|
PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 36576
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$553.80 |
| Rate for Payer: Aetna Commercial |
$232.58
|
| Rate for Payer: Aetna Medicare |
$173.57
|
| Rate for Payer: BCBS Complete |
$340.80
|
| Rate for Payer: BCBS MAPPO |
$173.57
|
| Rate for Payer: BCN Medicare Advantage |
$173.57
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$249.94
|
| Rate for Payer: Cofinity Commercial |
$232.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.57
|
| Rate for Payer: Healthscope Commercial |
$208.28
|
| Rate for Payer: Healthscope Whirlpool |
$208.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.25
|
| Rate for Payer: Nomi Health Commercial |
$208.28
|
| Rate for Payer: PACE SWMI |
$173.57
|
| Rate for Payer: PHP Medicare Advantage |
$173.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.80
|
| Rate for Payer: Priority Health Medicare |
$173.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.57
|
| Rate for Payer: UHC Medicare Advantage |
$173.57
|
| Rate for Payer: UHCCP DNSP |
$173.57
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT
|
Professional
|
Both
|
$5,993.00
|
|
|
Service Code
|
HCPCS 39540
|
| Min. Negotiated Rate |
$835.58 |
| Max. Negotiated Rate |
$3,895.45 |
| Rate for Payer: Aetna Commercial |
$1,119.68
|
| Rate for Payer: Aetna Medicare |
$835.58
|
| Rate for Payer: BCBS Complete |
$2,397.20
|
| Rate for Payer: BCBS MAPPO |
$835.58
|
| Rate for Payer: BCN Medicare Advantage |
$835.58
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cofinity Commercial |
$1,203.24
|
| Rate for Payer: Cofinity Commercial |
$1,119.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.58
|
| Rate for Payer: Healthscope Commercial |
$1,002.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,002.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.36
|
| Rate for Payer: Nomi Health Commercial |
$1,002.70
|
| Rate for Payer: PACE SWMI |
$835.58
|
| Rate for Payer: PHP Medicare Advantage |
$835.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,895.45
|
| Rate for Payer: Priority Health Medicare |
$835.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.58
|
| Rate for Payer: UHC Medicare Advantage |
$835.58
|
| Rate for Payer: UHCCP DNSP |
$835.58
|
|
|
PR RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 39541
|
| Min. Negotiated Rate |
$684.80 |
| Max. Negotiated Rate |
$1,306.90 |
| Rate for Payer: Aetna Commercial |
$1,216.14
|
| Rate for Payer: Aetna Medicare |
$907.57
|
| Rate for Payer: BCBS Complete |
$684.80
|
| Rate for Payer: BCBS MAPPO |
$907.57
|
| Rate for Payer: BCN Medicare Advantage |
$907.57
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$1,306.90
|
| Rate for Payer: Cofinity Commercial |
$1,216.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.57
|
| Rate for Payer: Healthscope Commercial |
$1,089.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$952.95
|
| Rate for Payer: Nomi Health Commercial |
$1,089.08
|
| Rate for Payer: PACE SWMI |
$907.57
|
| Rate for Payer: PHP Medicare Advantage |
$907.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health Medicare |
$907.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$907.57
|
| Rate for Payer: UHC Medicare Advantage |
$907.57
|
| Rate for Payer: UHCCP DNSP |
$907.57
|
|
|
PR RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 27675
|
| Min. Negotiated Rate |
$477.80 |
| Max. Negotiated Rate |
$845.65 |
| Rate for Payer: Aetna Commercial |
$640.25
|
| Rate for Payer: Aetna Medicare |
$477.80
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$477.80
|
| Rate for Payer: BCN Medicare Advantage |
$477.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$688.03
|
| Rate for Payer: Cofinity Commercial |
$640.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.80
|
| Rate for Payer: Healthscope Commercial |
$573.36
|
| Rate for Payer: Healthscope Whirlpool |
$573.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.69
|
| Rate for Payer: Nomi Health Commercial |
$573.36
|
| Rate for Payer: PACE SWMI |
$477.80
|
| Rate for Payer: PHP Medicare Advantage |
$477.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$477.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.80
|
| Rate for Payer: UHC Medicare Advantage |
$477.80
|
| Rate for Payer: UHCCP DNSP |
$477.80
|
|
|
PR RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 63707
|
| Min. Negotiated Rate |
$771.20 |
| Max. Negotiated Rate |
$1,336.94 |
| Rate for Payer: Aetna Commercial |
$1,244.10
|
| Rate for Payer: Aetna Medicare |
$928.43
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$928.43
|
| Rate for Payer: BCN Medicare Advantage |
$928.43
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,336.94
|
| Rate for Payer: Cofinity Commercial |
$1,244.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.43
|
| Rate for Payer: Healthscope Commercial |
$1,114.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.85
|
| Rate for Payer: Nomi Health Commercial |
$1,114.12
|
| Rate for Payer: PACE SWMI |
$928.43
|
| Rate for Payer: PHP Medicare Advantage |
$928.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health Medicare |
$928.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.43
|
| Rate for Payer: UHC Medicare Advantage |
$928.43
|
| Rate for Payer: UHCCP DNSP |
$928.43
|
|
|
PR RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM
|
Professional
|
Both
|
$6,028.00
|
|
|
Service Code
|
HCPCS 63709
|
| Min. Negotiated Rate |
$1,092.82 |
| Max. Negotiated Rate |
$3,918.20 |
| Rate for Payer: Aetna Commercial |
$1,464.38
|
| Rate for Payer: Aetna Medicare |
$1,092.82
|
| Rate for Payer: BCBS Complete |
$2,411.20
|
| Rate for Payer: BCBS MAPPO |
$1,092.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,092.82
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,573.66
|
| Rate for Payer: Cofinity Commercial |
$1,464.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,092.82
|
| Rate for Payer: Healthscope Commercial |
$1,311.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,311.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,147.46
|
| Rate for Payer: Nomi Health Commercial |
$1,311.38
|
| Rate for Payer: PACE SWMI |
$1,092.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,092.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.20
|
| Rate for Payer: Priority Health Medicare |
$1,092.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,092.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,092.82
|
| Rate for Payer: UHCCP DNSP |
$1,092.82
|
|
|
PR RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY
|
Professional
|
Both
|
$5,844.00
|
|
|
Service Code
|
HCPCS 62120
|
| Min. Negotiated Rate |
$2,018.41 |
| Max. Negotiated Rate |
$3,798.60 |
| Rate for Payer: Aetna Commercial |
$2,704.67
|
| Rate for Payer: Aetna Medicare |
$2,018.41
|
| Rate for Payer: BCBS Complete |
$2,337.60
|
| Rate for Payer: BCBS MAPPO |
$2,018.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,018.41
|
| Rate for Payer: Cash Price |
$4,675.20
|
| Rate for Payer: Cash Price |
$4,675.20
|
| Rate for Payer: Cofinity Commercial |
$2,906.51
|
| Rate for Payer: Cofinity Commercial |
$2,704.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,018.41
|
| Rate for Payer: Healthscope Commercial |
$2,422.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,422.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,119.33
|
| Rate for Payer: Nomi Health Commercial |
$2,422.09
|
| Rate for Payer: PACE SWMI |
$2,018.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,018.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,798.60
|
| Rate for Payer: Priority Health Medicare |
$2,018.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,018.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,018.41
|
| Rate for Payer: UHCCP DNSP |
$2,018.41
|
|
|
PR RPR EPIGASTRIC HERNIA INCARCERATED
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 49572
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$967.20 |
| Rate for Payer: Aetna Medicare |
$744.00
|
| Rate for Payer: BCBS Complete |
$595.20
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.20
|
|
|
PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX
|
Professional
|
Both
|
$1,171.00
|
|
|
Service Code
|
HCPCS 49570
|
| Min. Negotiated Rate |
$468.40 |
| Max. Negotiated Rate |
$761.15 |
| Rate for Payer: Aetna Medicare |
$585.50
|
| Rate for Payer: BCBS Complete |
$468.40
|
| Rate for Payer: Cash Price |
$936.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.15
|
|
|
PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 27664
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$493.34 |
| Rate for Payer: Aetna Commercial |
$459.08
|
| Rate for Payer: Aetna Medicare |
$342.60
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS MAPPO |
$342.60
|
| Rate for Payer: BCN Medicare Advantage |
$342.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$493.34
|
| Rate for Payer: Cofinity Commercial |
$459.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.60
|
| Rate for Payer: Healthscope Commercial |
$411.12
|
| Rate for Payer: Healthscope Whirlpool |
$411.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.73
|
| Rate for Payer: Nomi Health Commercial |
$411.12
|
| Rate for Payer: PACE SWMI |
$342.60
|
| Rate for Payer: PHP Medicare Advantage |
$342.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health Medicare |
$342.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.60
|
| Rate for Payer: UHC Medicare Advantage |
$342.60
|
| Rate for Payer: UHCCP DNSP |
$342.60
|
|
|
PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 27665
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$575.77 |
| Rate for Payer: Aetna Commercial |
$535.79
|
| Rate for Payer: Aetna Medicare |
$399.84
|
| Rate for Payer: BCBS Complete |
$343.60
|
| Rate for Payer: BCBS MAPPO |
$399.84
|
| Rate for Payer: BCN Medicare Advantage |
$399.84
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$575.77
|
| Rate for Payer: Cofinity Commercial |
$535.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.84
|
| Rate for Payer: Healthscope Commercial |
$479.81
|
| Rate for Payer: Healthscope Whirlpool |
$479.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$419.83
|
| Rate for Payer: Nomi Health Commercial |
$479.81
|
| Rate for Payer: PACE SWMI |
$399.84
|
| Rate for Payer: PHP Medicare Advantage |
$399.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.35
|
| Rate for Payer: Priority Health Medicare |
$399.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.84
|
| Rate for Payer: UHC Medicare Advantage |
$399.84
|
| Rate for Payer: UHCCP DNSP |
$399.84
|
|
|
PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 27659
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$707.20 |
| Rate for Payer: Aetna Commercial |
$608.25
|
| Rate for Payer: Aetna Medicare |
$453.92
|
| Rate for Payer: BCBS Complete |
$435.20
|
| Rate for Payer: BCBS MAPPO |
$453.92
|
| Rate for Payer: BCN Medicare Advantage |
$453.92
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$653.64
|
| Rate for Payer: Cofinity Commercial |
$608.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.92
|
| Rate for Payer: Healthscope Commercial |
$544.70
|
| Rate for Payer: Healthscope Whirlpool |
$544.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$476.62
|
| Rate for Payer: Nomi Health Commercial |
$544.70
|
| Rate for Payer: PACE SWMI |
$453.92
|
| Rate for Payer: PHP Medicare Advantage |
$453.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.20
|
| Rate for Payer: Priority Health Medicare |
$453.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.92
|
| Rate for Payer: UHC Medicare Advantage |
$453.92
|
| Rate for Payer: UHCCP DNSP |
$453.92
|
|
|
PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$5,557.00
|
|
|
Service Code
|
HCPCS 46740
|
| Min. Negotiated Rate |
$2,105.37 |
| Max. Negotiated Rate |
$3,612.05 |
| Rate for Payer: Aetna Commercial |
$2,821.20
|
| Rate for Payer: Aetna Medicare |
$2,105.37
|
| Rate for Payer: BCBS Complete |
$2,222.80
|
| Rate for Payer: BCBS MAPPO |
$2,105.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,105.37
|
| Rate for Payer: Cash Price |
$4,445.60
|
| Rate for Payer: Cash Price |
$4,445.60
|
| Rate for Payer: Cofinity Commercial |
$3,031.73
|
| Rate for Payer: Cofinity Commercial |
$2,821.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,105.37
|
| Rate for Payer: Healthscope Commercial |
$2,526.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,526.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,210.64
|
| Rate for Payer: Nomi Health Commercial |
$2,526.44
|
| Rate for Payer: PACE SWMI |
$2,105.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,105.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,612.05
|
| Rate for Payer: Priority Health Medicare |
$2,105.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,105.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,105.37
|
| Rate for Payer: UHCCP DNSP |
$2,105.37
|
|
|
PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL
|
Professional
|
Both
|
$5,147.00
|
|
|
Service Code
|
HCPCS 46742
|
| Min. Negotiated Rate |
$2,058.80 |
| Max. Negotiated Rate |
$3,502.37 |
| Rate for Payer: Aetna Commercial |
$3,259.15
|
| Rate for Payer: Aetna Medicare |
$2,432.20
|
| Rate for Payer: BCBS Complete |
$2,058.80
|
| Rate for Payer: BCBS MAPPO |
$2,432.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,432.20
|
| Rate for Payer: Cash Price |
$4,117.60
|
| Rate for Payer: Cash Price |
$4,117.60
|
| Rate for Payer: Cofinity Commercial |
$3,502.37
|
| Rate for Payer: Cofinity Commercial |
$3,259.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,432.20
|
| Rate for Payer: Healthscope Commercial |
$2,918.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,918.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,553.81
|
| Rate for Payer: Nomi Health Commercial |
$2,918.64
|
| Rate for Payer: PACE SWMI |
$2,432.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,432.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,345.55
|
| Rate for Payer: Priority Health Medicare |
$2,432.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,432.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,432.20
|
| Rate for Payer: UHCCP DNSP |
$2,432.20
|
|
|
PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR
|
Professional
|
Both
|
$3,879.00
|
|
|
Service Code
|
HCPCS 46730
|
| Min. Negotiated Rate |
$1,551.60 |
| Max. Negotiated Rate |
$2,777.59 |
| Rate for Payer: Aetna Commercial |
$2,584.70
|
| Rate for Payer: Aetna Medicare |
$1,928.88
|
| Rate for Payer: BCBS Complete |
$1,551.60
|
| Rate for Payer: BCBS MAPPO |
$1,928.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,928.88
|
| Rate for Payer: Cash Price |
$3,103.20
|
| Rate for Payer: Cash Price |
$3,103.20
|
| Rate for Payer: Cofinity Commercial |
$2,777.59
|
| Rate for Payer: Cofinity Commercial |
$2,584.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,928.88
|
| Rate for Payer: Healthscope Commercial |
$2,314.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,314.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,025.32
|
| Rate for Payer: Nomi Health Commercial |
$2,314.66
|
| Rate for Payer: PACE SWMI |
$1,928.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,928.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.35
|
| Rate for Payer: Priority Health Medicare |
$1,928.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,928.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,928.88
|
| Rate for Payer: UHCCP DNSP |
$1,928.88
|
|
|
PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 54340
|
| Min. Negotiated Rate |
$544.04 |
| Max. Negotiated Rate |
$1,290.25 |
| Rate for Payer: Aetna Commercial |
$729.01
|
| Rate for Payer: Aetna Medicare |
$544.04
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$544.04
|
| Rate for Payer: BCN Medicare Advantage |
$544.04
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$783.42
|
| Rate for Payer: Cofinity Commercial |
$729.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.04
|
| Rate for Payer: Healthscope Commercial |
$652.85
|
| Rate for Payer: Healthscope Whirlpool |
$652.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.24
|
| Rate for Payer: Nomi Health Commercial |
$652.85
|
| Rate for Payer: PACE SWMI |
$544.04
|
| Rate for Payer: PHP Medicare Advantage |
$544.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$544.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$544.04
|
| Rate for Payer: UHC Medicare Advantage |
$544.04
|
| Rate for Payer: UHCCP DNSP |
$544.04
|
|
|
PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR
|
Professional
|
Both
|
$7,548.00
|
|
|
Service Code
|
HCPCS 33660
|
| Min. Negotiated Rate |
$1,685.84 |
| Max. Negotiated Rate |
$4,906.20 |
| Rate for Payer: Aetna Commercial |
$2,259.03
|
| Rate for Payer: Aetna Medicare |
$1,685.84
|
| Rate for Payer: BCBS Complete |
$3,019.20
|
| Rate for Payer: BCBS MAPPO |
$1,685.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,685.84
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cash Price |
$6,038.40
|
| Rate for Payer: Cofinity Commercial |
$2,427.61
|
| Rate for Payer: Cofinity Commercial |
$2,259.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,685.84
|
| Rate for Payer: Healthscope Commercial |
$2,023.01
|
| Rate for Payer: Healthscope Whirlpool |
$2,023.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.13
|
| Rate for Payer: Nomi Health Commercial |
$2,023.01
|
| Rate for Payer: PACE SWMI |
$1,685.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,685.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,906.20
|
| Rate for Payer: Priority Health Medicare |
$1,685.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,685.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,685.84
|
| Rate for Payer: UHCCP DNSP |
$1,685.84
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
IP
|
$1,636.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,063.40 |
| Max. Negotiated Rate |
$1,636.00 |
| Rate for Payer: Aetna Commercial |
$1,472.40
|
| Rate for Payer: ASR ASR |
$1,586.92
|
| Rate for Payer: ASR Commercial |
$1,586.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,333.18
|
| Rate for Payer: BCN Commercial |
$1,268.39
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$1,537.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,308.80
|
| Rate for Payer: Healthscope Commercial |
$1,636.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,586.92
|
| Rate for Payer: Mclaren Commercial |
$1,472.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,390.60
|
| Rate for Payer: Nomi Health Commercial |
$1,341.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,439.68
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$560.08 |
| Max. Negotiated Rate |
$1,063.40 |
| Rate for Payer: Aetna Commercial |
$750.51
|
| Rate for Payer: Aetna Medicare |
$560.08
|
| Rate for Payer: BCBS Complete |
$654.40
|
| Rate for Payer: BCBS MAPPO |
$560.08
|
| Rate for Payer: BCN Medicare Advantage |
$560.08
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$806.52
|
| Rate for Payer: Cofinity Commercial |
$750.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.08
|
| Rate for Payer: Healthscope Commercial |
$672.10
|
| Rate for Payer: Healthscope Whirlpool |
$672.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.08
|
| Rate for Payer: Nomi Health Commercial |
$672.10
|
| Rate for Payer: PACE SWMI |
$560.08
|
| Rate for Payer: PHP Medicare Advantage |
$560.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health Medicare |
$560.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.08
|
| Rate for Payer: UHC Medicare Advantage |
$560.08
|
| Rate for Payer: UHCCP DNSP |
$560.08
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,063.40 |
| Max. Negotiated Rate |
$5,334.82 |
| Rate for Payer: Aetna Commercial |
$1,472.40
|
| Rate for Payer: Aetna Medicare |
$3,441.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: ASR ASR |
$1,586.92
|
| Rate for Payer: ASR Commercial |
$1,586.92
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.72
|
| Rate for Payer: BCN Commercial |
$1,268.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$1,537.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,308.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$1,636.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,586.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,441.82
|
| Rate for Payer: Mclaren Commercial |
$1,472.40
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,390.60
|
| Rate for Payer: Nomi Health Commercial |
$1,341.52
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$3,786.00
|
| Rate for Payer: PHP Medicaid |
$1,844.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,433.46
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,146.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,439.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$5,334.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP DNSP |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$560.08 |
| Max. Negotiated Rate |
$1,063.40 |
| Rate for Payer: Aetna Commercial |
$750.51
|
| Rate for Payer: Aetna Medicare |
$560.08
|
| Rate for Payer: BCBS Complete |
$654.40
|
| Rate for Payer: BCBS MAPPO |
$560.08
|
| Rate for Payer: BCN Medicare Advantage |
$560.08
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$806.52
|
| Rate for Payer: Cofinity Commercial |
$750.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.08
|
| Rate for Payer: Healthscope Commercial |
$672.10
|
| Rate for Payer: Healthscope Whirlpool |
$672.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.08
|
| Rate for Payer: Nomi Health Commercial |
$672.10
|
| Rate for Payer: PACE SWMI |
$560.08
|
| Rate for Payer: PHP Medicare Advantage |
$560.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health Medicare |
$560.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.08
|
| Rate for Payer: UHC Medicare Advantage |
$560.08
|
| Rate for Payer: UHCCP DNSP |
$560.08
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$305.77 |
| Max. Negotiated Rate |
$603.20 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna Medicare |
$305.77
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$305.77
|
| Rate for Payer: BCN Medicare Advantage |
$305.77
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$440.31
|
| Rate for Payer: Cofinity Commercial |
$409.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.77
|
| Rate for Payer: Healthscope Commercial |
$366.92
|
| Rate for Payer: Healthscope Whirlpool |
$366.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.06
|
| Rate for Payer: Nomi Health Commercial |
$366.92
|
| Rate for Payer: PACE SWMI |
$305.77
|
| Rate for Payer: PHP Medicare Advantage |
$305.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$305.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.77
|
| Rate for Payer: UHC Medicare Advantage |
$305.77
|
| Rate for Payer: UHCCP DNSP |
$305.77
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$211.48 |
| Rate for Payer: Aetna Commercial |
$196.79
|
| Rate for Payer: Aetna Medicare |
$146.86
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$146.86
|
| Rate for Payer: BCN Medicare Advantage |
$146.86
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$211.48
|
| Rate for Payer: Cofinity Commercial |
$196.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.86
|
| Rate for Payer: Healthscope Commercial |
$176.23
|
| Rate for Payer: Healthscope Whirlpool |
$176.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.20
|
| Rate for Payer: Nomi Health Commercial |
$176.23
|
| Rate for Payer: PACE SWMI |
$146.86
|
| Rate for Payer: PHP Medicare Advantage |
$146.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$146.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.86
|
| Rate for Payer: UHC Medicare Advantage |
$146.86
|
| Rate for Payer: UHCCP DNSP |
$146.86
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$199.55 |
| Max. Negotiated Rate |
$704.60 |
| Rate for Payer: Aetna Commercial |
$267.40
|
| Rate for Payer: Aetna Medicare |
$199.55
|
| Rate for Payer: BCBS Complete |
$433.60
|
| Rate for Payer: BCBS MAPPO |
$199.55
|
| Rate for Payer: BCN Medicare Advantage |
$199.55
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cofinity Commercial |
$287.35
|
| Rate for Payer: Cofinity Commercial |
$267.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.55
|
| Rate for Payer: Healthscope Commercial |
$239.46
|
| Rate for Payer: Healthscope Whirlpool |
$239.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.53
|
| Rate for Payer: Nomi Health Commercial |
$239.46
|
| Rate for Payer: PACE SWMI |
$199.55
|
| Rate for Payer: PHP Medicare Advantage |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.60
|
| Rate for Payer: Priority Health Medicare |
$199.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.55
|
| Rate for Payer: UHC Medicare Advantage |
$199.55
|
| Rate for Payer: UHCCP DNSP |
$199.55
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$3,409.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$1,107.13 |
| Max. Negotiated Rate |
$2,215.85 |
| Rate for Payer: Aetna Commercial |
$1,483.55
|
| Rate for Payer: Aetna Medicare |
$1,107.13
|
| Rate for Payer: BCBS Complete |
$1,363.60
|
| Rate for Payer: BCBS MAPPO |
$1,107.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,107.13
|
| Rate for Payer: Cash Price |
$2,727.20
|
| Rate for Payer: Cash Price |
$2,727.20
|
| Rate for Payer: Cofinity Commercial |
$1,594.27
|
| Rate for Payer: Cofinity Commercial |
$1,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,107.13
|
| Rate for Payer: Healthscope Commercial |
$1,328.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,162.49
|
| Rate for Payer: Nomi Health Commercial |
$1,328.56
|
| Rate for Payer: PACE SWMI |
$1,107.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,107.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,215.85
|
| Rate for Payer: Priority Health Medicare |
$1,107.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,107.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,107.13
|
| Rate for Payer: UHCCP DNSP |
$1,107.13
|
|
