|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN
|
Professional
|
Both
|
$3,227.00
|
|
|
Service Code
|
HCPCS 33522
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$2,258.90 |
| Rate for Payer: Aetna Commercial |
$965.90
|
| Rate for Payer: Aetna Medicare |
$749.65
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCBS MAPPO |
$720.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.94
|
| Rate for Payer: BCN Commercial |
$1,044.31
|
| Rate for Payer: BCN Medicare Advantage |
$720.82
|
| Rate for Payer: Cash Price |
$2,581.60
|
| Rate for Payer: Cash Price |
$2,581.60
|
| Rate for Payer: Cofinity Commercial |
$1,037.98
|
| Rate for Payer: Cofinity Commercial |
$965.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.82
|
| Rate for Payer: Mclaren Medicaid |
$455.61
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$756.86
|
| Rate for Payer: PACE SWMI |
$720.82
|
| Rate for Payer: PHP Medicare Advantage |
$720.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,258.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.79
|
| Rate for Payer: Priority Health Medicare |
$720.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,136.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$720.82
|
| Rate for Payer: UHC Medicare Advantage |
$742.44
|
|
|
PR CORONARY ENDARTERCOMY OPEN ANY METHOD
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 33572
|
| Min. Negotiated Rate |
$143.78 |
| Max. Negotiated Rate |
$889.00 |
| Rate for Payer: Aetna Commercial |
$304.70
|
| Rate for Payer: Aetna Medicare |
$236.49
|
| Rate for Payer: BCBS Complete |
$150.97
|
| Rate for Payer: BCBS MAPPO |
$227.39
|
| Rate for Payer: BCBS Trust/PPO |
$863.77
|
| Rate for Payer: BCN Commercial |
$329.36
|
| Rate for Payer: BCN Medicare Advantage |
$227.39
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$304.70
|
| Rate for Payer: Cofinity Commercial |
$327.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.39
|
| Rate for Payer: Mclaren Medicaid |
$143.78
|
| Rate for Payer: Meridian Medicaid |
$150.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$238.76
|
| Rate for Payer: PACE SWMI |
$227.39
|
| Rate for Payer: PHP Medicare Advantage |
$227.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.54
|
| Rate for Payer: Priority Health Medicare |
$227.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.39
|
| Rate for Payer: UHC Medicare Advantage |
$234.21
|
|
|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$1,837.00
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$3,265.16 |
| Rate for Payer: Aetna Commercial |
$835.53
|
| Rate for Payer: Aetna Medicare |
$648.47
|
| Rate for Payer: BCBS Complete |
$428.06
|
| Rate for Payer: BCBS MAPPO |
$623.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.16
|
| Rate for Payer: BCN Commercial |
$922.62
|
| Rate for Payer: BCN Medicare Advantage |
$623.53
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cash Price |
$1,469.60
|
| Rate for Payer: Cofinity Commercial |
$835.53
|
| Rate for Payer: Cofinity Commercial |
$897.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.53
|
| Rate for Payer: Mclaren Medicaid |
$407.68
|
| Rate for Payer: Meridian Medicaid |
$428.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$654.71
|
| Rate for Payer: PACE SWMI |
$623.53
|
| Rate for Payer: PHP Medicare Advantage |
$623.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.20
|
| Rate for Payer: Priority Health Medicare |
$623.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,020.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.53
|
| Rate for Payer: UHC Medicare Advantage |
$642.24
|
|
|
PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 54435
|
| Min. Negotiated Rate |
$265.61 |
| Max. Negotiated Rate |
$1,738.11 |
| Rate for Payer: Aetna Commercial |
$541.51
|
| Rate for Payer: Aetna Medicare |
$420.27
|
| Rate for Payer: BCBS Complete |
$278.89
|
| Rate for Payer: BCBS MAPPO |
$404.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.11
|
| Rate for Payer: BCN Commercial |
$600.09
|
| Rate for Payer: BCN Medicare Advantage |
$404.11
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cofinity Commercial |
$581.92
|
| Rate for Payer: Cofinity Commercial |
$541.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.11
|
| Rate for Payer: Mclaren Medicaid |
$265.61
|
| Rate for Payer: Meridian Medicaid |
$278.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$424.32
|
| Rate for Payer: PACE SWMI |
$404.11
|
| Rate for Payer: PHP Medicare Advantage |
$404.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.55
|
| Rate for Payer: Priority Health Medicare |
$404.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$663.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.11
|
| Rate for Payer: UHC Medicare Advantage |
$416.23
|
|
|
PR CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 54420
|
| Min. Negotiated Rate |
$447.73 |
| Max. Negotiated Rate |
$2,612.13 |
| Rate for Payer: Aetna Commercial |
$919.53
|
| Rate for Payer: Aetna Medicare |
$713.67
|
| Rate for Payer: BCBS Complete |
$470.12
|
| Rate for Payer: BCBS MAPPO |
$686.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,612.13
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$686.22
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$988.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.22
|
| Rate for Payer: Mclaren Medicaid |
$447.73
|
| Rate for Payer: Meridian Medicaid |
$470.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$720.53
|
| Rate for Payer: PACE SWMI |
$686.22
|
| Rate for Payer: PHP Medicare Advantage |
$686.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,121.24
|
| Rate for Payer: Priority Health Medicare |
$686.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,121.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.22
|
| Rate for Payer: UHC Medicare Advantage |
$706.81
|
|
|
PR CORRECT BUNION,SIMPLE
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 28290
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$949.90 |
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.90
|
|
|
PR CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 28286
|
| Min. Negotiated Rate |
$192.13 |
| Max. Negotiated Rate |
$2,002.26 |
| Rate for Payer: Aetna Commercial |
$386.30
|
| Rate for Payer: Aetna Medicare |
$299.81
|
| Rate for Payer: BCBS Complete |
$201.74
|
| Rate for Payer: BCBS MAPPO |
$288.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,002.26
|
| Rate for Payer: BCN Commercial |
$639.19
|
| Rate for Payer: BCN Medicare Advantage |
$288.28
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$415.12
|
| Rate for Payer: Cofinity Commercial |
$386.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.28
|
| Rate for Payer: Mclaren Medicaid |
$192.13
|
| Rate for Payer: Meridian Medicaid |
$201.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$302.69
|
| Rate for Payer: PACE SWMI |
$288.28
|
| Rate for Payer: PHP Medicare Advantage |
$288.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$449.89
|
| Rate for Payer: Priority Health Medicare |
$288.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$449.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.28
|
| Rate for Payer: UHC Medicare Advantage |
$296.93
|
|
|
PR CORRECTION HAMMERTOE
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Aetna Commercial |
$501.95
|
| Rate for Payer: Aetna Medicare |
$389.57
|
| Rate for Payer: BCBS Complete |
$262.34
|
| Rate for Payer: BCBS MAPPO |
$374.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.65
|
| Rate for Payer: BCN Commercial |
$860.92
|
| Rate for Payer: BCN Medicare Advantage |
$374.59
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$501.95
|
| Rate for Payer: Cofinity Commercial |
$539.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.59
|
| Rate for Payer: Mclaren Medicaid |
$249.85
|
| Rate for Payer: Meridian Medicaid |
$262.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$393.32
|
| Rate for Payer: PACE SWMI |
$374.59
|
| Rate for Payer: PHP Medicare Advantage |
$374.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.23
|
| Rate for Payer: Priority Health Medicare |
$374.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.59
|
| Rate for Payer: UHC Medicare Advantage |
$385.83
|
|
|
PR CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 19355
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,136.10 |
| Rate for Payer: Aetna Commercial |
$811.26
|
| Rate for Payer: Aetna Medicare |
$629.64
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS MAPPO |
$605.42
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$1,109.79
|
| Rate for Payer: BCN Medicare Advantage |
$605.42
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$871.80
|
| Rate for Payer: Cofinity Commercial |
$811.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.42
|
| Rate for Payer: Mclaren Medicaid |
$395.97
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$635.69
|
| Rate for Payer: PACE SWMI |
$605.42
|
| Rate for Payer: PHP Medicare Advantage |
$605.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.42
|
| Rate for Payer: Priority Health Medicare |
$605.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.42
|
| Rate for Payer: UHC Medicare Advantage |
$623.58
|
|
|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$668.83 |
| Rate for Payer: Aetna Commercial |
$28.33
|
| Rate for Payer: Aetna Medicare |
$21.99
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$668.83
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: BCN Medicare Advantage |
$21.14
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$28.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.14
|
| Rate for Payer: Mclaren Medicaid |
$14.06
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.20
|
| Rate for Payer: PACE SWMI |
$21.14
|
| Rate for Payer: PHP Medicare Advantage |
$21.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$21.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.14
|
| Rate for Payer: UHC Medicare Advantage |
$21.77
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL CNF
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 28297
|
| Min. Negotiated Rate |
$387.45 |
| Max. Negotiated Rate |
$1,499.26 |
| Rate for Payer: Aetna Commercial |
$789.65
|
| Rate for Payer: Aetna Medicare |
$612.86
|
| Rate for Payer: BCBS Complete |
$406.82
|
| Rate for Payer: BCBS MAPPO |
$589.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.37
|
| Rate for Payer: BCN Commercial |
$1,499.26
|
| Rate for Payer: BCN Medicare Advantage |
$589.29
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$848.58
|
| Rate for Payer: Cofinity Commercial |
$789.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.29
|
| Rate for Payer: Mclaren Medicaid |
$387.45
|
| Rate for Payer: Meridian Medicaid |
$406.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.75
|
| Rate for Payer: PACE SWMI |
$589.29
|
| Rate for Payer: PHP Medicare Advantage |
$589.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$918.15
|
| Rate for Payer: Priority Health Medicare |
$589.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$918.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.29
|
| Rate for Payer: UHC Medicare Advantage |
$606.97
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 28299
|
| Min. Negotiated Rate |
$383.61 |
| Max. Negotiated Rate |
$1,651.30 |
| Rate for Payer: Aetna Commercial |
$774.49
|
| Rate for Payer: Aetna Medicare |
$601.10
|
| Rate for Payer: BCBS Complete |
$402.79
|
| Rate for Payer: BCBS MAPPO |
$577.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$1,468.47
|
| Rate for Payer: BCN Medicare Advantage |
$577.98
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$832.29
|
| Rate for Payer: Cofinity Commercial |
$774.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.98
|
| Rate for Payer: Mclaren Medicaid |
$383.61
|
| Rate for Payer: Meridian Medicaid |
$402.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$606.88
|
| Rate for Payer: PACE SWMI |
$577.98
|
| Rate for Payer: PHP Medicare Advantage |
$577.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.27
|
| Rate for Payer: Priority Health Medicare |
$577.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$577.98
|
| Rate for Payer: UHC Medicare Advantage |
$595.32
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$330.79 |
| Max. Negotiated Rate |
$1,537.90 |
| Rate for Payer: Aetna Commercial |
$669.81
|
| Rate for Payer: Aetna Medicare |
$519.85
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: BCBS MAPPO |
$499.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.56
|
| Rate for Payer: BCN Commercial |
$1,288.16
|
| Rate for Payer: BCN Medicare Advantage |
$499.86
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cofinity Commercial |
$719.80
|
| Rate for Payer: Cofinity Commercial |
$669.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.86
|
| Rate for Payer: Mclaren Medicaid |
$330.79
|
| Rate for Payer: Meridian Medicaid |
$347.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$524.85
|
| Rate for Payer: PACE SWMI |
$499.86
|
| Rate for Payer: PHP Medicare Advantage |
$499.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.74
|
| Rate for Payer: Priority Health Medicare |
$499.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.86
|
| Rate for Payer: UHC Medicare Advantage |
$514.86
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 28295
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,564.75 |
| Rate for Payer: Aetna Commercial |
$798.24
|
| Rate for Payer: Aetna Medicare |
$619.53
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS MAPPO |
$595.70
|
| Rate for Payer: BCBS Trust/PPO |
$982.11
|
| Rate for Payer: BCN Commercial |
$1,564.75
|
| Rate for Payer: BCN Medicare Advantage |
$595.70
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$798.24
|
| Rate for Payer: Cofinity Commercial |
$857.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.70
|
| Rate for Payer: Mclaren Medicaid |
$388.30
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$625.48
|
| Rate for Payer: PACE SWMI |
$595.70
|
| Rate for Payer: PHP Medicare Advantage |
$595.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,128.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.42
|
| Rate for Payer: Priority Health Medicare |
$595.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$931.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.70
|
| Rate for Payer: UHC Medicare Advantage |
$613.57
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 28298
|
| Min. Negotiated Rate |
$327.59 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$661.06
|
| Rate for Payer: Aetna Medicare |
$513.06
|
| Rate for Payer: BCBS Complete |
$343.97
|
| Rate for Payer: BCBS MAPPO |
$493.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.48
|
| Rate for Payer: BCN Commercial |
$1,212.90
|
| Rate for Payer: BCN Medicare Advantage |
$493.33
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$710.40
|
| Rate for Payer: Cofinity Commercial |
$661.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.33
|
| Rate for Payer: Mclaren Medicaid |
$327.59
|
| Rate for Payer: Meridian Medicaid |
$343.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$518.00
|
| Rate for Payer: PACE SWMI |
$493.33
|
| Rate for Payer: PHP Medicare Advantage |
$493.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,311.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.04
|
| Rate for Payer: Priority Health Medicare |
$493.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$769.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.33
|
| Rate for Payer: UHC Medicare Advantage |
$508.13
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL
|
Professional
|
Both
|
$1,745.00
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$1,544.75 |
| Rate for Payer: Aetna Commercial |
$630.74
|
| Rate for Payer: Aetna Medicare |
$489.53
|
| Rate for Payer: BCBS Complete |
$329.22
|
| Rate for Payer: BCBS MAPPO |
$470.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.75
|
| Rate for Payer: BCN Commercial |
$1,011.07
|
| Rate for Payer: BCN Medicare Advantage |
$470.70
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cofinity Commercial |
$677.81
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.70
|
| Rate for Payer: Mclaren Medicaid |
$313.54
|
| Rate for Payer: Meridian Medicaid |
$329.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$494.24
|
| Rate for Payer: PACE SWMI |
$470.70
|
| Rate for Payer: PHP Medicare Advantage |
$470.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.83
|
| Rate for Payer: Priority Health Medicare |
$470.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$734.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.70
|
| Rate for Payer: UHC Medicare Advantage |
$484.82
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$460.51 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: Aetna Commercial |
$1,648.15
|
| Rate for Payer: Aetna Medicare |
$504.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$605.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$605.94
|
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: BCBS MAPPO |
$484.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.57
|
| Rate for Payer: BCN Commercial |
$1,507.57
|
| Rate for Payer: BCN Medicare Advantage |
$484.75
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$1,667.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.75
|
| Rate for Payer: Healthscope Commercial |
$1,745.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.25
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$508.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,648.15
|
| Rate for Payer: PACE Senior Care Partners |
$460.51
|
| Rate for Payer: PACE SWMI |
$484.75
|
| Rate for Payer: PHP Commercial |
$1,648.15
|
| Rate for Payer: PHP Medicare Advantage |
$484.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.93
|
| Rate for Payer: Priority Health Medicare |
$484.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,182.60
|
| Rate for Payer: Railroad Medicare Medicare |
$484.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,706.32
|
| Rate for Payer: UHC Core |
$1,619.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.75
|
| Rate for Payer: UHC Medicare Advantage |
$499.29
|
| Rate for Payer: VA VA |
$484.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.25
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,182.60 |
| Max. Negotiated Rate |
$1,745.10 |
| Rate for Payer: Aetna Commercial |
$1,648.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.46
|
| Rate for Payer: BCN Commercial |
$1,498.46
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$1,667.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.20
|
| Rate for Payer: Healthscope Commercial |
$1,745.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,648.15
|
| Rate for Payer: PHP Commercial |
$1,648.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,686.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,182.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,706.32
|
| Rate for Payer: UHC Core |
$1,619.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.25
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$949.55 |
| Max. Negotiated Rate |
$2,603.55 |
| Rate for Payer: Aetna Commercial |
$1,981.34
|
| Rate for Payer: Aetna Medicare |
$1,537.75
|
| Rate for Payer: BCBS Complete |
$997.03
|
| Rate for Payer: BCBS MAPPO |
$1,478.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$2,163.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,478.61
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cofinity Commercial |
$1,981.34
|
| Rate for Payer: Cofinity Commercial |
$2,129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,478.61
|
| Rate for Payer: Mclaren Medicaid |
$949.55
|
| Rate for Payer: Meridian Medicaid |
$997.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,552.54
|
| Rate for Payer: PACE SWMI |
$1,478.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,478.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$949.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,603.55
|
| Rate for Payer: Priority Health Medicare |
$1,478.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,603.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,478.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.97
|
|
|
PR COSMETIC CORRECTION OF INVERTED NIPPLES
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 00557
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG
|
Professional
|
Both
|
$6,133.00
|
|
|
Service Code
|
HCPCS 63064
|
| Min. Negotiated Rate |
$631.85 |
| Max. Negotiated Rate |
$4,293.10 |
| Rate for Payer: Aetna Commercial |
$2,395.61
|
| Rate for Payer: Aetna Medicare |
$1,859.28
|
| Rate for Payer: BCBS Complete |
$1,205.69
|
| Rate for Payer: BCBS MAPPO |
$1,787.77
|
| Rate for Payer: BCBS Trust/PPO |
$631.85
|
| Rate for Payer: BCN Commercial |
$2,887.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,787.77
|
| Rate for Payer: Cash Price |
$4,906.40
|
| Rate for Payer: Cash Price |
$4,906.40
|
| Rate for Payer: Cofinity Commercial |
$2,574.39
|
| Rate for Payer: Cofinity Commercial |
$2,395.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,787.77
|
| Rate for Payer: Mclaren Medicaid |
$1,148.28
|
| Rate for Payer: Meridian Medicaid |
$1,205.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,877.16
|
| Rate for Payer: PACE SWMI |
$1,787.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,787.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,148.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,293.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,038.93
|
| Rate for Payer: Priority Health Medicare |
$1,787.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,038.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,787.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,841.40
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 63066
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$1,472.10 |
| Rate for Payer: Aetna Commercial |
$277.47
|
| Rate for Payer: Aetna Medicare |
$215.35
|
| Rate for Payer: BCBS Complete |
$137.99
|
| Rate for Payer: BCBS MAPPO |
$207.07
|
| Rate for Payer: BCBS Trust/PPO |
$766.04
|
| Rate for Payer: BCN Commercial |
$330.92
|
| Rate for Payer: BCN Medicare Advantage |
$207.07
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$277.47
|
| Rate for Payer: Cofinity Commercial |
$298.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.07
|
| Rate for Payer: Mclaren Medicaid |
$131.42
|
| Rate for Payer: Meridian Medicaid |
$137.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$217.42
|
| Rate for Payer: PACE SWMI |
$207.07
|
| Rate for Payer: PHP Medicare Advantage |
$207.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.23
|
| Rate for Payer: Priority Health Medicare |
$207.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.07
|
| Rate for Payer: UHC Medicare Advantage |
$213.28
|
|
|
PR COUDE TIP URINARY CATHETER
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4352
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
|
