|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,588.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$1,394.99 |
| Max. Negotiated Rate |
$2,332.20 |
| Rate for Payer: Aetna Commercial |
$1,869.29
|
| Rate for Payer: Aetna Medicare |
$1,450.79
|
| Rate for Payer: BCBS Complete |
$1,435.20
|
| Rate for Payer: BCBS MAPPO |
$1,394.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,394.99
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cofinity Commercial |
$2,008.79
|
| Rate for Payer: Cofinity Commercial |
$1,869.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,394.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,464.74
|
| Rate for Payer: Nomi Health Commercial |
$1,673.99
|
| Rate for Payer: PACE SWMI |
$1,394.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,394.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.20
|
| Rate for Payer: Priority Health Medicare |
$1,408.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,394.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,394.99
|
| Rate for Payer: UHC Exchange |
$1,394.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,394.99
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,662.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$664.80 |
| Max. Negotiated Rate |
$1,352.66 |
| Rate for Payer: Aetna Commercial |
$1,258.73
|
| Rate for Payer: Aetna Medicare |
$976.92
|
| Rate for Payer: BCBS Complete |
$664.80
|
| Rate for Payer: BCBS MAPPO |
$939.35
|
| Rate for Payer: BCN Medicare Advantage |
$939.35
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cofinity Commercial |
$1,352.66
|
| Rate for Payer: Cofinity Commercial |
$1,258.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.32
|
| Rate for Payer: Nomi Health Commercial |
$1,127.22
|
| Rate for Payer: PACE SWMI |
$939.35
|
| Rate for Payer: PHP Medicare Advantage |
$939.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.30
|
| Rate for Payer: Priority Health Medicare |
$948.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.35
|
| Rate for Payer: UHC Exchange |
$939.35
|
| Rate for Payer: UHC Medicare Advantage |
$939.35
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 67413
|
| Min. Negotiated Rate |
$871.96 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Commercial |
$1,168.43
|
| Rate for Payer: Aetna Medicare |
$906.84
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$871.96
|
| Rate for Payer: BCN Medicare Advantage |
$871.96
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,255.62
|
| Rate for Payer: Cofinity Commercial |
$1,168.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$871.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.56
|
| Rate for Payer: Nomi Health Commercial |
$1,046.35
|
| Rate for Payer: PACE SWMI |
$871.96
|
| Rate for Payer: PHP Medicare Advantage |
$871.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$880.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$871.96
|
| Rate for Payer: UHC Exchange |
$871.96
|
| Rate for Payer: UHC Medicare Advantage |
$871.96
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$809.67 |
| Rate for Payer: Aetna Commercial |
$753.44
|
| Rate for Payer: Aetna Medicare |
$584.76
|
| Rate for Payer: BCBS Complete |
$441.20
|
| Rate for Payer: BCBS MAPPO |
$562.27
|
| Rate for Payer: BCN Medicare Advantage |
$562.27
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$809.67
|
| Rate for Payer: Cofinity Commercial |
$753.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.38
|
| Rate for Payer: Nomi Health Commercial |
$674.72
|
| Rate for Payer: PACE SWMI |
$562.27
|
| Rate for Payer: PHP Medicare Advantage |
$562.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health Medicare |
$567.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$562.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.27
|
| Rate for Payer: UHC Exchange |
$562.27
|
| Rate for Payer: UHC Medicare Advantage |
$562.27
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$702.03 |
| Rate for Payer: Aetna Commercial |
$653.28
|
| Rate for Payer: Aetna Medicare |
$507.02
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$487.52
|
| Rate for Payer: BCN Medicare Advantage |
$487.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$702.03
|
| Rate for Payer: Cofinity Commercial |
$653.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.90
|
| Rate for Payer: Nomi Health Commercial |
$585.02
|
| Rate for Payer: PACE SWMI |
$487.52
|
| Rate for Payer: PHP Medicare Advantage |
$487.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$492.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.52
|
| Rate for Payer: UHC Exchange |
$487.52
|
| Rate for Payer: UHC Medicare Advantage |
$487.52
|
|
|
PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 54535
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$1,024.17 |
| Rate for Payer: Aetna Commercial |
$953.05
|
| Rate for Payer: Aetna Medicare |
$739.68
|
| Rate for Payer: BCBS Complete |
$560.40
|
| Rate for Payer: BCBS MAPPO |
$711.23
|
| Rate for Payer: BCN Medicare Advantage |
$711.23
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$953.05
|
| Rate for Payer: Cofinity Commercial |
$1,024.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$746.79
|
| Rate for Payer: Nomi Health Commercial |
$853.48
|
| Rate for Payer: PACE SWMI |
$711.23
|
| Rate for Payer: PHP Medicare Advantage |
$711.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health Medicare |
$718.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.23
|
| Rate for Payer: UHC Exchange |
$711.23
|
| Rate for Payer: UHC Medicare Advantage |
$711.23
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$452.85 |
| Rate for Payer: Aetna Commercial |
$421.40
|
| Rate for Payer: Aetna Medicare |
$327.06
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$314.48
|
| Rate for Payer: BCN Medicare Advantage |
$314.48
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Cofinity Commercial |
$421.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.20
|
| Rate for Payer: Nomi Health Commercial |
$377.38
|
| Rate for Payer: PACE SWMI |
$314.48
|
| Rate for Payer: PHP Medicare Advantage |
$314.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$317.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.48
|
| Rate for Payer: UHC Exchange |
$314.48
|
| Rate for Payer: UHC Medicare Advantage |
$314.48
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$599.60 |
| Max. Negotiated Rate |
$980.71 |
| Rate for Payer: Aetna Commercial |
$912.61
|
| Rate for Payer: Aetna Medicare |
$708.29
|
| Rate for Payer: BCBS Complete |
$599.60
|
| Rate for Payer: BCBS MAPPO |
$681.05
|
| Rate for Payer: BCN Medicare Advantage |
$681.05
|
| Rate for Payer: Cash Price |
$1,199.20
|
| Rate for Payer: Cash Price |
$1,199.20
|
| Rate for Payer: Cofinity Commercial |
$980.71
|
| Rate for Payer: Cofinity Commercial |
$912.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.10
|
| Rate for Payer: Nomi Health Commercial |
$817.26
|
| Rate for Payer: PACE SWMI |
$681.05
|
| Rate for Payer: PHP Medicare Advantage |
$681.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.35
|
| Rate for Payer: Priority Health Medicare |
$687.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.05
|
| Rate for Payer: UHC Exchange |
$681.05
|
| Rate for Payer: UHC Medicare Advantage |
$681.05
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$415.58 |
| Max. Negotiated Rate |
$1,141.40 |
| Rate for Payer: Aetna Commercial |
$556.88
|
| Rate for Payer: Aetna Medicare |
$432.20
|
| Rate for Payer: BCBS Complete |
$702.40
|
| Rate for Payer: BCBS MAPPO |
$415.58
|
| Rate for Payer: BCN Medicare Advantage |
$415.58
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cofinity Commercial |
$598.44
|
| Rate for Payer: Cofinity Commercial |
$556.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.36
|
| Rate for Payer: Nomi Health Commercial |
$498.70
|
| Rate for Payer: PACE SWMI |
$415.58
|
| Rate for Payer: PHP Medicare Advantage |
$415.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.40
|
| Rate for Payer: Priority Health Medicare |
$419.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.58
|
| Rate for Payer: UHC Exchange |
$415.58
|
| Rate for Payer: UHC Medicare Advantage |
$415.58
|
|
|
PR ORPHENADRINE INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J2360
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$11.19
|
| Rate for Payer: BCN Medicare Advantage |
$11.19
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.75
|
| Rate for Payer: Nomi Health Commercial |
$13.43
|
| Rate for Payer: PACE SWMI |
$11.19
|
| Rate for Payer: PHP Medicare Advantage |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.19
|
| Rate for Payer: UHC Exchange |
$11.19
|
| Rate for Payer: UHC Medicare Advantage |
$11.19
|
|
|
PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 97760
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$62.45 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: Aetna Medicare |
$45.10
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS MAPPO |
$43.37
|
| Rate for Payer: BCN Medicare Advantage |
$43.37
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE SWMI |
$43.37
|
| Rate for Payer: PHP Medicare Advantage |
$43.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health Medicare |
$43.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.37
|
| Rate for Payer: UHC Exchange |
$43.37
|
| Rate for Payer: UHC Medicare Advantage |
$43.37
|
|
|
PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 97763
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: BCBS MAPPO |
$47.14
|
| Rate for Payer: BCN Medicare Advantage |
$47.14
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$67.88
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$56.57
|
| Rate for Payer: PACE SWMI |
$47.14
|
| Rate for Payer: PHP Medicare Advantage |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.90
|
| Rate for Payer: Priority Health Medicare |
$47.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.14
|
| Rate for Payer: UHC Exchange |
$47.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.14
|
|
|
PR ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS J7324
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$164.94 |
| Rate for Payer: Aetna Commercial |
$153.48
|
| Rate for Payer: Aetna Medicare |
$119.12
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$114.54
|
| Rate for Payer: BCN Medicare Advantage |
$114.54
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$164.94
|
| Rate for Payer: Cofinity Commercial |
$153.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.27
|
| Rate for Payer: Nomi Health Commercial |
$137.45
|
| Rate for Payer: PACE SWMI |
$114.54
|
| Rate for Payer: PHP Medicare Advantage |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health Medicare |
$115.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.54
|
| Rate for Payer: UHC Exchange |
$114.54
|
| Rate for Payer: UHC Medicare Advantage |
$114.54
|
|
|
PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 28114
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$1,075.66
|
| Rate for Payer: Aetna Medicare |
$834.84
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$802.73
|
| Rate for Payer: BCN Medicare Advantage |
$802.73
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,155.93
|
| Rate for Payer: Cofinity Commercial |
$1,075.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$842.87
|
| Rate for Payer: Nomi Health Commercial |
$963.28
|
| Rate for Payer: PACE SWMI |
$802.73
|
| Rate for Payer: PHP Medicare Advantage |
$802.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$810.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$802.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$802.73
|
| Rate for Payer: UHC Exchange |
$802.73
|
| Rate for Payer: UHC Medicare Advantage |
$802.73
|
|
|
PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 28288
|
| Min. Negotiated Rate |
$395.20 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$555.27
|
| Rate for Payer: Aetna Medicare |
$430.96
|
| Rate for Payer: BCBS Complete |
$395.20
|
| Rate for Payer: BCBS MAPPO |
$414.38
|
| Rate for Payer: BCN Medicare Advantage |
$414.38
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$596.71
|
| Rate for Payer: Cofinity Commercial |
$555.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.10
|
| Rate for Payer: Nomi Health Commercial |
$497.26
|
| Rate for Payer: PACE SWMI |
$414.38
|
| Rate for Payer: PHP Medicare Advantage |
$414.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health Medicare |
$418.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.38
|
| Rate for Payer: UHC Exchange |
$414.38
|
| Rate for Payer: UHC Medicare Advantage |
$414.38
|
|
|
PR OSTECTOMY CALCANEUS
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 28118
|
| Min. Negotiated Rate |
$407.09 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: Aetna Commercial |
$545.50
|
| Rate for Payer: Aetna Medicare |
$423.37
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: BCBS MAPPO |
$407.09
|
| Rate for Payer: BCN Medicare Advantage |
$407.09
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$586.21
|
| Rate for Payer: Cofinity Commercial |
$545.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.44
|
| Rate for Payer: Nomi Health Commercial |
$488.51
|
| Rate for Payer: PACE SWMI |
$407.09
|
| Rate for Payer: PHP Medicare Advantage |
$407.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: Priority Health Medicare |
$411.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.09
|
| Rate for Payer: UHC Exchange |
$407.09
|
| Rate for Payer: UHC Medicare Advantage |
$407.09
|
|
|
PR OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS
|
Professional
|
Both
|
$1,222.00
|
|
|
Service Code
|
HCPCS 28119
|
| Min. Negotiated Rate |
$348.90 |
| Max. Negotiated Rate |
$794.30 |
| Rate for Payer: Aetna Commercial |
$467.53
|
| Rate for Payer: Aetna Medicare |
$362.86
|
| Rate for Payer: BCBS Complete |
$488.80
|
| Rate for Payer: BCBS MAPPO |
$348.90
|
| Rate for Payer: BCN Medicare Advantage |
$348.90
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cofinity Commercial |
$502.42
|
| Rate for Payer: Cofinity Commercial |
$467.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.35
|
| Rate for Payer: Nomi Health Commercial |
$418.68
|
| Rate for Payer: PACE SWMI |
$348.90
|
| Rate for Payer: PHP Medicare Advantage |
$348.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.30
|
| Rate for Payer: Priority Health Medicare |
$352.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.90
|
| Rate for Payer: UHC Exchange |
$348.90
|
| Rate for Payer: UHC Medicare Advantage |
$348.90
|
|
|
PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 28111
|
| Min. Negotiated Rate |
$305.36 |
| Max. Negotiated Rate |
$540.15 |
| Rate for Payer: Aetna Commercial |
$409.18
|
| Rate for Payer: Aetna Medicare |
$317.57
|
| Rate for Payer: BCBS Complete |
$332.40
|
| Rate for Payer: BCBS MAPPO |
$305.36
|
| Rate for Payer: BCN Medicare Advantage |
$305.36
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cofinity Commercial |
$439.72
|
| Rate for Payer: Cofinity Commercial |
$409.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.63
|
| Rate for Payer: Nomi Health Commercial |
$366.43
|
| Rate for Payer: PACE SWMI |
$305.36
|
| Rate for Payer: PHP Medicare Advantage |
$305.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$540.15
|
| Rate for Payer: Priority Health Medicare |
$308.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.36
|
| Rate for Payer: UHC Exchange |
$305.36
|
| Rate for Payer: UHC Medicare Advantage |
$305.36
|
|
|
PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 28113
|
| Min. Negotiated Rate |
$408.41 |
| Max. Negotiated Rate |
$672.10 |
| Rate for Payer: Aetna Commercial |
$547.27
|
| Rate for Payer: Aetna Medicare |
$424.75
|
| Rate for Payer: BCBS Complete |
$413.60
|
| Rate for Payer: BCBS MAPPO |
$408.41
|
| Rate for Payer: BCN Medicare Advantage |
$408.41
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cofinity Commercial |
$588.11
|
| Rate for Payer: Cofinity Commercial |
$547.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.83
|
| Rate for Payer: Nomi Health Commercial |
$490.09
|
| Rate for Payer: PACE SWMI |
$408.41
|
| Rate for Payer: PHP Medicare Advantage |
$408.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.10
|
| Rate for Payer: Priority Health Medicare |
$412.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.41
|
| Rate for Payer: UHC Exchange |
$408.41
|
| Rate for Payer: UHC Medicare Advantage |
$408.41
|
|
|
PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 28112
|
| Min. Negotiated Rate |
$300.16 |
| Max. Negotiated Rate |
$631.15 |
| Rate for Payer: Aetna Commercial |
$402.21
|
| Rate for Payer: Aetna Medicare |
$312.17
|
| Rate for Payer: BCBS Complete |
$388.40
|
| Rate for Payer: BCBS MAPPO |
$300.16
|
| Rate for Payer: BCN Medicare Advantage |
$300.16
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cofinity Commercial |
$432.23
|
| Rate for Payer: Cofinity Commercial |
$402.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.17
|
| Rate for Payer: Nomi Health Commercial |
$360.19
|
| Rate for Payer: PACE SWMI |
$300.16
|
| Rate for Payer: PHP Medicare Advantage |
$300.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health Medicare |
$303.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.16
|
| Rate for Payer: UHC Exchange |
$300.16
|
| Rate for Payer: UHC Medicare Advantage |
$300.16
|
|
|
PR OSTECTOMY PRTL 5TH METAR HEAD SPX
|
Professional
|
Both
|
$914.00
|
|
|
Service Code
|
HCPCS 28110
|
| Min. Negotiated Rate |
$282.52 |
| Max. Negotiated Rate |
$594.10 |
| Rate for Payer: Aetna Commercial |
$378.58
|
| Rate for Payer: Aetna Medicare |
$293.82
|
| Rate for Payer: BCBS Complete |
$365.60
|
| Rate for Payer: BCBS MAPPO |
$282.52
|
| Rate for Payer: BCN Medicare Advantage |
$282.52
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cofinity Commercial |
$406.83
|
| Rate for Payer: Cofinity Commercial |
$378.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.65
|
| Rate for Payer: Nomi Health Commercial |
$339.02
|
| Rate for Payer: PACE SWMI |
$282.52
|
| Rate for Payer: PHP Medicare Advantage |
$282.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$594.10
|
| Rate for Payer: Priority Health Medicare |
$285.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.52
|
| Rate for Payer: UHC Exchange |
$282.52
|
| Rate for Payer: UHC Medicare Advantage |
$282.52
|
|
|
PR OSTECTOMY STERNUM PARTIAL
|
Professional
|
Both
|
$3,953.00
|
|
|
Service Code
|
HCPCS 21620
|
| Min. Negotiated Rate |
$484.45 |
| Max. Negotiated Rate |
$2,569.45 |
| Rate for Payer: Aetna Commercial |
$649.16
|
| Rate for Payer: Aetna Medicare |
$503.83
|
| Rate for Payer: BCBS Complete |
$1,581.20
|
| Rate for Payer: BCBS MAPPO |
$484.45
|
| Rate for Payer: BCN Medicare Advantage |
$484.45
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cofinity Commercial |
$697.61
|
| Rate for Payer: Cofinity Commercial |
$649.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.67
|
| Rate for Payer: Nomi Health Commercial |
$581.34
|
| Rate for Payer: PACE SWMI |
$484.45
|
| Rate for Payer: PHP Medicare Advantage |
$484.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,569.45
|
| Rate for Payer: Priority Health Medicare |
$489.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.45
|
| Rate for Payer: UHC Exchange |
$484.45
|
| Rate for Payer: UHC Medicare Advantage |
$484.45
|
|
|
PR OSTECTOMY TARSAL COALITION
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
HCPCS 28116
|
| Min. Negotiated Rate |
$499.10 |
| Max. Negotiated Rate |
$935.35 |
| Rate for Payer: Aetna Commercial |
$668.79
|
| Rate for Payer: Aetna Medicare |
$519.06
|
| Rate for Payer: BCBS Complete |
$575.60
|
| Rate for Payer: BCBS MAPPO |
$499.10
|
| Rate for Payer: BCN Medicare Advantage |
$499.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cofinity Commercial |
$718.70
|
| Rate for Payer: Cofinity Commercial |
$668.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.05
|
| Rate for Payer: Nomi Health Commercial |
$598.92
|
| Rate for Payer: PACE SWMI |
$499.10
|
| Rate for Payer: PHP Medicare Advantage |
$499.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.35
|
| Rate for Payer: Priority Health Medicare |
$504.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$499.10
|
| Rate for Payer: UHC Exchange |
$499.10
|
| Rate for Payer: UHC Medicare Advantage |
$499.10
|
|
|
PR OSTEOCHONDRAL ALLOGRAFT KNEE OPEN
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 27415
|
| Min. Negotiated Rate |
$1,322.51 |
| Max. Negotiated Rate |
$2,973.75 |
| Rate for Payer: Aetna Commercial |
$1,772.16
|
| Rate for Payer: Aetna Medicare |
$1,375.41
|
| Rate for Payer: BCBS Complete |
$1,830.00
|
| Rate for Payer: BCBS MAPPO |
$1,322.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,322.51
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$1,904.41
|
| Rate for Payer: Cofinity Commercial |
$1,772.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,322.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,388.64
|
| Rate for Payer: Nomi Health Commercial |
$1,587.01
|
| Rate for Payer: PACE SWMI |
$1,322.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,322.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health Medicare |
$1,335.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,322.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,322.51
|
| Rate for Payer: UHC Exchange |
$1,322.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,322.51
|
|
|
PR OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27416
|
| Min. Negotiated Rate |
$946.93 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,268.89
|
| Rate for Payer: Aetna Medicare |
$984.81
|
| Rate for Payer: BCBS Complete |
$1,238.80
|
| Rate for Payer: BCBS MAPPO |
$946.93
|
| Rate for Payer: BCN Medicare Advantage |
$946.93
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,363.58
|
| Rate for Payer: Cofinity Commercial |
$1,268.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$994.28
|
| Rate for Payer: Nomi Health Commercial |
$1,136.32
|
| Rate for Payer: PACE SWMI |
$946.93
|
| Rate for Payer: PHP Medicare Advantage |
$946.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$956.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$946.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.93
|
| Rate for Payer: UHC Exchange |
$946.93
|
| Rate for Payer: UHC Medicare Advantage |
$946.93
|
|
