|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$560.08 |
| Max. Negotiated Rate |
$1,063.40 |
| Rate for Payer: Aetna Commercial |
$750.51
|
| Rate for Payer: Aetna Medicare |
$582.48
|
| Rate for Payer: BCBS Complete |
$654.40
|
| Rate for Payer: BCBS MAPPO |
$560.08
|
| Rate for Payer: BCN Medicare Advantage |
$560.08
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$806.52
|
| Rate for Payer: Cofinity Commercial |
$750.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.08
|
| Rate for Payer: Nomi Health Commercial |
$672.10
|
| Rate for Payer: PACE SWMI |
$560.08
|
| Rate for Payer: PHP Medicare Advantage |
$560.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health Medicare |
$565.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.08
|
| Rate for Payer: UHC Exchange |
$560.08
|
| Rate for Payer: UHC Medicare Advantage |
$560.08
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$560.08 |
| Max. Negotiated Rate |
$1,063.40 |
| Rate for Payer: Aetna Commercial |
$750.51
|
| Rate for Payer: Aetna Medicare |
$582.48
|
| Rate for Payer: BCBS Complete |
$654.40
|
| Rate for Payer: BCBS MAPPO |
$560.08
|
| Rate for Payer: BCN Medicare Advantage |
$560.08
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$806.52
|
| Rate for Payer: Cofinity Commercial |
$750.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.08
|
| Rate for Payer: Nomi Health Commercial |
$672.10
|
| Rate for Payer: PACE SWMI |
$560.08
|
| Rate for Payer: PHP Medicare Advantage |
$560.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health Medicare |
$565.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.08
|
| Rate for Payer: UHC Exchange |
$560.08
|
| Rate for Payer: UHC Medicare Advantage |
$560.08
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
IP
|
$1,636.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,063.40 |
| Max. Negotiated Rate |
$1,472.40 |
| Rate for Payer: Aetna Commercial |
$1,390.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.47
|
| Rate for Payer: BCN Commercial |
$1,264.30
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$1,406.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,308.80
|
| Rate for Payer: Healthscope Commercial |
$1,472.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,227.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,390.60
|
| Rate for Payer: Nomi Health Commercial |
$1,341.52
|
| Rate for Payer: PHP Commercial |
$1,390.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,423.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,096.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,439.68
|
| Rate for Payer: UHC Core |
$1,366.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,227.00
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Facility
|
OP
|
$1,636.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
49525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$388.55 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: Aetna Commercial |
$1,390.60
|
| Rate for Payer: Aetna Medicare |
$425.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$511.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$511.25
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$409.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,344.96
|
| Rate for Payer: BCN Commercial |
$1,271.99
|
| Rate for Payer: BCN Medicare Advantage |
$409.00
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$1,406.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,308.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.00
|
| Rate for Payer: Healthscope Commercial |
$1,472.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,227.00
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.45
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$470.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,390.60
|
| Rate for Payer: Nomi Health Commercial |
$1,341.52
|
| Rate for Payer: PACE Senior Care Partners |
$388.55
|
| Rate for Payer: PACE SWMI |
$409.00
|
| Rate for Payer: PHP Commercial |
$1,390.60
|
| Rate for Payer: PHP Medicare Advantage |
$409.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,423.32
|
| Rate for Payer: Priority Health Medicare |
$413.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,096.12
|
| Rate for Payer: Railroad Medicare Medicare |
$409.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,439.68
|
| Rate for Payer: UHC Core |
$1,366.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$409.00
|
| Rate for Payer: UHC Exchange |
$409.00
|
| Rate for Payer: UHC Medicare Advantage |
$409.00
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$409.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,227.00
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$305.77 |
| Max. Negotiated Rate |
$603.20 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna Medicare |
$318.00
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$305.77
|
| Rate for Payer: BCN Medicare Advantage |
$305.77
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$440.31
|
| Rate for Payer: Cofinity Commercial |
$409.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.06
|
| Rate for Payer: Nomi Health Commercial |
$366.92
|
| Rate for Payer: PACE SWMI |
$305.77
|
| Rate for Payer: PHP Medicare Advantage |
$305.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$308.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.77
|
| Rate for Payer: UHC Exchange |
$305.77
|
| Rate for Payer: UHC Medicare Advantage |
$305.77
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$211.48 |
| Rate for Payer: Aetna Commercial |
$196.79
|
| Rate for Payer: Aetna Medicare |
$152.73
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$146.86
|
| Rate for Payer: BCN Medicare Advantage |
$146.86
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$211.48
|
| Rate for Payer: Cofinity Commercial |
$196.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.20
|
| Rate for Payer: Nomi Health Commercial |
$176.23
|
| Rate for Payer: PACE SWMI |
$146.86
|
| Rate for Payer: PHP Medicare Advantage |
$146.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$148.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.86
|
| Rate for Payer: UHC Exchange |
$146.86
|
| Rate for Payer: UHC Medicare Advantage |
$146.86
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$199.55 |
| Max. Negotiated Rate |
$704.60 |
| Rate for Payer: Aetna Commercial |
$267.40
|
| Rate for Payer: Aetna Medicare |
$207.53
|
| Rate for Payer: BCBS Complete |
$433.60
|
| Rate for Payer: BCBS MAPPO |
$199.55
|
| Rate for Payer: BCN Medicare Advantage |
$199.55
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cofinity Commercial |
$287.35
|
| Rate for Payer: Cofinity Commercial |
$267.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.53
|
| Rate for Payer: Nomi Health Commercial |
$239.46
|
| Rate for Payer: PACE SWMI |
$199.55
|
| Rate for Payer: PHP Medicare Advantage |
$199.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.60
|
| Rate for Payer: Priority Health Medicare |
$201.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.55
|
| Rate for Payer: UHC Exchange |
$199.55
|
| Rate for Payer: UHC Medicare Advantage |
$199.55
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$3,409.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$1,107.13 |
| Max. Negotiated Rate |
$2,215.85 |
| Rate for Payer: Aetna Commercial |
$1,483.55
|
| Rate for Payer: Aetna Medicare |
$1,151.42
|
| Rate for Payer: BCBS Complete |
$1,363.60
|
| Rate for Payer: BCBS MAPPO |
$1,107.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,107.13
|
| Rate for Payer: Cash Price |
$2,727.20
|
| Rate for Payer: Cash Price |
$2,727.20
|
| Rate for Payer: Cofinity Commercial |
$1,594.27
|
| Rate for Payer: Cofinity Commercial |
$1,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,107.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,162.49
|
| Rate for Payer: Nomi Health Commercial |
$1,328.56
|
| Rate for Payer: PACE SWMI |
$1,107.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,107.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,215.85
|
| Rate for Payer: Priority Health Medicare |
$1,118.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,107.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,107.13
|
| Rate for Payer: UHC Exchange |
$1,107.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,107.13
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$9,119.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$3,647.60 |
| Max. Negotiated Rate |
$6,883.13 |
| Rate for Payer: Aetna Commercial |
$6,405.13
|
| Rate for Payer: Aetna Medicare |
$4,971.15
|
| Rate for Payer: BCBS Complete |
$3,647.60
|
| Rate for Payer: BCBS MAPPO |
$4,779.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,779.95
|
| Rate for Payer: Cash Price |
$7,295.20
|
| Rate for Payer: Cash Price |
$7,295.20
|
| Rate for Payer: Cofinity Commercial |
$6,883.13
|
| Rate for Payer: Cofinity Commercial |
$6,405.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,779.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,018.95
|
| Rate for Payer: Nomi Health Commercial |
$5,735.94
|
| Rate for Payer: PACE SWMI |
$4,779.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,779.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,927.35
|
| Rate for Payer: Priority Health Medicare |
$4,827.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,779.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,779.95
|
| Rate for Payer: UHC Exchange |
$4,779.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,779.95
|
|
|
PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$585.99 |
| Rate for Payer: Aetna Commercial |
$545.30
|
| Rate for Payer: Aetna Medicare |
$423.22
|
| Rate for Payer: BCBS Complete |
$303.20
|
| Rate for Payer: BCBS MAPPO |
$406.94
|
| Rate for Payer: BCN Medicare Advantage |
$406.94
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$585.99
|
| Rate for Payer: Cofinity Commercial |
$545.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.29
|
| Rate for Payer: Nomi Health Commercial |
$488.33
|
| Rate for Payer: PACE SWMI |
$406.94
|
| Rate for Payer: PHP Medicare Advantage |
$406.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health Medicare |
$411.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$406.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.94
|
| Rate for Payer: UHC Exchange |
$406.94
|
| Rate for Payer: UHC Medicare Advantage |
$406.94
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$774.63 |
| Rate for Payer: Aetna Commercial |
$720.84
|
| Rate for Payer: Aetna Medicare |
$559.46
|
| Rate for Payer: BCBS Complete |
$475.20
|
| Rate for Payer: BCBS MAPPO |
$537.94
|
| Rate for Payer: BCN Medicare Advantage |
$537.94
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$774.63
|
| Rate for Payer: Cofinity Commercial |
$720.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.84
|
| Rate for Payer: Nomi Health Commercial |
$645.53
|
| Rate for Payer: PACE SWMI |
$537.94
|
| Rate for Payer: PHP Medicare Advantage |
$537.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.20
|
| Rate for Payer: Priority Health Medicare |
$543.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$537.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.94
|
| Rate for Payer: UHC Exchange |
$537.94
|
| Rate for Payer: UHC Medicare Advantage |
$537.94
|
|
|
PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA
|
Professional
|
Both
|
$2,992.00
|
|
|
Service Code
|
HCPCS 46716
|
| Min. Negotiated Rate |
$1,196.80 |
| Max. Negotiated Rate |
$1,944.80 |
| Rate for Payer: Aetna Commercial |
$1,604.03
|
| Rate for Payer: Aetna Medicare |
$1,244.92
|
| Rate for Payer: BCBS Complete |
$1,196.80
|
| Rate for Payer: BCBS MAPPO |
$1,197.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,197.04
|
| Rate for Payer: Cash Price |
$2,393.60
|
| Rate for Payer: Cash Price |
$2,393.60
|
| Rate for Payer: Cofinity Commercial |
$1,723.74
|
| Rate for Payer: Cofinity Commercial |
$1,604.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,197.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,256.89
|
| Rate for Payer: Nomi Health Commercial |
$1,436.45
|
| Rate for Payer: PACE SWMI |
$1,197.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.80
|
| Rate for Payer: Priority Health Medicare |
$1,209.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,197.04
|
| Rate for Payer: UHC Exchange |
$1,197.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,197.04
|
|
|
PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ
|
Professional
|
Both
|
$10,278.00
|
|
|
Service Code
|
HCPCS 39503
|
| Min. Negotiated Rate |
$4,111.20 |
| Max. Negotiated Rate |
$8,044.47 |
| Rate for Payer: Aetna Commercial |
$7,485.83
|
| Rate for Payer: Aetna Medicare |
$5,809.90
|
| Rate for Payer: BCBS Complete |
$4,111.20
|
| Rate for Payer: BCBS MAPPO |
$5,586.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.44
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cofinity Commercial |
$8,044.47
|
| Rate for Payer: Cofinity Commercial |
$7,485.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.76
|
| Rate for Payer: Nomi Health Commercial |
$6,703.73
|
| Rate for Payer: PACE SWMI |
$5,586.44
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,680.70
|
| Rate for Payer: Priority Health Medicare |
$5,642.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,586.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.44
|
| Rate for Payer: UHC Exchange |
$5,586.44
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.44
|
|
|
PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 53449
|
| Min. Negotiated Rate |
$466.00 |
| Max. Negotiated Rate |
$844.42 |
| Rate for Payer: Aetna Commercial |
$785.78
|
| Rate for Payer: Aetna Medicare |
$609.86
|
| Rate for Payer: BCBS Complete |
$466.00
|
| Rate for Payer: BCBS MAPPO |
$586.40
|
| Rate for Payer: BCN Medicare Advantage |
$586.40
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$844.42
|
| Rate for Payer: Cofinity Commercial |
$785.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.72
|
| Rate for Payer: Nomi Health Commercial |
$703.68
|
| Rate for Payer: PACE SWMI |
$586.40
|
| Rate for Payer: PHP Medicare Advantage |
$586.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health Medicare |
$592.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.40
|
| Rate for Payer: UHC Exchange |
$586.40
|
| Rate for Payer: UHC Medicare Advantage |
$586.40
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE
|
Professional
|
Both
|
$3,865.00
|
|
|
Service Code
|
HCPCS 27472
|
| Min. Negotiated Rate |
$1,218.33 |
| Max. Negotiated Rate |
$2,512.25 |
| Rate for Payer: Aetna Commercial |
$1,632.56
|
| Rate for Payer: Aetna Medicare |
$1,267.06
|
| Rate for Payer: BCBS Complete |
$1,546.00
|
| Rate for Payer: BCBS MAPPO |
$1,218.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.33
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Cofinity Commercial |
$1,632.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.25
|
| Rate for Payer: Nomi Health Commercial |
$1,462.00
|
| Rate for Payer: PACE SWMI |
$1,218.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,512.25
|
| Rate for Payer: Priority Health Medicare |
$1,230.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.33
|
| Rate for Payer: UHC Exchange |
$1,218.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.33
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/O GRF
|
Professional
|
Both
|
$2,927.00
|
|
|
Service Code
|
HCPCS 27470
|
| Min. Negotiated Rate |
$1,136.51 |
| Max. Negotiated Rate |
$1,902.55 |
| Rate for Payer: Aetna Commercial |
$1,522.92
|
| Rate for Payer: Aetna Medicare |
$1,181.97
|
| Rate for Payer: BCBS Complete |
$1,170.80
|
| Rate for Payer: BCBS MAPPO |
$1,136.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.51
|
| Rate for Payer: Cash Price |
$2,341.60
|
| Rate for Payer: Cash Price |
$2,341.60
|
| Rate for Payer: Cofinity Commercial |
$1,636.57
|
| Rate for Payer: Cofinity Commercial |
$1,522.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,193.34
|
| Rate for Payer: Nomi Health Commercial |
$1,363.81
|
| Rate for Payer: PACE SWMI |
$1,136.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.55
|
| Rate for Payer: Priority Health Medicare |
$1,147.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,136.51
|
| Rate for Payer: UHC Exchange |
$1,136.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,136.51
|
|
|
PR RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH
|
Professional
|
Both
|
$5,421.00
|
|
|
Service Code
|
HCPCS 27725
|
| Min. Negotiated Rate |
$1,171.90 |
| Max. Negotiated Rate |
$3,523.65 |
| Rate for Payer: Aetna Commercial |
$1,570.35
|
| Rate for Payer: Aetna Medicare |
$1,218.78
|
| Rate for Payer: BCBS Complete |
$2,168.40
|
| Rate for Payer: BCBS MAPPO |
$1,171.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,171.90
|
| Rate for Payer: Cash Price |
$4,336.80
|
| Rate for Payer: Cash Price |
$4,336.80
|
| Rate for Payer: Cofinity Commercial |
$1,687.54
|
| Rate for Payer: Cofinity Commercial |
$1,570.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,171.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,230.49
|
| Rate for Payer: Nomi Health Commercial |
$1,406.28
|
| Rate for Payer: PACE SWMI |
$1,171.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,171.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,523.65
|
| Rate for Payer: Priority Health Medicare |
$1,183.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,171.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,171.90
|
| Rate for Payer: UHC Exchange |
$1,171.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,171.90
|
|
|
PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,771.00
|
|
|
Service Code
|
HCPCS 27724
|
| Min. Negotiated Rate |
$1,208.33 |
| Max. Negotiated Rate |
$3,101.15 |
| Rate for Payer: Aetna Commercial |
$1,619.16
|
| Rate for Payer: Aetna Medicare |
$1,256.66
|
| Rate for Payer: BCBS Complete |
$1,908.40
|
| Rate for Payer: BCBS MAPPO |
$1,208.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,208.33
|
| Rate for Payer: Cash Price |
$3,816.80
|
| Rate for Payer: Cash Price |
$3,816.80
|
| Rate for Payer: Cofinity Commercial |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,619.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,208.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,268.75
|
| Rate for Payer: Nomi Health Commercial |
$1,450.00
|
| Rate for Payer: PACE SWMI |
$1,208.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,208.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,101.15
|
| Rate for Payer: Priority Health Medicare |
$1,220.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,208.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,208.33
|
| Rate for Payer: UHC Exchange |
$1,208.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,208.33
|
|
|
PR RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 28322
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$855.40 |
| Rate for Payer: Aetna Commercial |
$743.19
|
| Rate for Payer: Aetna Medicare |
$576.80
|
| Rate for Payer: BCBS Complete |
$526.40
|
| Rate for Payer: BCBS MAPPO |
$554.62
|
| Rate for Payer: BCN Medicare Advantage |
$554.62
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$798.65
|
| Rate for Payer: Cofinity Commercial |
$743.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.35
|
| Rate for Payer: Nomi Health Commercial |
$665.54
|
| Rate for Payer: PACE SWMI |
$554.62
|
| Rate for Payer: PHP Medicare Advantage |
$554.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health Medicare |
$560.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.62
|
| Rate for Payer: UHC Exchange |
$554.62
|
| Rate for Payer: UHC Medicare Advantage |
$554.62
|
|
|
PR RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS
|
Professional
|
Both
|
$7,025.00
|
|
|
Service Code
|
HCPCS 33496
|
| Min. Negotiated Rate |
$1,591.45 |
| Max. Negotiated Rate |
$4,566.25 |
| Rate for Payer: Aetna Commercial |
$2,132.54
|
| Rate for Payer: Aetna Medicare |
$1,655.11
|
| Rate for Payer: BCBS Complete |
$2,810.00
|
| Rate for Payer: BCBS MAPPO |
$1,591.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.45
|
| Rate for Payer: Cash Price |
$5,620.00
|
| Rate for Payer: Cash Price |
$5,620.00
|
| Rate for Payer: Cofinity Commercial |
$2,291.69
|
| Rate for Payer: Cofinity Commercial |
$2,132.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,671.02
|
| Rate for Payer: Nomi Health Commercial |
$1,909.74
|
| Rate for Payer: PACE SWMI |
$1,591.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,566.25
|
| Rate for Payer: Priority Health Medicare |
$1,607.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,591.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.45
|
| Rate for Payer: UHC Exchange |
$1,591.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,591.45
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,241.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$1,000.77 |
| Max. Negotiated Rate |
$2,106.65 |
| Rate for Payer: Aetna Commercial |
$1,341.03
|
| Rate for Payer: Aetna Medicare |
$1,040.80
|
| Rate for Payer: BCBS Complete |
$1,296.40
|
| Rate for Payer: BCBS MAPPO |
$1,000.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.77
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,441.11
|
| Rate for Payer: Cofinity Commercial |
$1,341.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,050.81
|
| Rate for Payer: Nomi Health Commercial |
$1,200.92
|
| Rate for Payer: PACE SWMI |
$1,000.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.65
|
| Rate for Payer: Priority Health Medicare |
$1,010.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,000.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.77
|
| Rate for Payer: UHC Exchange |
$1,000.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,000.77
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 25415
|
| Min. Negotiated Rate |
$933.93 |
| Max. Negotiated Rate |
$2,128.75 |
| Rate for Payer: Aetna Commercial |
$1,251.47
|
| Rate for Payer: Aetna Medicare |
$971.29
|
| Rate for Payer: BCBS Complete |
$1,310.00
|
| Rate for Payer: BCBS MAPPO |
$933.93
|
| Rate for Payer: BCN Medicare Advantage |
$933.93
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,344.86
|
| Rate for Payer: Cofinity Commercial |
$1,251.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.63
|
| Rate for Payer: Nomi Health Commercial |
$1,120.72
|
| Rate for Payer: PACE SWMI |
$933.93
|
| Rate for Payer: PHP Medicare Advantage |
$933.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.75
|
| Rate for Payer: Priority Health Medicare |
$943.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$933.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.93
|
| Rate for Payer: UHC Exchange |
$933.93
|
| Rate for Payer: UHC Medicare Advantage |
$933.93
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$774.63 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$1,038.00
|
| Rate for Payer: Aetna Medicare |
$805.62
|
| Rate for Payer: BCBS Complete |
$1,053.20
|
| Rate for Payer: BCBS MAPPO |
$774.63
|
| Rate for Payer: BCN Medicare Advantage |
$774.63
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,115.47
|
| Rate for Payer: Cofinity Commercial |
$1,038.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.36
|
| Rate for Payer: Nomi Health Commercial |
$929.56
|
| Rate for Payer: PACE SWMI |
$774.63
|
| Rate for Payer: PHP Medicare Advantage |
$774.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health Medicare |
$782.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.63
|
| Rate for Payer: UHC Exchange |
$774.63
|
| Rate for Payer: UHC Medicare Advantage |
$774.63
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$2,109.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$843.60 |
| Max. Negotiated Rate |
$1,416.21 |
| Rate for Payer: Aetna Commercial |
$1,317.86
|
| Rate for Payer: Aetna Medicare |
$1,022.82
|
| Rate for Payer: BCBS Complete |
$843.60
|
| Rate for Payer: BCBS MAPPO |
$983.48
|
| Rate for Payer: BCN Medicare Advantage |
$983.48
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,416.21
|
| Rate for Payer: Cofinity Commercial |
$1,317.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$983.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,032.65
|
| Rate for Payer: Nomi Health Commercial |
$1,180.18
|
| Rate for Payer: PACE SWMI |
$983.48
|
| Rate for Payer: PHP Medicare Advantage |
$983.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.85
|
| Rate for Payer: Priority Health Medicare |
$993.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$983.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$983.48
|
| Rate for Payer: UHC Exchange |
$983.48
|
| Rate for Payer: UHC Medicare Advantage |
$983.48
|
|
|
PR RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$550.40 |
| Max. Negotiated Rate |
$1,070.35 |
| Rate for Payer: Aetna Commercial |
$996.02
|
| Rate for Payer: Aetna Medicare |
$773.03
|
| Rate for Payer: BCBS Complete |
$550.40
|
| Rate for Payer: BCBS MAPPO |
$743.30
|
| Rate for Payer: BCN Medicare Advantage |
$743.30
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$996.02
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$780.47
|
| Rate for Payer: Nomi Health Commercial |
$891.96
|
| Rate for Payer: PACE SWMI |
$743.30
|
| Rate for Payer: PHP Medicare Advantage |
$743.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.40
|
| Rate for Payer: Priority Health Medicare |
$750.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$743.30
|
| Rate for Payer: UHC Exchange |
$743.30
|
| Rate for Payer: UHC Medicare Advantage |
$743.30
|
|
