|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$4,817.00
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$431.97 |
| Max. Negotiated Rate |
$3,131.05 |
| Rate for Payer: Aetna Commercial |
$578.84
|
| Rate for Payer: Aetna Medicare |
$431.97
|
| Rate for Payer: BCBS Complete |
$1,926.80
|
| Rate for Payer: BCBS MAPPO |
$431.97
|
| Rate for Payer: BCN Medicare Advantage |
$431.97
|
| Rate for Payer: Cash Price |
$3,853.60
|
| Rate for Payer: Cash Price |
$3,853.60
|
| Rate for Payer: Cofinity Commercial |
$622.04
|
| Rate for Payer: Cofinity Commercial |
$578.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.97
|
| Rate for Payer: Healthscope Commercial |
$518.36
|
| Rate for Payer: Healthscope Whirlpool |
$518.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$453.57
|
| Rate for Payer: Nomi Health Commercial |
$518.36
|
| Rate for Payer: PACE SWMI |
$431.97
|
| Rate for Payer: PHP Medicare Advantage |
$431.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,131.05
|
| Rate for Payer: Priority Health Medicare |
$431.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.97
|
| Rate for Payer: UHC Medicare Advantage |
$431.97
|
| Rate for Payer: UHCCP DNSP |
$431.97
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$1,273.87 |
| Rate for Payer: Aetna Commercial |
$1,185.40
|
| Rate for Payer: Aetna Medicare |
$884.63
|
| Rate for Payer: BCBS Complete |
$730.00
|
| Rate for Payer: BCBS MAPPO |
$884.63
|
| Rate for Payer: BCN Medicare Advantage |
$884.63
|
| Rate for Payer: Cash Price |
$1,460.00
|
| Rate for Payer: Cash Price |
$1,460.00
|
| Rate for Payer: Cofinity Commercial |
$1,273.87
|
| Rate for Payer: Cofinity Commercial |
$1,185.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.63
|
| Rate for Payer: Healthscope Commercial |
$1,061.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,061.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.86
|
| Rate for Payer: Nomi Health Commercial |
$1,061.56
|
| Rate for Payer: PACE SWMI |
$884.63
|
| Rate for Payer: PHP Medicare Advantage |
$884.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.25
|
| Rate for Payer: Priority Health Medicare |
$884.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.63
|
| Rate for Payer: UHC Medicare Advantage |
$884.63
|
| Rate for Payer: UHCCP DNSP |
$884.63
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$2,119.00
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$1,412.88 |
| Rate for Payer: Aetna Commercial |
$1,314.77
|
| Rate for Payer: Aetna Medicare |
$981.17
|
| Rate for Payer: BCBS Complete |
$847.60
|
| Rate for Payer: BCBS MAPPO |
$981.17
|
| Rate for Payer: BCN Medicare Advantage |
$981.17
|
| Rate for Payer: Cash Price |
$1,695.20
|
| Rate for Payer: Cash Price |
$1,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,412.88
|
| Rate for Payer: Cofinity Commercial |
$1,314.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.17
|
| Rate for Payer: Healthscope Commercial |
$1,177.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.23
|
| Rate for Payer: Nomi Health Commercial |
$1,177.40
|
| Rate for Payer: PACE SWMI |
$981.17
|
| Rate for Payer: PHP Medicare Advantage |
$981.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,377.35
|
| Rate for Payer: Priority Health Medicare |
$981.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.17
|
| Rate for Payer: UHC Medicare Advantage |
$981.17
|
| Rate for Payer: UHCCP DNSP |
$981.17
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,374.62 |
| Rate for Payer: Aetna Commercial |
$1,279.16
|
| Rate for Payer: Aetna Medicare |
$954.60
|
| Rate for Payer: BCBS Complete |
$834.80
|
| Rate for Payer: BCBS MAPPO |
$954.60
|
| Rate for Payer: BCN Medicare Advantage |
$954.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,374.62
|
| Rate for Payer: Cofinity Commercial |
$1,279.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$954.60
|
| Rate for Payer: Healthscope Commercial |
$1,145.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,002.33
|
| Rate for Payer: Nomi Health Commercial |
$1,145.52
|
| Rate for Payer: PACE SWMI |
$954.60
|
| Rate for Payer: PHP Medicare Advantage |
$954.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health Medicare |
$954.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$954.60
|
| Rate for Payer: UHC Medicare Advantage |
$954.60
|
| Rate for Payer: UHCCP DNSP |
$954.60
|
|
|
PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
HCPCS 69604
|
| Min. Negotiated Rate |
$895.60 |
| Max. Negotiated Rate |
$1,497.47 |
| Rate for Payer: Aetna Commercial |
$1,393.48
|
| Rate for Payer: Aetna Medicare |
$1,039.91
|
| Rate for Payer: BCBS Complete |
$895.60
|
| Rate for Payer: BCBS MAPPO |
$1,039.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,039.91
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cofinity Commercial |
$1,497.47
|
| Rate for Payer: Cofinity Commercial |
$1,393.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,039.91
|
| Rate for Payer: Healthscope Commercial |
$1,247.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,247.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,091.91
|
| Rate for Payer: Nomi Health Commercial |
$1,247.89
|
| Rate for Payer: PACE SWMI |
$1,039.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,039.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.35
|
| Rate for Payer: Priority Health Medicare |
$1,039.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,039.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,039.91
|
| Rate for Payer: UHCCP DNSP |
$1,039.91
|
|
|
PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 36832
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$1,040.26 |
| Rate for Payer: Aetna Commercial |
$968.02
|
| Rate for Payer: Aetna Medicare |
$722.40
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: BCBS MAPPO |
$722.40
|
| Rate for Payer: BCN Medicare Advantage |
$722.40
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Commercial |
$968.02
|
| Rate for Payer: Cofinity Commercial |
$1,040.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.40
|
| Rate for Payer: Healthscope Commercial |
$866.88
|
| Rate for Payer: Healthscope Whirlpool |
$866.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.52
|
| Rate for Payer: Nomi Health Commercial |
$866.88
|
| Rate for Payer: PACE SWMI |
$722.40
|
| Rate for Payer: PHP Medicare Advantage |
$722.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
| Rate for Payer: Priority Health Medicare |
$722.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.40
|
| Rate for Payer: UHC Medicare Advantage |
$722.40
|
| Rate for Payer: UHCCP DNSP |
$722.40
|
|
|
PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 36833
|
| Min. Negotiated Rate |
$771.31 |
| Max. Negotiated Rate |
$1,516.45 |
| Rate for Payer: Aetna Commercial |
$1,033.56
|
| Rate for Payer: Aetna Medicare |
$771.31
|
| Rate for Payer: BCBS Complete |
$933.20
|
| Rate for Payer: BCBS MAPPO |
$771.31
|
| Rate for Payer: BCN Medicare Advantage |
$771.31
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,110.69
|
| Rate for Payer: Cofinity Commercial |
$1,033.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.31
|
| Rate for Payer: Healthscope Commercial |
$925.57
|
| Rate for Payer: Healthscope Whirlpool |
$925.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.88
|
| Rate for Payer: Nomi Health Commercial |
$925.57
|
| Rate for Payer: PACE SWMI |
$771.31
|
| Rate for Payer: PHP Medicare Advantage |
$771.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: Priority Health Medicare |
$771.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.31
|
| Rate for Payer: UHC Medicare Advantage |
$771.31
|
| Rate for Payer: UHCCP DNSP |
$771.31
|
|
|
PR REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
HCPCS 63688
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$1,182.35 |
| Rate for Payer: Aetna Commercial |
$387.23
|
| Rate for Payer: Aetna Medicare |
$288.98
|
| Rate for Payer: BCBS Complete |
$727.60
|
| Rate for Payer: BCBS MAPPO |
$288.98
|
| Rate for Payer: BCN Medicare Advantage |
$288.98
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cash Price |
$1,455.20
|
| Rate for Payer: Cofinity Commercial |
$416.13
|
| Rate for Payer: Cofinity Commercial |
$387.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.98
|
| Rate for Payer: Healthscope Commercial |
$346.78
|
| Rate for Payer: Healthscope Whirlpool |
$346.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.43
|
| Rate for Payer: Nomi Health Commercial |
$346.78
|
| Rate for Payer: PACE SWMI |
$288.98
|
| Rate for Payer: PHP Medicare Advantage |
$288.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.35
|
| Rate for Payer: Priority Health Medicare |
$288.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.98
|
| Rate for Payer: UHC Medicare Advantage |
$288.98
|
| Rate for Payer: UHCCP DNSP |
$288.98
|
|
|
PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS
|
Professional
|
Both
|
$3,184.00
|
|
|
Service Code
|
HCPCS 61880
|
| Min. Negotiated Rate |
$579.59 |
| Max. Negotiated Rate |
$2,069.60 |
| Rate for Payer: Aetna Commercial |
$776.65
|
| Rate for Payer: Aetna Medicare |
$579.59
|
| Rate for Payer: BCBS Complete |
$1,273.60
|
| Rate for Payer: BCBS MAPPO |
$579.59
|
| Rate for Payer: BCN Medicare Advantage |
$579.59
|
| Rate for Payer: Cash Price |
$2,547.20
|
| Rate for Payer: Cash Price |
$2,547.20
|
| Rate for Payer: Cofinity Commercial |
$834.61
|
| Rate for Payer: Cofinity Commercial |
$776.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.59
|
| Rate for Payer: Healthscope Commercial |
$695.51
|
| Rate for Payer: Healthscope Whirlpool |
$695.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$608.57
|
| Rate for Payer: Nomi Health Commercial |
$695.51
|
| Rate for Payer: PACE SWMI |
$579.59
|
| Rate for Payer: PHP Medicare Advantage |
$579.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,069.60
|
| Rate for Payer: Priority Health Medicare |
$579.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$579.59
|
| Rate for Payer: UHC Medicare Advantage |
$579.59
|
| Rate for Payer: UHCCP DNSP |
$579.59
|
|
|
PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
HCPCS 61888
|
| Min. Negotiated Rate |
$392.23 |
| Max. Negotiated Rate |
$681.20 |
| Rate for Payer: Aetna Commercial |
$525.59
|
| Rate for Payer: Aetna Medicare |
$392.23
|
| Rate for Payer: BCBS Complete |
$419.20
|
| Rate for Payer: BCBS MAPPO |
$392.23
|
| Rate for Payer: BCN Medicare Advantage |
$392.23
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cash Price |
$838.40
|
| Rate for Payer: Cofinity Commercial |
$564.81
|
| Rate for Payer: Cofinity Commercial |
$525.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.23
|
| Rate for Payer: Healthscope Commercial |
$470.68
|
| Rate for Payer: Healthscope Whirlpool |
$470.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.84
|
| Rate for Payer: Nomi Health Commercial |
$470.68
|
| Rate for Payer: PACE SWMI |
$392.23
|
| Rate for Payer: PHP Medicare Advantage |
$392.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.20
|
| Rate for Payer: Priority Health Medicare |
$392.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.23
|
| Rate for Payer: UHC Medicare Advantage |
$392.23
|
| Rate for Payer: UHCCP DNSP |
$392.23
|
|
|
PR REVJ/RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 64585
|
| Min. Negotiated Rate |
$136.72 |
| Max. Negotiated Rate |
$869.70 |
| Rate for Payer: Aetna Commercial |
$183.20
|
| Rate for Payer: Aetna Medicare |
$136.72
|
| Rate for Payer: BCBS Complete |
$535.20
|
| Rate for Payer: BCBS MAPPO |
$136.72
|
| Rate for Payer: BCN Medicare Advantage |
$136.72
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$183.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.72
|
| Rate for Payer: Healthscope Commercial |
$164.06
|
| Rate for Payer: Healthscope Whirlpool |
$164.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.56
|
| Rate for Payer: Nomi Health Commercial |
$164.06
|
| Rate for Payer: PACE SWMI |
$136.72
|
| Rate for Payer: PHP Medicare Advantage |
$136.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.70
|
| Rate for Payer: Priority Health Medicare |
$136.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.72
|
| Rate for Payer: UHC Medicare Advantage |
$136.72
|
| Rate for Payer: UHCCP DNSP |
$136.72
|
|
|
PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 57295
|
| Min. Negotiated Rate |
$478.91 |
| Max. Negotiated Rate |
$923.00 |
| Rate for Payer: Aetna Commercial |
$641.74
|
| Rate for Payer: Aetna Medicare |
$478.91
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$478.91
|
| Rate for Payer: BCN Medicare Advantage |
$478.91
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$689.63
|
| Rate for Payer: Cofinity Commercial |
$641.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.91
|
| Rate for Payer: Healthscope Commercial |
$574.69
|
| Rate for Payer: Healthscope Whirlpool |
$574.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.86
|
| Rate for Payer: Nomi Health Commercial |
$574.69
|
| Rate for Payer: PACE SWMI |
$478.91
|
| Rate for Payer: PHP Medicare Advantage |
$478.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$478.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.91
|
| Rate for Payer: UHC Medicare Advantage |
$478.91
|
| Rate for Payer: UHCCP DNSP |
$478.91
|
|
|
PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 64583
|
| Min. Negotiated Rate |
$701.60 |
| Max. Negotiated Rate |
$1,191.25 |
| Rate for Payer: Aetna Commercial |
$1,108.53
|
| Rate for Payer: Aetna Medicare |
$827.26
|
| Rate for Payer: BCBS Complete |
$701.60
|
| Rate for Payer: BCBS MAPPO |
$827.26
|
| Rate for Payer: BCN Medicare Advantage |
$827.26
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cofinity Commercial |
$1,191.25
|
| Rate for Payer: Cofinity Commercial |
$1,108.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.26
|
| Rate for Payer: Healthscope Commercial |
$992.71
|
| Rate for Payer: Healthscope Whirlpool |
$992.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.62
|
| Rate for Payer: Nomi Health Commercial |
$992.71
|
| Rate for Payer: PACE SWMI |
$827.26
|
| Rate for Payer: PHP Medicare Advantage |
$827.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.10
|
| Rate for Payer: Priority Health Medicare |
$827.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.26
|
| Rate for Payer: UHC Medicare Advantage |
$827.26
|
| Rate for Payer: UHCCP DNSP |
$827.26
|
|
|
PR REVJ/RPLMNT CH WAL RESPIR ELTRD & CONJ PULSE GEN
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 0467T
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
|
|
PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$4,568.00
|
|
|
Service Code
|
HCPCS 27486
|
| Min. Negotiated Rate |
$1,352.57 |
| Max. Negotiated Rate |
$2,969.20 |
| Rate for Payer: Aetna Commercial |
$1,812.44
|
| Rate for Payer: Aetna Medicare |
$1,352.57
|
| Rate for Payer: BCBS Complete |
$1,827.20
|
| Rate for Payer: BCBS MAPPO |
$1,352.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,352.57
|
| Rate for Payer: Cash Price |
$3,654.40
|
| Rate for Payer: Cash Price |
$3,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,947.70
|
| Rate for Payer: Cofinity Commercial |
$1,812.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,352.57
|
| Rate for Payer: Healthscope Commercial |
$1,623.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,623.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.20
|
| Rate for Payer: Nomi Health Commercial |
$1,623.08
|
| Rate for Payer: PACE SWMI |
$1,352.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,352.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,969.20
|
| Rate for Payer: Priority Health Medicare |
$1,352.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,352.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,352.57
|
| Rate for Payer: UHCCP DNSP |
$1,352.57
|
|
|
PR REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,038.00
|
|
|
Service Code
|
HCPCS 27137
|
| Min. Negotiated Rate |
$1,215.20 |
| Max. Negotiated Rate |
$2,032.10 |
| Rate for Payer: Aetna Commercial |
$1,890.98
|
| Rate for Payer: Aetna Medicare |
$1,411.18
|
| Rate for Payer: BCBS Complete |
$1,215.20
|
| Rate for Payer: BCBS MAPPO |
$1,411.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.18
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,032.10
|
| Rate for Payer: Cofinity Commercial |
$1,890.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.18
|
| Rate for Payer: Healthscope Commercial |
$1,693.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,693.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,481.74
|
| Rate for Payer: Nomi Health Commercial |
$1,693.42
|
| Rate for Payer: PACE SWMI |
$1,411.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.70
|
| Rate for Payer: Priority Health Medicare |
$1,411.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.18
|
| Rate for Payer: UHCCP DNSP |
$1,411.18
|
|
|
PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$3,958.00
|
|
|
Service Code
|
HCPCS 27134
|
| Min. Negotiated Rate |
$1,583.20 |
| Max. Negotiated Rate |
$2,639.04 |
| Rate for Payer: Aetna Commercial |
$2,455.78
|
| Rate for Payer: Aetna Medicare |
$1,832.67
|
| Rate for Payer: BCBS Complete |
$1,583.20
|
| Rate for Payer: BCBS MAPPO |
$1,832.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,832.67
|
| Rate for Payer: Cash Price |
$3,166.40
|
| Rate for Payer: Cash Price |
$3,166.40
|
| Rate for Payer: Cofinity Commercial |
$2,639.04
|
| Rate for Payer: Cofinity Commercial |
$2,455.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,832.67
|
| Rate for Payer: Healthscope Commercial |
$2,199.20
|
| Rate for Payer: Healthscope Whirlpool |
$2,199.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,924.30
|
| Rate for Payer: Nomi Health Commercial |
$2,199.20
|
| Rate for Payer: PACE SWMI |
$1,832.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,832.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,572.70
|
| Rate for Payer: Priority Health Medicare |
$1,832.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,832.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,832.67
|
| Rate for Payer: UHCCP DNSP |
$1,832.67
|
|
|
PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$3,157.00
|
|
|
Service Code
|
HCPCS 27138
|
| Min. Negotiated Rate |
$1,262.80 |
| Max. Negotiated Rate |
$2,111.26 |
| Rate for Payer: Aetna Commercial |
$1,964.64
|
| Rate for Payer: Aetna Medicare |
$1,466.15
|
| Rate for Payer: BCBS Complete |
$1,262.80
|
| Rate for Payer: BCBS MAPPO |
$1,466.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.15
|
| Rate for Payer: Cash Price |
$2,525.60
|
| Rate for Payer: Cash Price |
$2,525.60
|
| Rate for Payer: Cofinity Commercial |
$2,111.26
|
| Rate for Payer: Cofinity Commercial |
$1,964.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.15
|
| Rate for Payer: Healthscope Commercial |
$1,759.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,759.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.46
|
| Rate for Payer: Nomi Health Commercial |
$1,759.38
|
| Rate for Payer: PACE SWMI |
$1,466.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,052.05
|
| Rate for Payer: Priority Health Medicare |
$1,466.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.15
|
| Rate for Payer: UHCCP DNSP |
$1,466.15
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
OP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$2,401.20 |
| Max. Negotiated Rate |
$6,003.00 |
| Rate for Payer: Aetna Commercial |
$5,402.70
|
| Rate for Payer: Aetna Medicare |
$3,001.50
|
| Rate for Payer: ASR ASR |
$5,822.91
|
| Rate for Payer: ASR Commercial |
$5,822.91
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,915.86
|
| Rate for Payer: BCN Commercial |
$4,654.13
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$5,642.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$6,003.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,822.91
|
| Rate for Payer: Mclaren Commercial |
$5,402.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: Nomi Health Commercial |
$4,922.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,259.83
|
| Rate for Payer: Priority Health Narrow Network |
$4,208.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,282.64
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Min. Negotiated Rate |
$1,686.61 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,686.61
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Healthscope Commercial |
$2,023.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,023.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health Medicare |
$1,686.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
| Rate for Payer: UHCCP DNSP |
$1,686.61
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
IP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$3,901.95 |
| Max. Negotiated Rate |
$6,003.00 |
| Rate for Payer: Aetna Commercial |
$5,402.70
|
| Rate for Payer: ASR ASR |
$5,822.91
|
| Rate for Payer: ASR Commercial |
$5,822.91
|
| Rate for Payer: BCBS Trust/PPO |
$4,891.84
|
| Rate for Payer: BCN Commercial |
$4,654.13
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$5,642.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$6,003.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,822.91
|
| Rate for Payer: Mclaren Commercial |
$5,402.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: Nomi Health Commercial |
$4,922.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,282.64
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,686.61 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,686.61
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Healthscope Commercial |
$2,023.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,023.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health Medicare |
$1,686.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
| Rate for Payer: UHCCP DNSP |
$1,686.61
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$963.78 |
| Rate for Payer: Aetna Commercial |
$896.85
|
| Rate for Payer: Aetna Medicare |
$669.29
|
| Rate for Payer: BCBS Complete |
$574.00
|
| Rate for Payer: BCBS MAPPO |
$669.29
|
| Rate for Payer: BCN Medicare Advantage |
$669.29
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cofinity Commercial |
$963.78
|
| Rate for Payer: Cofinity Commercial |
$896.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.29
|
| Rate for Payer: Healthscope Commercial |
$803.15
|
| Rate for Payer: Healthscope Whirlpool |
$803.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.75
|
| Rate for Payer: Nomi Health Commercial |
$803.15
|
| Rate for Payer: PACE SWMI |
$669.29
|
| Rate for Payer: PHP Medicare Advantage |
$669.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.75
|
| Rate for Payer: Priority Health Medicare |
$669.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$669.29
|
| Rate for Payer: UHC Medicare Advantage |
$669.29
|
| Rate for Payer: UHCCP DNSP |
$669.29
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$487.42 |
| Max. Negotiated Rate |
$842.40 |
| Rate for Payer: Aetna Commercial |
$653.14
|
| Rate for Payer: Aetna Medicare |
$487.42
|
| Rate for Payer: BCBS Complete |
$518.40
|
| Rate for Payer: BCBS MAPPO |
$487.42
|
| Rate for Payer: BCN Medicare Advantage |
$487.42
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$701.88
|
| Rate for Payer: Cofinity Commercial |
$653.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.42
|
| Rate for Payer: Healthscope Commercial |
$584.90
|
| Rate for Payer: Healthscope Whirlpool |
$584.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.79
|
| Rate for Payer: Nomi Health Commercial |
$584.90
|
| Rate for Payer: PACE SWMI |
$487.42
|
| Rate for Payer: PHP Medicare Advantage |
$487.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.40
|
| Rate for Payer: Priority Health Medicare |
$487.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.42
|
| Rate for Payer: UHC Medicare Advantage |
$487.42
|
| Rate for Payer: UHCCP DNSP |
$487.42
|
|
|
PR REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$452.40 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Aetna Medicare |
$220.08
|
| Rate for Payer: BCBS Complete |
$278.40
|
| Rate for Payer: BCBS MAPPO |
$220.08
|
| Rate for Payer: BCN Medicare Advantage |
$220.08
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cofinity Commercial |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$294.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.08
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Healthscope Whirlpool |
$264.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.08
|
| Rate for Payer: Nomi Health Commercial |
$264.10
|
| Rate for Payer: PACE SWMI |
$220.08
|
| Rate for Payer: PHP Medicare Advantage |
$220.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health Medicare |
$220.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.08
|
| Rate for Payer: UHC Medicare Advantage |
$220.08
|
| Rate for Payer: UHCCP DNSP |
$220.08
|
|
