|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$346.08 |
| Max. Negotiated Rate |
$638.95 |
| Rate for Payer: Aetna Commercial |
$463.75
|
| Rate for Payer: Aetna Medicare |
$359.92
|
| Rate for Payer: BCBS Complete |
$393.20
|
| Rate for Payer: BCBS MAPPO |
$346.08
|
| Rate for Payer: BCN Medicare Advantage |
$346.08
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cofinity Commercial |
$498.36
|
| Rate for Payer: Cofinity Commercial |
$463.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.38
|
| Rate for Payer: Nomi Health Commercial |
$415.30
|
| Rate for Payer: PACE SWMI |
$346.08
|
| Rate for Payer: PHP Medicare Advantage |
$346.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.95
|
| Rate for Payer: Priority Health Medicare |
$349.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.08
|
| Rate for Payer: UHC Exchange |
$346.08
|
| Rate for Payer: UHC Medicare Advantage |
$346.08
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Commercial |
$407.19
|
| Rate for Payer: Aetna Medicare |
$316.02
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS MAPPO |
$303.87
|
| Rate for Payer: BCN Medicare Advantage |
$303.87
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Cofinity Commercial |
$407.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$364.64
|
| Rate for Payer: PACE SWMI |
$303.87
|
| Rate for Payer: PHP Medicare Advantage |
$303.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health Medicare |
$306.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.87
|
| Rate for Payer: UHC Exchange |
$303.87
|
| Rate for Payer: UHC Medicare Advantage |
$303.87
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$481.20 |
| Max. Negotiated Rate |
$945.36 |
| Rate for Payer: Aetna Commercial |
$879.71
|
| Rate for Payer: Aetna Medicare |
$682.76
|
| Rate for Payer: BCBS Complete |
$481.20
|
| Rate for Payer: BCBS MAPPO |
$656.50
|
| Rate for Payer: BCN Medicare Advantage |
$656.50
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$945.36
|
| Rate for Payer: Cofinity Commercial |
$879.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.33
|
| Rate for Payer: Nomi Health Commercial |
$787.80
|
| Rate for Payer: PACE SWMI |
$656.50
|
| Rate for Payer: PHP Medicare Advantage |
$656.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.95
|
| Rate for Payer: Priority Health Medicare |
$663.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$656.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$656.50
|
| Rate for Payer: UHC Exchange |
$656.50
|
| Rate for Payer: UHC Medicare Advantage |
$656.50
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$911.28 |
| Max. Negotiated Rate |
$1,531.40 |
| Rate for Payer: Aetna Commercial |
$1,221.12
|
| Rate for Payer: Aetna Medicare |
$947.73
|
| Rate for Payer: BCBS Complete |
$942.40
|
| Rate for Payer: BCBS MAPPO |
$911.28
|
| Rate for Payer: BCN Medicare Advantage |
$911.28
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cofinity Commercial |
$1,312.24
|
| Rate for Payer: Cofinity Commercial |
$1,221.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$911.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.84
|
| Rate for Payer: Nomi Health Commercial |
$1,093.54
|
| Rate for Payer: PACE SWMI |
$911.28
|
| Rate for Payer: PHP Medicare Advantage |
$911.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.40
|
| Rate for Payer: Priority Health Medicare |
$920.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$911.28
|
| Rate for Payer: UHC Exchange |
$911.28
|
| Rate for Payer: UHC Medicare Advantage |
$911.28
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$686.08 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$919.35
|
| Rate for Payer: Aetna Medicare |
$713.52
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS MAPPO |
$686.08
|
| Rate for Payer: BCN Medicare Advantage |
$686.08
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$987.96
|
| Rate for Payer: Cofinity Commercial |
$919.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.38
|
| Rate for Payer: Nomi Health Commercial |
$823.30
|
| Rate for Payer: PACE SWMI |
$686.08
|
| Rate for Payer: PHP Medicare Advantage |
$686.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health Medicare |
$692.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.08
|
| Rate for Payer: UHC Exchange |
$686.08
|
| Rate for Payer: UHC Medicare Advantage |
$686.08
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,458.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$1,301.93 |
| Max. Negotiated Rate |
$2,897.70 |
| Rate for Payer: Aetna Commercial |
$1,744.59
|
| Rate for Payer: Aetna Medicare |
$1,354.01
|
| Rate for Payer: BCBS Complete |
$1,783.20
|
| Rate for Payer: BCBS MAPPO |
$1,301.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,301.93
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cofinity Commercial |
$1,874.78
|
| Rate for Payer: Cofinity Commercial |
$1,744.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,301.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,367.03
|
| Rate for Payer: Nomi Health Commercial |
$1,562.32
|
| Rate for Payer: PACE SWMI |
$1,301.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,301.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,897.70
|
| Rate for Payer: Priority Health Medicare |
$1,314.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,301.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,301.93
|
| Rate for Payer: UHC Exchange |
$1,301.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.93
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,654.57 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$2,217.12
|
| Rate for Payer: Aetna Medicare |
$1,720.75
|
| Rate for Payer: BCBS Complete |
$2,036.80
|
| Rate for Payer: BCBS MAPPO |
$1,654.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,654.57
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cofinity Commercial |
$2,382.58
|
| Rate for Payer: Cofinity Commercial |
$2,217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,654.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,737.30
|
| Rate for Payer: Nomi Health Commercial |
$1,985.48
|
| Rate for Payer: PACE SWMI |
$1,654.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health Medicare |
$1,671.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,654.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,654.57
|
| Rate for Payer: UHC Exchange |
$1,654.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,654.57
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,361.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,836.61 |
| Max. Negotiated Rate |
$3,484.65 |
| Rate for Payer: Aetna Commercial |
$2,461.06
|
| Rate for Payer: Aetna Medicare |
$1,910.07
|
| Rate for Payer: BCBS Complete |
$2,144.40
|
| Rate for Payer: BCBS MAPPO |
$1,836.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,836.61
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cofinity Commercial |
$2,644.72
|
| Rate for Payer: Cofinity Commercial |
$2,461.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,836.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,928.44
|
| Rate for Payer: Nomi Health Commercial |
$2,203.93
|
| Rate for Payer: PACE SWMI |
$1,836.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,836.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,484.65
|
| Rate for Payer: Priority Health Medicare |
$1,854.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,836.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,836.61
|
| Rate for Payer: UHC Exchange |
$1,836.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,836.61
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$107.60
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: BCBS MAPPO |
$103.46
|
| Rate for Payer: BCN Medicare Advantage |
$103.46
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$148.98
|
| Rate for Payer: Cofinity Commercial |
$138.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.63
|
| Rate for Payer: Nomi Health Commercial |
$124.15
|
| Rate for Payer: PACE SWMI |
$103.46
|
| Rate for Payer: PHP Medicare Advantage |
$103.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health Medicare |
$104.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.46
|
| Rate for Payer: UHC Exchange |
$103.46
|
| Rate for Payer: UHC Medicare Advantage |
$103.46
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$621.18 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Commercial |
$832.38
|
| Rate for Payer: Aetna Medicare |
$646.03
|
| Rate for Payer: BCBS Complete |
$726.40
|
| Rate for Payer: BCBS MAPPO |
$621.18
|
| Rate for Payer: BCN Medicare Advantage |
$621.18
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cofinity Commercial |
$894.50
|
| Rate for Payer: Cofinity Commercial |
$832.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.24
|
| Rate for Payer: Nomi Health Commercial |
$745.42
|
| Rate for Payer: PACE SWMI |
$621.18
|
| Rate for Payer: PHP Medicare Advantage |
$621.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health Medicare |
$627.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$621.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.18
|
| Rate for Payer: UHC Exchange |
$621.18
|
| Rate for Payer: UHC Medicare Advantage |
$621.18
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$674.80 |
| Max. Negotiated Rate |
$1,377.73 |
| Rate for Payer: Aetna Commercial |
$1,282.06
|
| Rate for Payer: Aetna Medicare |
$995.03
|
| Rate for Payer: BCBS Complete |
$674.80
|
| Rate for Payer: BCBS MAPPO |
$956.76
|
| Rate for Payer: BCN Medicare Advantage |
$956.76
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.73
|
| Rate for Payer: Cofinity Commercial |
$1,282.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.60
|
| Rate for Payer: Nomi Health Commercial |
$1,148.11
|
| Rate for Payer: PACE SWMI |
$956.76
|
| Rate for Payer: PHP Medicare Advantage |
$956.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health Medicare |
$966.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$956.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.76
|
| Rate for Payer: UHC Exchange |
$956.76
|
| Rate for Payer: UHC Medicare Advantage |
$956.76
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$1,040.63 |
| Max. Negotiated Rate |
$2,991.30 |
| Rate for Payer: Aetna Commercial |
$1,394.44
|
| Rate for Payer: Aetna Medicare |
$1,082.26
|
| Rate for Payer: BCBS Complete |
$1,840.80
|
| Rate for Payer: BCBS MAPPO |
$1,040.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.63
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cofinity Commercial |
$1,498.51
|
| Rate for Payer: Cofinity Commercial |
$1,394.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.66
|
| Rate for Payer: Nomi Health Commercial |
$1,248.76
|
| Rate for Payer: PACE SWMI |
$1,040.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health Medicare |
$1,051.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,040.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.63
|
| Rate for Payer: UHC Exchange |
$1,040.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.63
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$1,018.61 |
| Max. Negotiated Rate |
$1,879.15 |
| Rate for Payer: Aetna Commercial |
$1,364.94
|
| Rate for Payer: Aetna Medicare |
$1,059.35
|
| Rate for Payer: BCBS Complete |
$1,156.40
|
| Rate for Payer: BCBS MAPPO |
$1,018.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.61
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,466.80
|
| Rate for Payer: Cofinity Commercial |
$1,364.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.54
|
| Rate for Payer: Nomi Health Commercial |
$1,222.33
|
| Rate for Payer: PACE SWMI |
$1,018.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.15
|
| Rate for Payer: Priority Health Medicare |
$1,028.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,018.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.61
|
| Rate for Payer: UHC Exchange |
$1,018.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.61
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$1,098.40 |
| Rate for Payer: Aetna Commercial |
$1,022.13
|
| Rate for Payer: Aetna Medicare |
$793.29
|
| Rate for Payer: BCBS Complete |
$560.40
|
| Rate for Payer: BCBS MAPPO |
$762.78
|
| Rate for Payer: BCN Medicare Advantage |
$762.78
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$1,022.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.92
|
| Rate for Payer: Nomi Health Commercial |
$915.34
|
| Rate for Payer: PACE SWMI |
$762.78
|
| Rate for Payer: PHP Medicare Advantage |
$762.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health Medicare |
$770.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.78
|
| Rate for Payer: UHC Exchange |
$762.78
|
| Rate for Payer: UHC Medicare Advantage |
$762.78
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$527.20 |
| Max. Negotiated Rate |
$856.70 |
| Rate for Payer: Aetna Commercial |
$793.49
|
| Rate for Payer: Aetna Medicare |
$615.85
|
| Rate for Payer: BCBS Complete |
$527.20
|
| Rate for Payer: BCBS MAPPO |
$592.16
|
| Rate for Payer: BCN Medicare Advantage |
$592.16
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cofinity Commercial |
$852.71
|
| Rate for Payer: Cofinity Commercial |
$793.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.77
|
| Rate for Payer: Nomi Health Commercial |
$710.59
|
| Rate for Payer: PACE SWMI |
$592.16
|
| Rate for Payer: PHP Medicare Advantage |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.70
|
| Rate for Payer: Priority Health Medicare |
$598.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.16
|
| Rate for Payer: UHC Exchange |
$592.16
|
| Rate for Payer: UHC Medicare Advantage |
$592.16
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,903.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$841.45 |
| Max. Negotiated Rate |
$2,536.95 |
| Rate for Payer: Aetna Commercial |
$1,127.54
|
| Rate for Payer: Aetna Medicare |
$875.11
|
| Rate for Payer: BCBS Complete |
$1,561.20
|
| Rate for Payer: BCBS MAPPO |
$841.45
|
| Rate for Payer: BCN Medicare Advantage |
$841.45
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cofinity Commercial |
$1,211.69
|
| Rate for Payer: Cofinity Commercial |
$1,127.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$841.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$883.52
|
| Rate for Payer: Nomi Health Commercial |
$1,009.74
|
| Rate for Payer: PACE SWMI |
$841.45
|
| Rate for Payer: PHP Medicare Advantage |
$841.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,536.95
|
| Rate for Payer: Priority Health Medicare |
$849.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$841.45
|
| Rate for Payer: UHC Exchange |
$841.45
|
| Rate for Payer: UHC Medicare Advantage |
$841.45
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$863.98 |
| Max. Negotiated Rate |
$2,487.55 |
| Rate for Payer: Aetna Commercial |
$1,157.73
|
| Rate for Payer: Aetna Medicare |
$898.54
|
| Rate for Payer: BCBS Complete |
$1,530.80
|
| Rate for Payer: BCBS MAPPO |
$863.98
|
| Rate for Payer: BCN Medicare Advantage |
$863.98
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,244.13
|
| Rate for Payer: Cofinity Commercial |
$1,157.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.18
|
| Rate for Payer: Nomi Health Commercial |
$1,036.78
|
| Rate for Payer: PACE SWMI |
$863.98
|
| Rate for Payer: PHP Medicare Advantage |
$863.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.55
|
| Rate for Payer: Priority Health Medicare |
$872.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.98
|
| Rate for Payer: UHC Exchange |
$863.98
|
| Rate for Payer: UHC Medicare Advantage |
$863.98
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$934.95 |
| Rate for Payer: Aetna Commercial |
$870.02
|
| Rate for Payer: Aetna Medicare |
$675.24
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$649.27
|
| Rate for Payer: BCN Medicare Advantage |
$649.27
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$934.95
|
| Rate for Payer: Cofinity Commercial |
$870.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$681.73
|
| Rate for Payer: Nomi Health Commercial |
$779.12
|
| Rate for Payer: PACE SWMI |
$649.27
|
| Rate for Payer: PHP Medicare Advantage |
$649.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$655.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$649.27
|
| Rate for Payer: UHC Exchange |
$649.27
|
| Rate for Payer: UHC Medicare Advantage |
$649.27
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS BY LIGATION
|
Professional
|
Both
|
$4,402.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$931.08 |
| Max. Negotiated Rate |
$2,861.30 |
| Rate for Payer: Aetna Commercial |
$1,247.65
|
| Rate for Payer: Aetna Medicare |
$968.32
|
| Rate for Payer: BCBS Complete |
$1,760.80
|
| Rate for Payer: BCBS MAPPO |
$931.08
|
| Rate for Payer: BCN Medicare Advantage |
$931.08
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cofinity Commercial |
$1,340.76
|
| Rate for Payer: Cofinity Commercial |
$1,247.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.63
|
| Rate for Payer: Nomi Health Commercial |
$1,117.30
|
| Rate for Payer: PACE SWMI |
$931.08
|
| Rate for Payer: PHP Medicare Advantage |
$931.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.30
|
| Rate for Payer: Priority Health Medicare |
$940.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$931.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.08
|
| Rate for Payer: UHC Exchange |
$931.08
|
| Rate for Payer: UHC Medicare Advantage |
$931.08
|
|
|
PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21743
|
| Min. Negotiated Rate |
$1,656.40 |
| Max. Negotiated Rate |
$2,691.65 |
| Rate for Payer: Aetna Medicare |
$2,070.50
|
| Rate for Payer: BCBS Complete |
$1,656.40
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
|
|
PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21740
|
| Min. Negotiated Rate |
$992.65 |
| Max. Negotiated Rate |
$2,691.65 |
| Rate for Payer: Aetna Commercial |
$1,330.15
|
| Rate for Payer: Aetna Medicare |
$1,032.36
|
| Rate for Payer: BCBS Complete |
$1,656.40
|
| Rate for Payer: BCBS MAPPO |
$992.65
|
| Rate for Payer: BCN Medicare Advantage |
$992.65
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,429.42
|
| Rate for Payer: Cofinity Commercial |
$1,330.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.28
|
| Rate for Payer: Nomi Health Commercial |
$1,191.18
|
| Rate for Payer: PACE SWMI |
$992.65
|
| Rate for Payer: PHP Medicare Advantage |
$992.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
| Rate for Payer: Priority Health Medicare |
$1,002.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$992.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.65
|
| Rate for Payer: UHC Exchange |
$992.65
|
| Rate for Payer: UHC Medicare Advantage |
$992.65
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$1,691.30 |
| Rate for Payer: Aetna Commercial |
$847.71
|
| Rate for Payer: Aetna Medicare |
$657.92
|
| Rate for Payer: BCBS Complete |
$1,040.80
|
| Rate for Payer: BCBS MAPPO |
$632.62
|
| Rate for Payer: BCN Medicare Advantage |
$632.62
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Cofinity Commercial |
$910.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.25
|
| Rate for Payer: Nomi Health Commercial |
$759.14
|
| Rate for Payer: PACE SWMI |
$632.62
|
| Rate for Payer: PHP Medicare Advantage |
$632.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health Medicare |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$632.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.62
|
| Rate for Payer: UHC Exchange |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$632.62
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
IP
|
$2,602.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$1,691.30 |
| Max. Negotiated Rate |
$2,341.80 |
| Rate for Payer: Aetna Commercial |
$2,211.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,124.01
|
| Rate for Payer: BCN Commercial |
$2,010.83
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$2,237.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.60
|
| Rate for Payer: Healthscope Commercial |
$2,341.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,951.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,211.70
|
| Rate for Payer: Nomi Health Commercial |
$2,133.64
|
| Rate for Payer: PHP Commercial |
$2,211.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health HMO/PPO |
$2,263.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,743.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,289.76
|
| Rate for Payer: UHC Core |
$2,172.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,951.50
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$1,691.30 |
| Rate for Payer: Aetna Commercial |
$847.71
|
| Rate for Payer: Aetna Medicare |
$657.92
|
| Rate for Payer: BCBS Complete |
$1,040.80
|
| Rate for Payer: BCBS MAPPO |
$632.62
|
| Rate for Payer: BCN Medicare Advantage |
$632.62
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$910.97
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.25
|
| Rate for Payer: Nomi Health Commercial |
$759.14
|
| Rate for Payer: PACE SWMI |
$632.62
|
| Rate for Payer: PHP Medicare Advantage |
$632.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health Medicare |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$632.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.62
|
| Rate for Payer: UHC Exchange |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$632.62
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
OP
|
$2,602.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$617.98 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$2,211.70
|
| Rate for Payer: Aetna Medicare |
$676.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.12
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$650.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,139.10
|
| Rate for Payer: BCN Commercial |
$2,023.06
|
| Rate for Payer: BCN Medicare Advantage |
$650.50
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$2,237.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.50
|
| Rate for Payer: Healthscope Commercial |
$2,341.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,951.50
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.02
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,211.70
|
| Rate for Payer: Nomi Health Commercial |
$2,133.64
|
| Rate for Payer: PACE Senior Care Partners |
$617.98
|
| Rate for Payer: PACE SWMI |
$650.50
|
| Rate for Payer: PHP Commercial |
$2,211.70
|
| Rate for Payer: PHP Medicare Advantage |
$650.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health HMO/PPO |
$2,263.74
|
| Rate for Payer: Priority Health Medicare |
$657.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,743.34
|
| Rate for Payer: Railroad Medicare Medicare |
$650.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,289.76
|
| Rate for Payer: UHC Core |
$2,172.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.50
|
| Rate for Payer: UHC Exchange |
$650.50
|
| Rate for Payer: UHC Medicare Advantage |
$650.50
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$650.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,951.50
|
|
