
$487.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.28
|
| Rate for Payer: UHC Medicare Advantage |
$487.28
|
| Rate for Payer: UHCCP DNSP |
$487.28
|
|
|
PR REPAIR BIFID EARLOBES - BILATERAL
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00535
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
|
|
PR REPAIR BIFID EARLOBES - UNILATERAL
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00534
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR REPAIR BLOOD VESSEL DIRECT HAND FINGER
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 35207
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,045.56 |
| Rate for Payer: Aetna Commercial |
$972.95
|
| Rate for Payer: Aetna Medicare |
$726.08
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$726.08
|
| Rate for Payer: BCN Medicare Advantage |
$726.08
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$972.95
|
| Rate for Payer: Cofinity Commercial |
$1,045.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.08
|
| Rate for Payer: Healthscope Commercial |
$871.30
|
| Rate for Payer: Healthscope Whirlpool |
$871.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$762.38
|
| Rate for Payer: Nomi Health Commercial |
$871.30
|
| Rate for Payer: PACE SWMI |
$726.08
|
| Rate for Payer: PHP Medicare Advantage |
$726.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health Medicare |
$726.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$726.08
|
| Rate for Payer: UHC Medicare Advantage |
$726.08
|
| Rate for Payer: UHCCP DNSP |
$726.08
|
|
|
PR REPAIR BLOOD VESSEL DIRECT INTRA-ABDOMINAL
|
Professional
|
Both
|
$5,052.00
|
|
|
Service Code
|
HCPCS 35221
|
| Min. Negotiated Rate |
$1,412.76 |
| Max. Negotiated Rate |
$3,283.80 |
| Rate for Payer: Aetna Commercial |
$1,893.10
|
| Rate for Payer: Aetna Medicare |
$1,412.76
|
| Rate for Payer: BCBS Complete |
$2,020.80
|
| Rate for Payer: BCBS MAPPO |
$1,412.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,412.76
|
| Rate for Payer: Cash Price |
$4,041.60
|
| Rate for Payer: Cash Price |
$4,041.60
|
| Rate for Payer: Cofinity Commercial |
$2,034.37
|
| Rate for Payer: Cofinity Commercial |
$1,893.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,412.76
|
| Rate for Payer: Healthscope Commercial |
$1,695.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,695.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,483.40
|
| Rate for Payer: Nomi Health Commercial |
$1,695.31
|
| Rate for Payer: PACE SWMI |
$1,412.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,412.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,283.80
|
| Rate for Payer: Priority Health Medicare |
$1,412.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,412.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,412.76
|
| Rate for Payer: UHCCP DNSP |
$1,412.76
|
|
|
PR REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY
|
Professional
|
Both
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35226
|
| Min. Negotiated Rate |
$793.95 |
| Max. Negotiated Rate |
$1,729.00 |
| Rate for Payer: Aetna Commercial |
$1,063.89
|
| Rate for Payer: Aetna Medicare |
$793.95
|
| Rate for Payer: BCBS Complete |
$1,064.00
|
| Rate for Payer: BCBS MAPPO |
$793.95
|
| Rate for Payer: BCN Medicare Advantage |
$793.95
|
| Rate for Payer: Cash Price |
$2,128.00
|
| Rate for Payer: Cash Price |
$2,128.00
|
| Rate for Payer: Cofinity Commercial |
$1,143.29
|
| Rate for Payer: Cofinity Commercial |
$1,063.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.95
|
| Rate for Payer: Healthscope Commercial |
$952.74
|
| Rate for Payer: Healthscope Whirlpool |
$952.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$833.65
|
| Rate for Payer: Nomi Health Commercial |
$952.74
|
| Rate for Payer: PACE SWMI |
$793.95
|
| Rate for Payer: PHP Medicare Advantage |
$793.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.00
|
| Rate for Payer: Priority Health Medicare |
$793.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.95
|
| Rate for Payer: UHC Medicare Advantage |
$793.95
|
| Rate for Payer: UHCCP DNSP |
$793.95
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,240.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$890.13 |
| Max. Negotiated Rate |
$2,756.00 |
| Rate for Payer: Aetna Commercial |
$1,192.77
|
| Rate for Payer: Aetna Medicare |
$890.13
|
| Rate for Payer: BCBS Complete |
$1,696.00
|
| Rate for Payer: BCBS MAPPO |
$890.13
|
| Rate for Payer: BCN Medicare Advantage |
$890.13
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cofinity Commercial |
$1,281.79
|
| Rate for Payer: Cofinity Commercial |
$1,192.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.13
|
| Rate for Payer: Healthscope Commercial |
$1,068.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.64
|
| Rate for Payer: Nomi Health Commercial |
$1,068.16
|
| Rate for Payer: PACE SWMI |
$890.13
|
| Rate for Payer: PHP Medicare Advantage |
$890.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,756.00
|
| Rate for Payer: Priority Health Medicare |
$890.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.13
|
| Rate for Payer: UHC Medicare Advantage |
$890.13
|
| Rate for Payer: UHCCP DNSP |
$890.13
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$763.15 |
| Max. Negotiated Rate |
$1,813.50 |
| Rate for Payer: Aetna Commercial |
$1,022.62
|
| Rate for Payer: Aetna Medicare |
$763.15
|
| Rate for Payer: BCBS Complete |
$1,116.00
|
| Rate for Payer: BCBS MAPPO |
$763.15
|
| Rate for Payer: BCN Medicare Advantage |
$763.15
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cofinity Commercial |
$1,098.94
|
| Rate for Payer: Cofinity Commercial |
$1,022.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.15
|
| Rate for Payer: Healthscope Commercial |
$915.78
|
| Rate for Payer: Healthscope Whirlpool |
$915.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.31
|
| Rate for Payer: Nomi Health Commercial |
$915.78
|
| Rate for Payer: PACE SWMI |
$763.15
|
| Rate for Payer: PHP Medicare Advantage |
$763.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,813.50
|
| Rate for Payer: Priority Health Medicare |
$763.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$763.15
|
| Rate for Payer: UHC Medicare Advantage |
$763.15
|
| Rate for Payer: UHCCP DNSP |
$763.15
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,839.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$1,535.60 |
| Max. Negotiated Rate |
$2,495.35 |
| Rate for Payer: Aetna Commercial |
$2,226.45
|
| Rate for Payer: Aetna Medicare |
$1,661.53
|
| Rate for Payer: BCBS Complete |
$1,535.60
|
| Rate for Payer: BCBS MAPPO |
$1,661.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.53
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cofinity Commercial |
$2,392.60
|
| Rate for Payer: Cofinity Commercial |
$2,226.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.53
|
| Rate for Payer: Healthscope Commercial |
$1,993.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,993.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,744.61
|
| Rate for Payer: Nomi Health Commercial |
$1,993.84
|
| Rate for Payer: PACE SWMI |
$1,661.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.35
|
| Rate for Payer: Priority Health Medicare |
$1,661.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,661.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,661.53
|
| Rate for Payer: UHCCP DNSP |
$1,661.53
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$978.13 |
| Max. Negotiated Rate |
$2,973.75 |
| Rate for Payer: Aetna Commercial |
$1,310.69
|
| Rate for Payer: Aetna Medicare |
$978.13
|
| Rate for Payer: BCBS Complete |
$1,830.00
|
| Rate for Payer: BCBS MAPPO |
$978.13
|
| Rate for Payer: BCN Medicare Advantage |
$978.13
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$1,408.51
|
| Rate for Payer: Cofinity Commercial |
$1,310.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.13
|
| Rate for Payer: Healthscope Commercial |
$1,173.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,173.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.04
|
| Rate for Payer: Nomi Health Commercial |
$1,173.76
|
| Rate for Payer: PACE SWMI |
$978.13
|
| Rate for Payer: PHP Medicare Advantage |
$978.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health Medicare |
$978.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.13
|
| Rate for Payer: UHC Medicare Advantage |
$978.13
|
| Rate for Payer: UHCCP DNSP |
$978.13
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,692.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$945.40 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: Aetna Medicare |
$945.40
|
| Rate for Payer: BCBS Complete |
$1,876.80
|
| Rate for Payer: BCBS MAPPO |
$945.40
|
| Rate for Payer: BCN Medicare Advantage |
$945.40
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,361.38
|
| Rate for Payer: Cofinity Commercial |
$1,266.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.40
|
| Rate for Payer: Healthscope Commercial |
$1,134.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.67
|
| Rate for Payer: Nomi Health Commercial |
$1,134.48
|
| Rate for Payer: PACE SWMI |
$945.40
|
| Rate for Payer: PHP Medicare Advantage |
$945.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,049.80
|
| Rate for Payer: Priority Health Medicare |
$945.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.40
|
| Rate for Payer: UHC Medicare Advantage |
$945.40
|
| Rate for Payer: UHCCP DNSP |
$945.40
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,896.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$758.40 |
| Max. Negotiated Rate |
$1,719.17 |
| Rate for Payer: Aetna Commercial |
$1,599.79
|
| Rate for Payer: Aetna Medicare |
$1,193.87
|
| Rate for Payer: BCBS Complete |
$758.40
|
| Rate for Payer: BCBS MAPPO |
$1,193.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cofinity Commercial |
$1,719.17
|
| Rate for Payer: Cofinity Commercial |
$1,599.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.87
|
| Rate for Payer: Healthscope Commercial |
$1,432.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.56
|
| Rate for Payer: Nomi Health Commercial |
$1,432.64
|
| Rate for Payer: PACE SWMI |
$1,193.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.40
|
| Rate for Payer: Priority Health Medicare |
$1,193.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.87
|
| Rate for Payer: UHCCP DNSP |
$1,193.87
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$966.53 |
| Max. Negotiated Rate |
$2,403.70 |
| Rate for Payer: Aetna Commercial |
$1,295.15
|
| Rate for Payer: Aetna Medicare |
$966.53
|
| Rate for Payer: BCBS Complete |
$1,479.20
|
| Rate for Payer: BCBS MAPPO |
$966.53
|
| Rate for Payer: BCN Medicare Advantage |
$966.53
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,391.80
|
| Rate for Payer: Cofinity Commercial |
$1,295.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.53
|
| Rate for Payer: Healthscope Commercial |
$1,159.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,159.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.86
|
| Rate for Payer: Nomi Health Commercial |
$1,159.84
|
| Rate for Payer: PACE SWMI |
$966.53
|
| Rate for Payer: PHP Medicare Advantage |
$966.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health Medicare |
$966.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.53
|
| Rate for Payer: UHC Medicare Advantage |
$966.53
|
| Rate for Payer: UHCCP DNSP |
$966.53
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$861.90 |
| Rate for Payer: Aetna Commercial |
$627.51
|
| Rate for Payer: Aetna Medicare |
$468.29
|
| Rate for Payer: BCBS Complete |
$530.40
|
| Rate for Payer: BCBS MAPPO |
$468.29
|
| Rate for Payer: BCN Medicare Advantage |
$468.29
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$674.34
|
| Rate for Payer: Cofinity Commercial |
$627.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.29
|
| Rate for Payer: Healthscope Commercial |
$561.95
|
| Rate for Payer: Healthscope Whirlpool |
$561.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.70
|
| Rate for Payer: Nomi Health Commercial |
$561.95
|
| Rate for Payer: PACE SWMI |
$468.29
|
| Rate for Payer: PHP Medicare Advantage |
$468.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.90
|
| Rate for Payer: Priority Health Medicare |
$468.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.29
|
| Rate for Payer: UHC Medicare Advantage |
$468.29
|
| Rate for Payer: UHCCP DNSP |
$468.29
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,686.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$3,074.40 |
| Max. Negotiated Rate |
$5,642.31 |
| Rate for Payer: Aetna Commercial |
$5,250.48
|
| Rate for Payer: Aetna Medicare |
$3,918.27
|
| Rate for Payer: BCBS Complete |
$3,074.40
|
| Rate for Payer: BCBS MAPPO |
$3,918.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,918.27
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cofinity Commercial |
$5,642.31
|
| Rate for Payer: Cofinity Commercial |
$5,250.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,918.27
|
| Rate for Payer: Healthscope Commercial |
$4,701.92
|
| Rate for Payer: Healthscope Whirlpool |
$4,701.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,114.18
|
| Rate for Payer: Nomi Health Commercial |
$4,701.92
|
| Rate for Payer: PACE SWMI |
$3,918.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,918.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,995.90
|
| Rate for Payer: Priority Health Medicare |
$3,918.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,918.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,918.27
|
| Rate for Payer: UHCCP DNSP |
$3,918.27
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,838.80 |
| Max. Negotiated Rate |
$3,379.67 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,346.99
|
| Rate for Payer: BCBS Complete |
$1,838.80
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,346.99
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$3,379.67
|
| Rate for Payer: Cofinity Commercial |
$3,144.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,346.99
|
| Rate for Payer: Healthscope Commercial |
$2,816.39
|
| Rate for Payer: Healthscope Whirlpool |
$2,816.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Nomi Health Commercial |
$2,816.39
|
| Rate for Payer: PACE SWMI |
$2,346.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,346.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health Medicare |
$2,346.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
| Rate for Payer: UHCCP DNSP |
$2,346.99
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$490.80 |
| Max. Negotiated Rate |
$988.04 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$686.14
|
| Rate for Payer: BCBS Complete |
$490.80
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCN Medicare Advantage |
$686.14
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cofinity Commercial |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$919.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.14
|
| Rate for Payer: Healthscope Commercial |
$823.37
|
| Rate for Payer: Healthscope Whirlpool |
$823.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Nomi Health Commercial |
$823.37
|
| Rate for Payer: PACE SWMI |
$686.14
|
| Rate for Payer: PHP Medicare Advantage |
$686.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health Medicare |
$686.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
| Rate for Payer: UHCCP DNSP |
$686.14
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$263.21 |
| Max. Negotiated Rate |
$603.20 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$263.21
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCN Medicare Advantage |
$263.21
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$379.02
|
| Rate for Payer: Cofinity Commercial |
$352.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.21
|
| Rate for Payer: Healthscope Commercial |
$315.85
|
| Rate for Payer: Healthscope Whirlpool |
$315.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Nomi Health Commercial |
$315.85
|
| Rate for Payer: PACE SWMI |
$263.21
|
| Rate for Payer: PHP Medicare Advantage |
$263.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$263.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
| Rate for Payer: UHCCP DNSP |
$263.21
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$316.36 |
| Max. Negotiated Rate |
$800.80 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$316.36
|
| Rate for Payer: BCBS Complete |
$492.80
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCN Medicare Advantage |
$316.36
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$455.56
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.36
|
| Rate for Payer: Healthscope Commercial |
$379.63
|
| Rate for Payer: Healthscope Whirlpool |
$379.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Nomi Health Commercial |
$379.63
|
| Rate for Payer: PACE SWMI |
$316.36
|
| Rate for Payer: PHP Medicare Advantage |
$316.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health Medicare |
$316.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
| Rate for Payer: UHCCP DNSP |
$316.36
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$229.33 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$229.33
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCN Medicare Advantage |
$229.33
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.33
|
| Rate for Payer: Healthscope Commercial |
$275.20
|
| Rate for Payer: Healthscope Whirlpool |
$275.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Nomi Health Commercial |
$275.20
|
| Rate for Payer: PACE SWMI |
$229.33
|
| Rate for Payer: PHP Medicare Advantage |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$229.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
| Rate for Payer: UHCCP DNSP |
$229.33
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$285.40
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCN Medicare Advantage |
$285.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$410.98
|
| Rate for Payer: Cofinity Commercial |
$382.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.40
|
| Rate for Payer: Healthscope Commercial |
$342.48
|
| Rate for Payer: Healthscope Whirlpool |
$342.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Nomi Health Commercial |
$342.48
|
| Rate for Payer: PACE SWMI |
$285.40
|
| Rate for Payer: PHP Medicare Advantage |
$285.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health Medicare |
$285.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
| Rate for Payer: UHCCP DNSP |
$285.40
|
|
