|
PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
|
Professional
|
Both
|
$4,999.00
|
|
|
Service Code
|
HCPCS 24371
|
| Min. Negotiated Rate |
$1,698.92 |
| Max. Negotiated Rate |
$3,249.35 |
| Rate for Payer: Aetna Commercial |
$2,276.55
|
| Rate for Payer: Aetna Medicare |
$1,698.92
|
| Rate for Payer: BCBS Complete |
$1,999.60
|
| Rate for Payer: BCBS MAPPO |
$1,698.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,698.92
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cofinity Commercial |
$2,446.44
|
| Rate for Payer: Cofinity Commercial |
$2,276.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,698.92
|
| Rate for Payer: Healthscope Commercial |
$2,038.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,038.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,783.87
|
| Rate for Payer: Nomi Health Commercial |
$2,038.70
|
| Rate for Payer: PACE SWMI |
$1,698.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,698.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,249.35
|
| Rate for Payer: Priority Health Medicare |
$1,698.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,698.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,698.92
|
| Rate for Payer: UHCCP DNSP |
$1,698.92
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
|
Professional
|
Both
|
$3,780.00
|
|
|
Service Code
|
HCPCS 24370
|
| Min. Negotiated Rate |
$1,479.30 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna Commercial |
$1,982.26
|
| Rate for Payer: Aetna Medicare |
$1,479.30
|
| Rate for Payer: BCBS Complete |
$1,512.00
|
| Rate for Payer: BCBS MAPPO |
$1,479.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.30
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cofinity Commercial |
$2,130.19
|
| Rate for Payer: Cofinity Commercial |
$1,982.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.30
|
| Rate for Payer: Healthscope Commercial |
$1,775.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,775.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.27
|
| Rate for Payer: Nomi Health Commercial |
$1,775.16
|
| Rate for Payer: PACE SWMI |
$1,479.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,457.00
|
| Rate for Payer: Priority Health Medicare |
$1,479.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,479.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,479.30
|
| Rate for Payer: UHCCP DNSP |
$1,479.30
|
|
|
PR REVISION OF LARYNX, UNSPECIFIED
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 31588
|
| Min. Negotiated Rate |
$824.00 |
| Max. Negotiated Rate |
$1,339.00 |
| Rate for Payer: Aetna Medicare |
$1,030.00
|
| Rate for Payer: BCBS Complete |
$824.00
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.00
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,113.31 |
| Rate for Payer: Aetna Commercial |
$1,035.99
|
| Rate for Payer: Aetna Medicare |
$773.13
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$773.13
|
| Rate for Payer: BCN Medicare Advantage |
$773.13
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,113.31
|
| Rate for Payer: Cofinity Commercial |
$1,035.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.13
|
| Rate for Payer: Healthscope Commercial |
$927.76
|
| Rate for Payer: Healthscope Whirlpool |
$927.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.79
|
| Rate for Payer: Nomi Health Commercial |
$927.76
|
| Rate for Payer: PACE SWMI |
$773.13
|
| Rate for Payer: PHP Medicare Advantage |
$773.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$773.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.13
|
| Rate for Payer: UHC Medicare Advantage |
$773.13
|
| Rate for Payer: UHCCP DNSP |
$773.13
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$791.70 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: ASR ASR |
$1,181.46
|
| Rate for Payer: ASR Commercial |
$1,181.46
|
| Rate for Payer: BCBS Trust/PPO |
$992.55
|
| Rate for Payer: BCN Commercial |
$944.32
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,144.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Healthscope Commercial |
$1,218.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.46
|
| Rate for Payer: Mclaren Commercial |
$1,096.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: Nomi Health Commercial |
$998.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.84
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,113.31 |
| Rate for Payer: Aetna Commercial |
$1,035.99
|
| Rate for Payer: Aetna Medicare |
$773.13
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$773.13
|
| Rate for Payer: BCN Medicare Advantage |
$773.13
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,113.31
|
| Rate for Payer: Cofinity Commercial |
$1,035.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.13
|
| Rate for Payer: Healthscope Commercial |
$927.76
|
| Rate for Payer: Healthscope Whirlpool |
$927.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.79
|
| Rate for Payer: Nomi Health Commercial |
$927.76
|
| Rate for Payer: PACE SWMI |
$773.13
|
| Rate for Payer: PHP Medicare Advantage |
$773.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$773.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.13
|
| Rate for Payer: UHC Medicare Advantage |
$773.13
|
| Rate for Payer: UHCCP DNSP |
$773.13
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$791.70 |
| Max. Negotiated Rate |
$9,858.39 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Medicare |
$6,360.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: ASR ASR |
$1,181.46
|
| Rate for Payer: ASR Commercial |
$1,181.46
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCBS Trust/PPO |
$997.42
|
| Rate for Payer: BCN Commercial |
$944.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,144.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$1,218.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,360.25
|
| Rate for Payer: Mclaren Commercial |
$1,096.20
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: Nomi Health Commercial |
$998.76
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$6,996.27
|
| Rate for Payer: PHP Medicaid |
$3,409.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,067.21
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Priority Health Narrow Network |
$853.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$9,858.39
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP DNSP |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$926.52 |
| Rate for Payer: Aetna Commercial |
$862.18
|
| Rate for Payer: Aetna Medicare |
$643.42
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$643.42
|
| Rate for Payer: BCN Medicare Advantage |
$643.42
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$926.52
|
| Rate for Payer: Cofinity Commercial |
$862.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.42
|
| Rate for Payer: Healthscope Commercial |
$772.10
|
| Rate for Payer: Healthscope Whirlpool |
$772.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.59
|
| Rate for Payer: Nomi Health Commercial |
$772.10
|
| Rate for Payer: PACE SWMI |
$643.42
|
| Rate for Payer: PHP Medicare Advantage |
$643.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$643.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.42
|
| Rate for Payer: UHC Medicare Advantage |
$643.42
|
| Rate for Payer: UHCCP DNSP |
$643.42
|
|
|
PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 57426
|
| Min. Negotiated Rate |
$644.80 |
| Max. Negotiated Rate |
$1,202.20 |
| Rate for Payer: Aetna Commercial |
$1,118.71
|
| Rate for Payer: Aetna Medicare |
$834.86
|
| Rate for Payer: BCBS Complete |
$644.80
|
| Rate for Payer: BCBS MAPPO |
$834.86
|
| Rate for Payer: BCN Medicare Advantage |
$834.86
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$1,202.20
|
| Rate for Payer: Cofinity Commercial |
$1,118.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.86
|
| Rate for Payer: Healthscope Commercial |
$1,001.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,001.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.60
|
| Rate for Payer: Nomi Health Commercial |
$1,001.83
|
| Rate for Payer: PACE SWMI |
$834.86
|
| Rate for Payer: PHP Medicare Advantage |
$834.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.80
|
| Rate for Payer: Priority Health Medicare |
$834.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.86
|
| Rate for Payer: UHC Medicare Advantage |
$834.86
|
| Rate for Payer: UHCCP DNSP |
$834.86
|
|
|
PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV
|
Professional
|
Both
|
$2,230.00
|
|
|
Service Code
|
HCPCS 64569
|
| Min. Negotiated Rate |
$760.86 |
| Max. Negotiated Rate |
$1,449.50 |
| Rate for Payer: Aetna Commercial |
$1,019.55
|
| Rate for Payer: Aetna Medicare |
$760.86
|
| Rate for Payer: BCBS Complete |
$892.00
|
| Rate for Payer: BCBS MAPPO |
$760.86
|
| Rate for Payer: BCN Medicare Advantage |
$760.86
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cofinity Commercial |
$1,095.64
|
| Rate for Payer: Cofinity Commercial |
$1,019.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.86
|
| Rate for Payer: Healthscope Commercial |
$913.03
|
| Rate for Payer: Healthscope Whirlpool |
$913.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.90
|
| Rate for Payer: Nomi Health Commercial |
$913.03
|
| Rate for Payer: PACE SWMI |
$760.86
|
| Rate for Payer: PHP Medicare Advantage |
$760.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,449.50
|
| Rate for Payer: Priority Health Medicare |
$760.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.86
|
| Rate for Payer: UHC Medicare Advantage |
$760.86
|
| Rate for Payer: UHCCP DNSP |
$760.86
|
|
|
PR REVISION STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
HCPCS 69662
|
| Min. Negotiated Rate |
$1,080.82 |
| Max. Negotiated Rate |
$2,546.05 |
| Rate for Payer: Aetna Commercial |
$1,448.30
|
| Rate for Payer: Aetna Medicare |
$1,080.82
|
| Rate for Payer: BCBS Complete |
$1,566.80
|
| Rate for Payer: BCBS MAPPO |
$1,080.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.82
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cofinity Commercial |
$1,556.38
|
| Rate for Payer: Cofinity Commercial |
$1,448.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.82
|
| Rate for Payer: Healthscope Commercial |
$1,296.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,296.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.86
|
| Rate for Payer: Nomi Health Commercial |
$1,296.98
|
| Rate for Payer: PACE SWMI |
$1,080.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,546.05
|
| Rate for Payer: Priority Health Medicare |
$1,080.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.82
|
| Rate for Payer: UHCCP DNSP |
$1,080.82
|
|
|
PR REVISION TRACHEOSTOMY SCAR
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 31830
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$499.49 |
| Rate for Payer: Aetna Commercial |
$464.81
|
| Rate for Payer: Aetna Medicare |
$346.87
|
| Rate for Payer: BCBS Complete |
$278.80
|
| Rate for Payer: BCBS MAPPO |
$346.87
|
| Rate for Payer: BCN Medicare Advantage |
$346.87
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cofinity Commercial |
$499.49
|
| Rate for Payer: Cofinity Commercial |
$464.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.87
|
| Rate for Payer: Healthscope Commercial |
$416.24
|
| Rate for Payer: Healthscope Whirlpool |
$416.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.21
|
| Rate for Payer: Nomi Health Commercial |
$416.24
|
| Rate for Payer: PACE SWMI |
$346.87
|
| Rate for Payer: PHP Medicare Advantage |
$346.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.05
|
| Rate for Payer: Priority Health Medicare |
$346.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.87
|
| Rate for Payer: UHC Medicare Advantage |
$346.87
|
| Rate for Payer: UHCCP DNSP |
$346.87
|
|
|
PR REVIS PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 49426
|
| Min. Negotiated Rate |
$652.09 |
| Max. Negotiated Rate |
$1,339.00 |
| Rate for Payer: Aetna Commercial |
$873.80
|
| Rate for Payer: Aetna Medicare |
$652.09
|
| Rate for Payer: BCBS Complete |
$824.00
|
| Rate for Payer: BCBS MAPPO |
$652.09
|
| Rate for Payer: BCN Medicare Advantage |
$652.09
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Cofinity Commercial |
$939.01
|
| Rate for Payer: Cofinity Commercial |
$873.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.09
|
| Rate for Payer: Healthscope Commercial |
$782.51
|
| Rate for Payer: Healthscope Whirlpool |
$782.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.69
|
| Rate for Payer: Nomi Health Commercial |
$782.51
|
| Rate for Payer: PACE SWMI |
$652.09
|
| Rate for Payer: PHP Medicare Advantage |
$652.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.00
|
| Rate for Payer: Priority Health Medicare |
$652.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.09
|
| Rate for Payer: UHC Medicare Advantage |
$652.09
|
| Rate for Payer: UHCCP DNSP |
$652.09
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$4,192.00
|
|
|
Service Code
|
HCPCS 23474
|
| Min. Negotiated Rate |
$1,669.59 |
| Max. Negotiated Rate |
$2,724.80 |
| Rate for Payer: Aetna Commercial |
$2,237.25
|
| Rate for Payer: Aetna Medicare |
$1,669.59
|
| Rate for Payer: BCBS Complete |
$1,676.80
|
| Rate for Payer: BCBS MAPPO |
$1,669.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,669.59
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cofinity Commercial |
$2,404.21
|
| Rate for Payer: Cofinity Commercial |
$2,237.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,669.59
|
| Rate for Payer: Healthscope Commercial |
$2,003.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,003.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,753.07
|
| Rate for Payer: Nomi Health Commercial |
$2,003.51
|
| Rate for Payer: PACE SWMI |
$1,669.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,669.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,724.80
|
| Rate for Payer: Priority Health Medicare |
$1,669.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,669.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.59
|
| Rate for Payer: UHCCP DNSP |
$1,669.59
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 23473
|
| Min. Negotiated Rate |
$1,434.40 |
| Max. Negotiated Rate |
$2,330.90 |
| Rate for Payer: Aetna Commercial |
$2,071.59
|
| Rate for Payer: Aetna Medicare |
$1,545.96
|
| Rate for Payer: BCBS Complete |
$1,434.40
|
| Rate for Payer: BCBS MAPPO |
$1,545.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,545.96
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$2,226.18
|
| Rate for Payer: Cofinity Commercial |
$2,071.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,545.96
|
| Rate for Payer: Healthscope Commercial |
$1,855.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,855.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.26
|
| Rate for Payer: Nomi Health Commercial |
$1,855.15
|
| Rate for Payer: PACE SWMI |
$1,545.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,545.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health Medicare |
$1,545.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,545.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,545.96
|
| Rate for Payer: UHCCP DNSP |
$1,545.96
|
|
|
PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25449
|
| Min. Negotiated Rate |
$833.20 |
| Max. Negotiated Rate |
$1,433.85 |
| Rate for Payer: Aetna Commercial |
$1,334.28
|
| Rate for Payer: Aetna Medicare |
$995.73
|
| Rate for Payer: BCBS Complete |
$833.20
|
| Rate for Payer: BCBS MAPPO |
$995.73
|
| Rate for Payer: BCN Medicare Advantage |
$995.73
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cofinity Commercial |
$1,433.85
|
| Rate for Payer: Cofinity Commercial |
$1,334.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$995.73
|
| Rate for Payer: Healthscope Commercial |
$1,194.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,194.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,045.52
|
| Rate for Payer: Nomi Health Commercial |
$1,194.88
|
| Rate for Payer: PACE SWMI |
$995.73
|
| Rate for Payer: PHP Medicare Advantage |
$995.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.95
|
| Rate for Payer: Priority Health Medicare |
$995.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$995.73
|
| Rate for Payer: UHC Medicare Advantage |
$995.73
|
| Rate for Payer: UHCCP DNSP |
$995.73
|
|
|
PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 44345
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$1,460.16 |
| Rate for Payer: Aetna Commercial |
$1,358.76
|
| Rate for Payer: Aetna Medicare |
$1,014.00
|
| Rate for Payer: BCBS Complete |
$850.00
|
| Rate for Payer: BCBS MAPPO |
$1,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cofinity Commercial |
$1,460.16
|
| Rate for Payer: Cofinity Commercial |
$1,358.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.00
|
| Rate for Payer: Healthscope Commercial |
$1,216.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,216.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,064.70
|
| Rate for Payer: Nomi Health Commercial |
$1,216.80
|
| Rate for Payer: PACE SWMI |
$1,014.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,381.25
|
| Rate for Payer: Priority Health Medicare |
$1,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,014.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.00
|
| Rate for Payer: UHCCP DNSP |
$1,014.00
|
|
|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$869.41 |
| Rate for Payer: Aetna Commercial |
$809.04
|
| Rate for Payer: Aetna Medicare |
$603.76
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$603.76
|
| Rate for Payer: BCN Medicare Advantage |
$603.76
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$869.41
|
| Rate for Payer: Cofinity Commercial |
$809.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.76
|
| Rate for Payer: Healthscope Commercial |
$724.51
|
| Rate for Payer: Healthscope Whirlpool |
$724.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.95
|
| Rate for Payer: Nomi Health Commercial |
$724.51
|
| Rate for Payer: PACE SWMI |
$603.76
|
| Rate for Payer: PHP Medicare Advantage |
$603.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$603.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$603.76
|
| Rate for Payer: UHC Medicare Advantage |
$603.76
|
| Rate for Payer: UHCCP DNSP |
$603.76
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$2,861.00
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$1,142.04 |
| Max. Negotiated Rate |
$1,859.65 |
| Rate for Payer: Aetna Commercial |
$1,530.33
|
| Rate for Payer: Aetna Medicare |
$1,142.04
|
| Rate for Payer: BCBS Complete |
$1,144.40
|
| Rate for Payer: BCBS MAPPO |
$1,142.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.04
|
| Rate for Payer: Cash Price |
$2,288.80
|
| Rate for Payer: Cash Price |
$2,288.80
|
| Rate for Payer: Cofinity Commercial |
$1,644.54
|
| Rate for Payer: Cofinity Commercial |
$1,530.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.04
|
| Rate for Payer: Healthscope Commercial |
$1,370.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.14
|
| Rate for Payer: Nomi Health Commercial |
$1,370.45
|
| Rate for Payer: PACE SWMI |
$1,142.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,859.65
|
| Rate for Payer: Priority Health Medicare |
$1,142.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.04
|
| Rate for Payer: UHCCP DNSP |
$1,142.04
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF
|
Professional
|
Both
|
$2,619.00
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$1,047.60 |
| Max. Negotiated Rate |
$1,719.01 |
| Rate for Payer: Aetna Commercial |
$1,599.64
|
| Rate for Payer: Aetna Medicare |
$1,193.76
|
| Rate for Payer: BCBS Complete |
$1,047.60
|
| Rate for Payer: BCBS MAPPO |
$1,193.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.76
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cofinity Commercial |
$1,719.01
|
| Rate for Payer: Cofinity Commercial |
$1,599.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.76
|
| Rate for Payer: Healthscope Commercial |
$1,432.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.45
|
| Rate for Payer: Nomi Health Commercial |
$1,432.51
|
| Rate for Payer: PACE SWMI |
$1,193.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.35
|
| Rate for Payer: Priority Health Medicare |
$1,193.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.76
|
| Rate for Payer: UHCCP DNSP |
$1,193.76
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$2,362.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$944.80 |
| Max. Negotiated Rate |
$1,650.10 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Aetna Medicare |
$1,145.90
|
| Rate for Payer: BCBS Complete |
$944.80
|
| Rate for Payer: BCBS MAPPO |
$1,145.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,145.90
|
| Rate for Payer: Cash Price |
$1,889.60
|
| Rate for Payer: Cash Price |
$1,889.60
|
| Rate for Payer: Cofinity Commercial |
$1,650.10
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,145.90
|
| Rate for Payer: Healthscope Commercial |
$1,375.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,203.19
|
| Rate for Payer: Nomi Health Commercial |
$1,375.08
|
| Rate for Payer: PACE SWMI |
$1,145.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,145.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.30
|
| Rate for Payer: Priority Health Medicare |
$1,145.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,145.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,145.90
|
| Rate for Payer: UHCCP DNSP |
$1,145.90
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$5,384.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$1,591.27 |
| Max. Negotiated Rate |
$3,499.60 |
| Rate for Payer: Aetna Commercial |
$2,132.30
|
| Rate for Payer: Aetna Medicare |
$1,591.27
|
| Rate for Payer: BCBS Complete |
$2,153.60
|
| Rate for Payer: BCBS MAPPO |
$1,591.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.27
|
| Rate for Payer: Cash Price |
$4,307.20
|
| Rate for Payer: Cash Price |
$4,307.20
|
| Rate for Payer: Cofinity Commercial |
$2,291.43
|
| Rate for Payer: Cofinity Commercial |
$2,132.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.27
|
| Rate for Payer: Healthscope Commercial |
$1,909.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,909.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,670.83
|
| Rate for Payer: Nomi Health Commercial |
$1,909.52
|
| Rate for Payer: PACE SWMI |
$1,591.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,499.60
|
| Rate for Payer: Priority Health Medicare |
$1,591.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,591.27
|
| Rate for Payer: UHCCP DNSP |
$1,591.27
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$964.69 |
| Max. Negotiated Rate |
$1,681.55 |
| Rate for Payer: Aetna Commercial |
$1,292.68
|
| Rate for Payer: Aetna Medicare |
$964.69
|
| Rate for Payer: BCBS Complete |
$1,034.80
|
| Rate for Payer: BCBS MAPPO |
$964.69
|
| Rate for Payer: BCN Medicare Advantage |
$964.69
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cofinity Commercial |
$1,389.15
|
| Rate for Payer: Cofinity Commercial |
$1,292.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.69
|
| Rate for Payer: Healthscope Commercial |
$1,157.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.92
|
| Rate for Payer: Nomi Health Commercial |
$1,157.63
|
| Rate for Payer: PACE SWMI |
$964.69
|
| Rate for Payer: PHP Medicare Advantage |
$964.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health Medicare |
$964.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.69
|
| Rate for Payer: UHC Medicare Advantage |
$964.69
|
| Rate for Payer: UHCCP DNSP |
$964.69
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$495.20 |
| Max. Negotiated Rate |
$828.58 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare |
$575.40
|
| Rate for Payer: BCBS Complete |
$495.20
|
| Rate for Payer: BCBS MAPPO |
$575.40
|
| Rate for Payer: BCN Medicare Advantage |
$575.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$828.58
|
| Rate for Payer: Cofinity Commercial |
$771.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.40
|
| Rate for Payer: Healthscope Commercial |
$690.48
|
| Rate for Payer: Healthscope Whirlpool |
$690.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.17
|
| Rate for Payer: Nomi Health Commercial |
$690.48
|
| Rate for Payer: PACE SWMI |
$575.40
|
| Rate for Payer: PHP Medicare Advantage |
$575.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.70
|
| Rate for Payer: Priority Health Medicare |
$575.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.40
|
| Rate for Payer: UHC Medicare Advantage |
$575.40
|
| Rate for Payer: UHCCP DNSP |
$575.40
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,128.00
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$2,683.20 |
| Rate for Payer: Aetna Commercial |
$1,166.62
|
| Rate for Payer: Aetna Medicare |
$870.61
|
| Rate for Payer: BCBS Complete |
$1,651.20
|
| Rate for Payer: BCBS MAPPO |
$870.61
|
| Rate for Payer: BCN Medicare Advantage |
$870.61
|
| Rate for Payer: Cash Price |
$3,302.40
|
| Rate for Payer: Cash Price |
$3,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,253.68
|
| Rate for Payer: Cofinity Commercial |
$1,166.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.61
|
| Rate for Payer: Healthscope Commercial |
$1,044.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.14
|
| Rate for Payer: Nomi Health Commercial |
$1,044.73
|
| Rate for Payer: PACE SWMI |
$870.61
|
| Rate for Payer: PHP Medicare Advantage |
$870.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,683.20
|
| Rate for Payer: Priority Health Medicare |
$870.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.61
|
| Rate for Payer: UHC Medicare Advantage |
$870.61
|
| Rate for Payer: UHCCP DNSP |
$870.61
|
|
