|
PR RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 63707
|
| Min. Negotiated Rate |
$591.71 |
| Max. Negotiated Rate |
$1,678.51 |
| Rate for Payer: Aetna Commercial |
$1,225.15
|
| Rate for Payer: Aetna Medicare |
$914.29
|
| Rate for Payer: BCBS Complete |
$621.30
|
| Rate for Payer: BCBS MAPPO |
$914.29
|
| Rate for Payer: BCN Commercial |
$1,587.59
|
| Rate for Payer: BCN Medicare Advantage |
$914.29
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,316.58
|
| Rate for Payer: Cofinity Commercial |
$1,225.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.29
|
| Rate for Payer: Healthscope Commercial |
$1,097.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,097.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.00
|
| Rate for Payer: Meridian Medicaid |
$621.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,005.72
|
| Rate for Payer: Nomi Health Commercial |
$1,097.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.50
|
| Rate for Payer: PACE SWMI |
$914.29
|
| Rate for Payer: PHP Medicare Advantage |
$914.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,678.51
|
| Rate for Payer: Priority Health Medicare |
$914.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,678.51
|
| Rate for Payer: Railroad Medicare Medicare |
$914.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,628.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$914.29
|
| Rate for Payer: UHC Exchange |
$1,628.59
|
| Rate for Payer: UHC Medicaid |
$591.71
|
| Rate for Payer: UHCCP DNSP |
$914.29
|
| Rate for Payer: UHCCP Medicaid |
$591.71
|
|
|
PR RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM
|
Professional
|
Both
|
$6,209.00
|
|
|
Service Code
|
HCPCS 63709
|
| Min. Negotiated Rate |
$691.82 |
| Max. Negotiated Rate |
$4,656.75 |
| Rate for Payer: Aetna Commercial |
$1,437.22
|
| Rate for Payer: Aetna Medicare |
$1,072.55
|
| Rate for Payer: BCBS Complete |
$726.41
|
| Rate for Payer: BCBS MAPPO |
$1,072.55
|
| Rate for Payer: BCN Commercial |
$1,866.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.55
|
| Rate for Payer: Cash Price |
$4,967.20
|
| Rate for Payer: Cash Price |
$4,967.20
|
| Rate for Payer: Cofinity Commercial |
$1,544.47
|
| Rate for Payer: Cofinity Commercial |
$1,437.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.55
|
| Rate for Payer: Healthscope Commercial |
$1,287.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,287.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,126.18
|
| Rate for Payer: Meridian Medicaid |
$726.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,179.81
|
| Rate for Payer: Nomi Health Commercial |
$1,287.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,656.75
|
| Rate for Payer: PACE SWMI |
$1,072.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,972.91
|
| Rate for Payer: Priority Health Medicare |
$1,072.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,972.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,072.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,948.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,072.55
|
| Rate for Payer: UHC Exchange |
$1,948.56
|
| Rate for Payer: UHC Medicaid |
$691.82
|
| Rate for Payer: UHCCP DNSP |
$1,072.55
|
| Rate for Payer: UHCCP Medicaid |
$691.82
|
|
|
PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY
|
Professional
|
Both
|
$6,019.00
|
|
|
Service Code
|
HCPCS 62120
|
| Min. Negotiated Rate |
$1,367.67 |
| Max. Negotiated Rate |
$4,514.25 |
| Rate for Payer: Aetna Commercial |
$2,815.14
|
| Rate for Payer: Aetna Medicare |
$2,100.85
|
| Rate for Payer: BCBS Complete |
$1,436.05
|
| Rate for Payer: BCBS MAPPO |
$2,100.85
|
| Rate for Payer: BCN Commercial |
$3,146.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,100.85
|
| Rate for Payer: Cash Price |
$4,815.20
|
| Rate for Payer: Cash Price |
$4,815.20
|
| Rate for Payer: Cofinity Commercial |
$2,815.14
|
| Rate for Payer: Cofinity Commercial |
$3,025.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,100.85
|
| Rate for Payer: Healthscope Commercial |
$2,521.02
|
| Rate for Payer: Healthscope Whirlpool |
$2,521.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,205.89
|
| Rate for Payer: Meridian Medicaid |
$1,436.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,310.93
|
| Rate for Payer: Nomi Health Commercial |
$2,521.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,514.25
|
| Rate for Payer: PACE SWMI |
$2,100.85
|
| Rate for Payer: PHP Medicare Advantage |
$2,100.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,367.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,654.30
|
| Rate for Payer: Priority Health Medicare |
$2,100.85
|
| Rate for Payer: Priority Health Narrow Network |
$3,654.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,100.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,662.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,100.85
|
| Rate for Payer: UHC Exchange |
$3,662.84
|
| Rate for Payer: UHC Medicaid |
$1,367.67
|
| Rate for Payer: UHCCP DNSP |
$2,100.85
|
| Rate for Payer: UHCCP Medicaid |
$1,367.67
|
|
|
PR RPR EPIGASTRIC HERNIA INCARCERATED
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 49572
|
| Min. Negotiated Rate |
$613.20 |
| Max. Negotiated Rate |
$1,149.75 |
| Rate for Payer: BCBS Complete |
$613.20
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,149.75
|
|
|
PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX
|
Professional
|
Both
|
$1,206.00
|
|
|
Service Code
|
HCPCS 49570
|
| Min. Negotiated Rate |
$482.40 |
| Max. Negotiated Rate |
$904.50 |
| Rate for Payer: BCBS Complete |
$482.40
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$904.50
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$219.39 |
| Max. Negotiated Rate |
$625.46 |
| Rate for Payer: Aetna Commercial |
$445.71
|
| Rate for Payer: Aetna Medicare |
$332.62
|
| Rate for Payer: BCBS Complete |
$230.36
|
| Rate for Payer: BCBS MAPPO |
$332.62
|
| Rate for Payer: BCN Commercial |
$545.79
|
| Rate for Payer: BCN Medicare Advantage |
$332.62
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$445.71
|
| Rate for Payer: Cofinity Commercial |
$478.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.62
|
| Rate for Payer: Healthscope Commercial |
$399.14
|
| Rate for Payer: Healthscope Whirlpool |
$399.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.25
|
| Rate for Payer: Meridian Medicaid |
$230.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$365.88
|
| Rate for Payer: Nomi Health Commercial |
$399.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.75
|
| Rate for Payer: PACE SWMI |
$332.62
|
| Rate for Payer: PHP Medicare Advantage |
$332.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$583.44
|
| Rate for Payer: Priority Health Medicare |
$332.62
|
| Rate for Payer: Priority Health Narrow Network |
$583.44
|
| Rate for Payer: Railroad Medicare Medicare |
$332.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$332.62
|
| Rate for Payer: UHC Exchange |
$625.46
|
| Rate for Payer: UHC Medicaid |
$219.39
|
| Rate for Payer: UHCCP DNSP |
$332.62
|
| Rate for Payer: UHCCP Medicaid |
$219.39
|
|
|
PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 27665
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$720.22 |
| Rate for Payer: Aetna Commercial |
$518.29
|
| Rate for Payer: Aetna Medicare |
$386.78
|
| Rate for Payer: BCBS Complete |
$267.49
|
| Rate for Payer: BCBS MAPPO |
$386.78
|
| Rate for Payer: BCN Commercial |
$636.42
|
| Rate for Payer: BCN Medicare Advantage |
$386.78
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cofinity Commercial |
$556.96
|
| Rate for Payer: Cofinity Commercial |
$518.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.78
|
| Rate for Payer: Healthscope Commercial |
$464.14
|
| Rate for Payer: Healthscope Whirlpool |
$464.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.12
|
| Rate for Payer: Meridian Medicaid |
$267.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$425.46
|
| Rate for Payer: Nomi Health Commercial |
$464.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$663.75
|
| Rate for Payer: PACE SWMI |
$386.78
|
| Rate for Payer: PHP Medicare Advantage |
$386.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$680.32
|
| Rate for Payer: Priority Health Medicare |
$386.78
|
| Rate for Payer: Priority Health Narrow Network |
$680.32
|
| Rate for Payer: Railroad Medicare Medicare |
$386.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$386.78
|
| Rate for Payer: UHC Exchange |
$720.22
|
| Rate for Payer: UHC Medicaid |
$254.75
|
| Rate for Payer: UHCCP DNSP |
$386.78
|
| Rate for Payer: UHCCP Medicaid |
$254.75
|
|
|
PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 27659
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$840.75 |
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Medicare |
$434.97
|
| Rate for Payer: BCBS Complete |
$299.02
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCN Commercial |
$719.08
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Healthscope Commercial |
$521.96
|
| Rate for Payer: Healthscope Whirlpool |
$521.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Meridian Medicaid |
$299.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$478.47
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.75
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$768.68
|
| Rate for Payer: Priority Health Medicare |
$434.97
|
| Rate for Payer: Priority Health Narrow Network |
$768.68
|
| Rate for Payer: Railroad Medicare Medicare |
$434.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$820.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$434.97
|
| Rate for Payer: UHC Exchange |
$820.64
|
| Rate for Payer: UHC Medicaid |
$284.78
|
| Rate for Payer: UHCCP DNSP |
$434.97
|
| Rate for Payer: UHCCP Medicaid |
$284.78
|
|
|
PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$5,724.00
|
|
|
Service Code
|
HCPCS 46740
|
| Min. Negotiated Rate |
$1,321.45 |
| Max. Negotiated Rate |
$4,293.00 |
| Rate for Payer: Aetna Commercial |
$2,749.41
|
| Rate for Payer: Aetna Medicare |
$2,051.80
|
| Rate for Payer: BCBS Complete |
$1,387.52
|
| Rate for Payer: BCBS MAPPO |
$2,051.80
|
| Rate for Payer: BCN Commercial |
$3,269.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,051.80
|
| Rate for Payer: Cash Price |
$4,579.20
|
| Rate for Payer: Cash Price |
$4,579.20
|
| Rate for Payer: Cofinity Commercial |
$2,954.59
|
| Rate for Payer: Cofinity Commercial |
$2,749.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,051.80
|
| Rate for Payer: Healthscope Commercial |
$2,462.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,462.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,154.39
|
| Rate for Payer: Meridian Medicaid |
$1,387.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,256.98
|
| Rate for Payer: Nomi Health Commercial |
$2,462.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,293.00
|
| Rate for Payer: PACE SWMI |
$2,051.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,051.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,321.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,983.37
|
| Rate for Payer: Priority Health Medicare |
$2,051.80
|
| Rate for Payer: Priority Health Narrow Network |
$3,983.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2,051.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,830.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,051.80
|
| Rate for Payer: UHC Exchange |
$3,830.44
|
| Rate for Payer: UHC Medicaid |
$1,321.45
|
| Rate for Payer: UHCCP DNSP |
$2,051.80
|
| Rate for Payer: UHCCP Medicaid |
$1,321.45
|
|
|
PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL
|
Professional
|
Both
|
$5,301.00
|
|
|
Service Code
|
HCPCS 46742
|
| Min. Negotiated Rate |
$1,514.43 |
| Max. Negotiated Rate |
$4,591.93 |
| Rate for Payer: Aetna Commercial |
$3,159.20
|
| Rate for Payer: Aetna Medicare |
$2,357.61
|
| Rate for Payer: BCBS Complete |
$1,590.15
|
| Rate for Payer: BCBS MAPPO |
$2,357.61
|
| Rate for Payer: BCN Commercial |
$3,768.72
|
| Rate for Payer: BCN Medicare Advantage |
$2,357.61
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cofinity Commercial |
$3,394.96
|
| Rate for Payer: Cofinity Commercial |
$3,159.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,357.61
|
| Rate for Payer: Healthscope Commercial |
$2,829.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,829.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,475.49
|
| Rate for Payer: Meridian Medicaid |
$1,590.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,593.37
|
| Rate for Payer: Nomi Health Commercial |
$2,829.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,975.75
|
| Rate for Payer: PACE SWMI |
$2,357.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,357.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,514.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,591.93
|
| Rate for Payer: Priority Health Medicare |
$2,357.61
|
| Rate for Payer: Priority Health Narrow Network |
$4,591.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2,357.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,443.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,357.61
|
| Rate for Payer: UHC Exchange |
$4,443.00
|
| Rate for Payer: UHC Medicaid |
$1,514.43
|
| Rate for Payer: UHCCP DNSP |
$2,357.61
|
| Rate for Payer: UHCCP Medicaid |
$1,514.43
|
|
|
PR RPR HI IMPRF ANUS W/O FISTULA CMBN APPR
|
Professional
|
Both
|
$4,903.00
|
|
|
Service Code
|
HCPCS 46735
|
| Min. Negotiated Rate |
$1,388.33 |
| Max. Negotiated Rate |
$4,198.77 |
| Rate for Payer: Aetna Commercial |
$2,891.76
|
| Rate for Payer: Aetna Medicare |
$2,158.03
|
| Rate for Payer: BCBS Complete |
$1,457.75
|
| Rate for Payer: BCBS MAPPO |
$2,158.03
|
| Rate for Payer: BCN Commercial |
$3,446.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,158.03
|
| Rate for Payer: Cash Price |
$3,922.40
|
| Rate for Payer: Cash Price |
$3,922.40
|
| Rate for Payer: Cofinity Commercial |
$3,107.56
|
| Rate for Payer: Cofinity Commercial |
$2,891.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,158.03
|
| Rate for Payer: Healthscope Commercial |
$2,589.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,589.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,265.93
|
| Rate for Payer: Meridian Medicaid |
$1,457.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,373.83
|
| Rate for Payer: Nomi Health Commercial |
$2,589.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,677.25
|
| Rate for Payer: PACE SWMI |
$2,158.03
|
| Rate for Payer: PHP Medicare Advantage |
$2,158.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,388.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,198.77
|
| Rate for Payer: Priority Health Medicare |
$2,158.03
|
| Rate for Payer: Priority Health Narrow Network |
$4,198.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,158.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,047.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,158.03
|
| Rate for Payer: UHC Exchange |
$4,047.66
|
| Rate for Payer: UHC Medicaid |
$1,388.33
|
| Rate for Payer: UHCCP DNSP |
$2,158.03
|
| Rate for Payer: UHCCP Medicaid |
$1,388.33
|
|
|
PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$3,995.00
|
|
|
Service Code
|
HCPCS 46730
|
| Min. Negotiated Rate |
$1,216.44 |
| Max. Negotiated Rate |
$3,653.90 |
| Rate for Payer: Aetna Commercial |
$2,527.40
|
| Rate for Payer: Aetna Medicare |
$1,886.12
|
| Rate for Payer: BCBS Complete |
$1,277.26
|
| Rate for Payer: BCBS MAPPO |
$1,886.12
|
| Rate for Payer: BCN Commercial |
$2,998.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,886.12
|
| Rate for Payer: Cash Price |
$3,196.00
|
| Rate for Payer: Cash Price |
$3,196.00
|
| Rate for Payer: Cofinity Commercial |
$2,716.01
|
| Rate for Payer: Cofinity Commercial |
$2,527.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,886.12
|
| Rate for Payer: Healthscope Commercial |
$2,263.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,263.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,980.43
|
| Rate for Payer: Meridian Medicaid |
$1,277.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,074.73
|
| Rate for Payer: Nomi Health Commercial |
$2,263.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,996.25
|
| Rate for Payer: PACE SWMI |
$1,886.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,886.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,216.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,653.90
|
| Rate for Payer: Priority Health Medicare |
$1,886.12
|
| Rate for Payer: Priority Health Narrow Network |
$3,653.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,886.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,505.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,886.12
|
| Rate for Payer: UHC Exchange |
$3,505.70
|
| Rate for Payer: UHC Medicaid |
$1,216.44
|
| Rate for Payer: UHCCP DNSP |
$1,886.12
|
| Rate for Payer: UHCCP Medicaid |
$1,216.44
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE
|
Professional
|
Both
|
$2,045.00
|
|
|
Service Code
|
HCPCS 54340
|
| Min. Negotiated Rate |
$332.07 |
| Max. Negotiated Rate |
$1,533.75 |
| Rate for Payer: Aetna Commercial |
$685.73
|
| Rate for Payer: Aetna Medicare |
$511.74
|
| Rate for Payer: BCBS Complete |
$348.67
|
| Rate for Payer: BCBS MAPPO |
$511.74
|
| Rate for Payer: BCN Commercial |
$855.53
|
| Rate for Payer: BCN Medicare Advantage |
$511.74
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cash Price |
$1,636.00
|
| Rate for Payer: Cofinity Commercial |
$736.91
|
| Rate for Payer: Cofinity Commercial |
$685.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.74
|
| Rate for Payer: Healthscope Commercial |
$614.09
|
| Rate for Payer: Healthscope Whirlpool |
$614.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.33
|
| Rate for Payer: Meridian Medicaid |
$348.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$562.91
|
| Rate for Payer: Nomi Health Commercial |
$614.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,533.75
|
| Rate for Payer: PACE SWMI |
$511.74
|
| Rate for Payer: PHP Medicare Advantage |
$511.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$931.95
|
| Rate for Payer: Priority Health Medicare |
$511.74
|
| Rate for Payer: Priority Health Narrow Network |
$931.95
|
| Rate for Payer: Railroad Medicare Medicare |
$511.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$511.74
|
| Rate for Payer: UHC Exchange |
$1,002.34
|
| Rate for Payer: UHC Medicaid |
$332.07
|
| Rate for Payer: UHCCP DNSP |
$511.74
|
| Rate for Payer: UHCCP Medicaid |
$332.07
|
|
|
PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR
|
Professional
|
Both
|
$7,774.00
|
|
|
Service Code
|
HCPCS 33660
|
| Min. Negotiated Rate |
$1,046.04 |
| Max. Negotiated Rate |
$5,830.50 |
| Rate for Payer: Aetna Commercial |
$2,203.32
|
| Rate for Payer: Aetna Medicare |
$1,644.27
|
| Rate for Payer: BCBS Complete |
$1,098.34
|
| Rate for Payer: BCBS MAPPO |
$1,644.27
|
| Rate for Payer: BCN Commercial |
$2,582.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,644.27
|
| Rate for Payer: Cash Price |
$6,219.20
|
| Rate for Payer: Cash Price |
$6,219.20
|
| Rate for Payer: Cofinity Commercial |
$2,367.75
|
| Rate for Payer: Cofinity Commercial |
$2,203.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,644.27
|
| Rate for Payer: Healthscope Commercial |
$1,973.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,973.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,726.48
|
| Rate for Payer: Meridian Medicaid |
$1,098.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,808.70
|
| Rate for Payer: Nomi Health Commercial |
$1,973.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,830.50
|
| Rate for Payer: PACE SWMI |
$1,644.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,644.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,777.18
|
| Rate for Payer: Priority Health Medicare |
$1,644.27
|
| Rate for Payer: Priority Health Narrow Network |
$2,777.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,644.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,131.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,644.27
|
| Rate for Payer: UHC Exchange |
$3,131.15
|
| Rate for Payer: UHC Medicaid |
$1,046.04
|
| Rate for Payer: UHCCP DNSP |
$1,644.27
|
| Rate for Payer: UHCCP Medicaid |
$1,046.04
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$353.58 |
| Max. Negotiated Rate |
$1,263.75 |
| Rate for Payer: Aetna Commercial |
$734.29
|
| Rate for Payer: Aetna Medicare |
$547.98
|
| Rate for Payer: BCBS Complete |
$371.26
|
| Rate for Payer: BCBS MAPPO |
$547.98
|
| Rate for Payer: BCN Commercial |
$870.97
|
| Rate for Payer: BCN Medicare Advantage |
$547.98
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cofinity Commercial |
$789.09
|
| Rate for Payer: Cofinity Commercial |
$734.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.98
|
| Rate for Payer: Healthscope Commercial |
$657.58
|
| Rate for Payer: Healthscope Whirlpool |
$657.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$575.38
|
| Rate for Payer: Meridian Medicaid |
$371.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$602.78
|
| Rate for Payer: Nomi Health Commercial |
$657.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.75
|
| Rate for Payer: PACE SWMI |
$547.98
|
| Rate for Payer: PHP Medicare Advantage |
$547.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,061.22
|
| Rate for Payer: Priority Health Medicare |
$547.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.22
|
| Rate for Payer: Railroad Medicare Medicare |
$547.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,019.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$547.98
|
| Rate for Payer: UHC Exchange |
$1,019.03
|
| Rate for Payer: UHC Medicaid |
$353.58
|
| Rate for Payer: UHCCP DNSP |
$547.98
|
| Rate for Payer: UHCCP Medicaid |
$353.58
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$353.58 |
| Max. Negotiated Rate |
$1,263.75 |
| Rate for Payer: Aetna Commercial |
$734.29
|
| Rate for Payer: Aetna Medicare |
$547.98
|
| Rate for Payer: BCBS Complete |
$371.26
|
| Rate for Payer: BCBS MAPPO |
$547.98
|
| Rate for Payer: BCN Commercial |
$870.97
|
| Rate for Payer: BCN Medicare Advantage |
$547.98
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cofinity Commercial |
$789.09
|
| Rate for Payer: Cofinity Commercial |
$734.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.98
|
| Rate for Payer: Healthscope Commercial |
$657.58
|
| Rate for Payer: Healthscope Whirlpool |
$657.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$575.38
|
| Rate for Payer: Meridian Medicaid |
$371.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$602.78
|
| Rate for Payer: Nomi Health Commercial |
$657.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.75
|
| Rate for Payer: PACE SWMI |
$547.98
|
| Rate for Payer: PHP Medicare Advantage |
$547.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,061.22
|
| Rate for Payer: Priority Health Medicare |
$547.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.22
|
| Rate for Payer: Railroad Medicare Medicare |
$547.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,019.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$547.98
|
| Rate for Payer: UHC Exchange |
$1,019.03
|
| Rate for Payer: UHC Medicaid |
$353.58
|
| Rate for Payer: UHCCP DNSP |
$547.98
|
| Rate for Payer: UHCCP Medicaid |
$353.58
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,181.18 |
| Max. Negotiated Rate |
$4,459.41 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Medicare |
$3,567.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: ASR ASR |
$1,634.45
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,389.28
|
| Rate for Payer: BCN Commercial |
$1,389.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cofinity Commercial |
$1,583.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Healthscope Commercial |
$1,634.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,685.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,567.53
|
| Rate for Payer: Mclaren Commercial |
$1,516.50
|
| Rate for Payer: Mclaren Medicaid |
$3,567.53
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$1,959.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.25
|
| Rate for Payer: Nomi Health Commercial |
$1,381.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.75
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Commercial |
$3,924.28
|
| Rate for Payer: PHP Medicaid |
$1,912.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,476.40
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,181.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP DNSP |
$3,567.53
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,263.75 |
| Max. Negotiated Rate |
$1,685.00 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: ASR ASR |
$1,634.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.72
|
| Rate for Payer: BCN Commercial |
$1,383.72
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cofinity Commercial |
$1,583.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.00
|
| Rate for Payer: Healthscope Commercial |
$1,634.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,685.00
|
| Rate for Payer: Mclaren Commercial |
$1,516.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.25
|
| Rate for Payer: Nomi Health Commercial |
$1,381.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.75
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$199.79 |
| Max. Negotiated Rate |
$717.00 |
| Rate for Payer: Aetna Commercial |
$410.44
|
| Rate for Payer: Aetna Medicare |
$306.30
|
| Rate for Payer: BCBS Complete |
$209.78
|
| Rate for Payer: BCBS MAPPO |
$306.30
|
| Rate for Payer: BCN Commercial |
$480.06
|
| Rate for Payer: BCN Medicare Advantage |
$306.30
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$441.07
|
| Rate for Payer: Cofinity Commercial |
$410.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$367.56
|
| Rate for Payer: Healthscope Whirlpool |
$367.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.62
|
| Rate for Payer: Meridian Medicaid |
$209.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.93
|
| Rate for Payer: Nomi Health Commercial |
$367.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$717.00
|
| Rate for Payer: PACE SWMI |
$306.30
|
| Rate for Payer: PHP Medicare Advantage |
$306.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$439.37
|
| Rate for Payer: Priority Health Medicare |
$306.30
|
| Rate for Payer: Priority Health Narrow Network |
$439.37
|
| Rate for Payer: Railroad Medicare Medicare |
$306.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$550.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$306.30
|
| Rate for Payer: UHC Exchange |
$550.15
|
| Rate for Payer: UHC Medicaid |
$199.79
|
| Rate for Payer: UHCCP DNSP |
$306.30
|
| Rate for Payer: UHCCP Medicaid |
$199.79
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$283.96 |
| Rate for Payer: Aetna Commercial |
$215.41
|
| Rate for Payer: Aetna Medicare |
$160.75
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$160.75
|
| Rate for Payer: BCN Commercial |
$233.06
|
| Rate for Payer: BCN Medicare Advantage |
$160.75
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$231.48
|
| Rate for Payer: Cofinity Commercial |
$215.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$192.90
|
| Rate for Payer: Healthscope Whirlpool |
$192.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.79
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.82
|
| Rate for Payer: Nomi Health Commercial |
$192.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.50
|
| Rate for Payer: PACE SWMI |
$160.75
|
| Rate for Payer: PHP Medicare Advantage |
$160.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$283.96
|
| Rate for Payer: Priority Health Medicare |
$160.75
|
| Rate for Payer: Priority Health Narrow Network |
$283.96
|
| Rate for Payer: Railroad Medicare Medicare |
$160.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.75
|
| Rate for Payer: UHC Exchange |
$266.85
|
| Rate for Payer: UHC Medicaid |
$106.29
|
| Rate for Payer: UHCCP DNSP |
$160.75
|
| Rate for Payer: UHCCP Medicaid |
$106.29
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$837.75 |
| Rate for Payer: Aetna Commercial |
$255.34
|
| Rate for Payer: Aetna Medicare |
$190.55
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCBS MAPPO |
$190.55
|
| Rate for Payer: BCN Commercial |
$315.23
|
| Rate for Payer: BCN Medicare Advantage |
$190.55
|
| Rate for Payer: Cash Price |
$893.60
|
| Rate for Payer: Cash Price |
$893.60
|
| Rate for Payer: Cofinity Commercial |
$274.39
|
| Rate for Payer: Cofinity Commercial |
$255.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.55
|
| Rate for Payer: Healthscope Commercial |
$228.66
|
| Rate for Payer: Healthscope Whirlpool |
$228.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.08
|
| Rate for Payer: Meridian Medicaid |
$130.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$209.60
|
| Rate for Payer: Nomi Health Commercial |
$228.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$837.75
|
| Rate for Payer: PACE SWMI |
$190.55
|
| Rate for Payer: PHP Medicare Advantage |
$190.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$384.07
|
| Rate for Payer: Priority Health Medicare |
$190.55
|
| Rate for Payer: Priority Health Narrow Network |
$384.07
|
| Rate for Payer: Railroad Medicare Medicare |
$190.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$190.55
|
| Rate for Payer: UHC Exchange |
$363.97
|
| Rate for Payer: UHC Medicaid |
$124.61
|
| Rate for Payer: UHCCP DNSP |
$190.55
|
| Rate for Payer: UHCCP Medicaid |
$124.61
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$3,511.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$676.06 |
| Max. Negotiated Rate |
$2,633.25 |
| Rate for Payer: Aetna Commercial |
$1,416.92
|
| Rate for Payer: Aetna Medicare |
$1,057.40
|
| Rate for Payer: BCBS Complete |
$709.86
|
| Rate for Payer: BCBS MAPPO |
$1,057.40
|
| Rate for Payer: BCN Commercial |
$1,709.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.40
|
| Rate for Payer: Cash Price |
$2,808.80
|
| Rate for Payer: Cash Price |
$2,808.80
|
| Rate for Payer: Cofinity Commercial |
$1,522.66
|
| Rate for Payer: Cofinity Commercial |
$1,416.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.40
|
| Rate for Payer: Healthscope Commercial |
$1,268.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,268.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,110.27
|
| Rate for Payer: Meridian Medicaid |
$709.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,163.14
|
| Rate for Payer: Nomi Health Commercial |
$1,268.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,633.25
|
| Rate for Payer: PACE SWMI |
$1,057.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$676.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,082.39
|
| Rate for Payer: Priority Health Medicare |
$1,057.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,082.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,027.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,057.40
|
| Rate for Payer: UHC Exchange |
$2,027.66
|
| Rate for Payer: UHC Medicaid |
$676.06
|
| Rate for Payer: UHCCP DNSP |
$1,057.40
|
| Rate for Payer: UHCCP Medicaid |
$676.06
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$9,393.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$2,864.00 |
| Max. Negotiated Rate |
$8,938.76 |
| Rate for Payer: Aetna Commercial |
$6,044.95
|
| Rate for Payer: Aetna Medicare |
$4,511.16
|
| Rate for Payer: BCBS Complete |
$3,007.20
|
| Rate for Payer: BCBS MAPPO |
$4,511.16
|
| Rate for Payer: BCN Commercial |
$7,336.25
|
| Rate for Payer: BCN Medicare Advantage |
$4,511.16
|
| Rate for Payer: Cash Price |
$7,514.40
|
| Rate for Payer: Cash Price |
$7,514.40
|
| Rate for Payer: Cofinity Commercial |
$6,496.07
|
| Rate for Payer: Cofinity Commercial |
$6,044.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,511.16
|
| Rate for Payer: Healthscope Commercial |
$5,413.39
|
| Rate for Payer: Healthscope Whirlpool |
$5,413.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,736.72
|
| Rate for Payer: Meridian Medicaid |
$3,007.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,962.28
|
| Rate for Payer: Nomi Health Commercial |
$5,413.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,044.75
|
| Rate for Payer: PACE SWMI |
$4,511.16
|
| Rate for Payer: PHP Medicare Advantage |
$4,511.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,864.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,938.76
|
| Rate for Payer: Priority Health Medicare |
$4,511.16
|
| Rate for Payer: Priority Health Narrow Network |
$8,938.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4,511.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,889.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,511.16
|
| Rate for Payer: UHC Exchange |
$8,889.05
|
| Rate for Payer: UHC Medicaid |
$2,864.00
|
| Rate for Payer: UHCCP DNSP |
$4,511.16
|
| Rate for Payer: UHCCP Medicaid |
$2,864.00
|
|
|
PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$251.98 |
| Max. Negotiated Rate |
$790.60 |
| Rate for Payer: Aetna Commercial |
$512.52
|
| Rate for Payer: Aetna Medicare |
$382.48
|
| Rate for Payer: BCBS Complete |
$264.58
|
| Rate for Payer: BCBS MAPPO |
$382.48
|
| Rate for Payer: BCN Commercial |
$648.87
|
| Rate for Payer: BCN Medicare Advantage |
$382.48
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cofinity Commercial |
$550.77
|
| Rate for Payer: Cofinity Commercial |
$512.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.48
|
| Rate for Payer: Healthscope Commercial |
$458.98
|
| Rate for Payer: Healthscope Whirlpool |
$458.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.60
|
| Rate for Payer: Meridian Medicaid |
$264.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$420.73
|
| Rate for Payer: Nomi Health Commercial |
$458.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.75
|
| Rate for Payer: PACE SWMI |
$382.48
|
| Rate for Payer: PHP Medicare Advantage |
$382.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$790.60
|
| Rate for Payer: Priority Health Medicare |
$382.48
|
| Rate for Payer: Priority Health Narrow Network |
$790.60
|
| Rate for Payer: Railroad Medicare Medicare |
$382.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$382.48
|
| Rate for Payer: UHC Exchange |
$732.11
|
| Rate for Payer: UHC Medicaid |
$251.98
|
| Rate for Payer: UHCCP DNSP |
$382.48
|
| Rate for Payer: UHCCP Medicaid |
$251.98
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$353.37 |
| Max. Negotiated Rate |
$1,028.45 |
| Rate for Payer: Aetna Commercial |
$726.00
|
| Rate for Payer: Aetna Medicare |
$541.79
|
| Rate for Payer: BCBS Complete |
$371.04
|
| Rate for Payer: BCBS MAPPO |
$541.79
|
| Rate for Payer: BCN Commercial |
$844.08
|
| Rate for Payer: BCN Medicare Advantage |
$541.79
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Commercial |
$780.18
|
| Rate for Payer: Cofinity Commercial |
$726.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.79
|
| Rate for Payer: Healthscope Commercial |
$650.15
|
| Rate for Payer: Healthscope Whirlpool |
$650.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.88
|
| Rate for Payer: Meridian Medicaid |
$371.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.97
|
| Rate for Payer: Nomi Health Commercial |
$650.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$918.00
|
| Rate for Payer: PACE SWMI |
$541.79
|
| Rate for Payer: PHP Medicare Advantage |
$541.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,028.45
|
| Rate for Payer: Priority Health Medicare |
$541.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.45
|
| Rate for Payer: Railroad Medicare Medicare |
$541.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.79
|
| Rate for Payer: UHC Exchange |
$969.25
|
| Rate for Payer: UHC Medicaid |
$353.37
|
| Rate for Payer: UHCCP DNSP |
$541.79
|
| Rate for Payer: UHCCP Medicaid |
$353.37
|
|
