|
PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$2,856.00
|
|
|
Service Code
|
HCPCS 44625
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$1,999.20 |
| Rate for Payer: Aetna Commercial |
$1,337.57
|
| Rate for Payer: Aetna Medicare |
$998.19
|
| Rate for Payer: BCBS Complete |
$674.97
|
| Rate for Payer: BCBS MAPPO |
$998.19
|
| Rate for Payer: BCBS Trust/PPO |
$203.40
|
| Rate for Payer: BCN Commercial |
$1,467.49
|
| Rate for Payer: BCN Medicare Advantage |
$998.19
|
| Rate for Payer: Cash Price |
$2,284.80
|
| Rate for Payer: Cash Price |
$2,284.80
|
| Rate for Payer: Cofinity Commercial |
$1,437.39
|
| Rate for Payer: Cofinity Commercial |
$1,337.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$998.19
|
| Rate for Payer: Healthscope Commercial |
$1,197.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,197.83
|
| Rate for Payer: Meridian Medicaid |
$674.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,048.10
|
| Rate for Payer: PACE SWMI |
$998.19
|
| Rate for Payer: PHP Medicare Advantage |
$998.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,999.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,765.68
|
| Rate for Payer: Priority Health Medicare |
$998.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,765.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,028.14
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$2,914.00
|
|
|
Service Code
|
HCPCS 44626
|
| Min. Negotiated Rate |
$205.51 |
| Max. Negotiated Rate |
$2,781.10 |
| Rate for Payer: Aetna Commercial |
$2,115.28
|
| Rate for Payer: Aetna Medicare |
$1,578.57
|
| Rate for Payer: BCBS Complete |
$1,060.10
|
| Rate for Payer: BCBS MAPPO |
$1,578.57
|
| Rate for Payer: BCBS Trust/PPO |
$205.51
|
| Rate for Payer: BCN Commercial |
$2,311.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,578.57
|
| Rate for Payer: Cash Price |
$2,331.20
|
| Rate for Payer: Cash Price |
$2,331.20
|
| Rate for Payer: Cofinity Commercial |
$2,115.28
|
| Rate for Payer: Cofinity Commercial |
$2,273.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,578.57
|
| Rate for Payer: Healthscope Commercial |
$1,894.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,894.28
|
| Rate for Payer: Meridian Medicaid |
$1,060.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,657.50
|
| Rate for Payer: PACE SWMI |
$1,578.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,578.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,009.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,039.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,781.10
|
| Rate for Payer: Priority Health Medicare |
$1,578.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,781.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,625.93
|
|
|
PR CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ
|
Professional
|
Both
|
$1,442.00
|
|
|
Service Code
|
HCPCS 57308
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$1,574.86 |
| Rate for Payer: Aetna Commercial |
$874.77
|
| Rate for Payer: Aetna Medicare |
$652.81
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$652.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,574.86
|
| Rate for Payer: BCN Commercial |
$970.51
|
| Rate for Payer: BCN Medicare Advantage |
$652.81
|
| Rate for Payer: Cash Price |
$1,153.60
|
| Rate for Payer: Cash Price |
$1,153.60
|
| Rate for Payer: Cofinity Commercial |
$940.05
|
| Rate for Payer: Cofinity Commercial |
$874.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.81
|
| Rate for Payer: Healthscope Commercial |
$783.37
|
| Rate for Payer: Healthscope Whirlpool |
$783.37
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$685.45
|
| Rate for Payer: PACE SWMI |
$652.81
|
| Rate for Payer: PHP Medicare Advantage |
$652.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.22
|
| Rate for Payer: Priority Health Medicare |
$652.81
|
| Rate for Payer: Priority Health Narrow Network |
$940.22
|
| Rate for Payer: UHC Medicare Advantage |
$672.39
|
|
|
PR CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,937.00
|
|
|
Service Code
|
HCPCS 57305
|
| Min. Negotiated Rate |
$627.50 |
| Max. Negotiated Rate |
$2,391.09 |
| Rate for Payer: Aetna Commercial |
$1,306.10
|
| Rate for Payer: Aetna Medicare |
$974.70
|
| Rate for Payer: BCBS Complete |
$658.88
|
| Rate for Payer: BCBS MAPPO |
$974.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,391.09
|
| Rate for Payer: BCN Commercial |
$1,444.05
|
| Rate for Payer: BCN Medicare Advantage |
$974.70
|
| Rate for Payer: Cash Price |
$1,549.60
|
| Rate for Payer: Cash Price |
$1,549.60
|
| Rate for Payer: Cofinity Commercial |
$1,403.57
|
| Rate for Payer: Cofinity Commercial |
$1,306.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.70
|
| Rate for Payer: Healthscope Commercial |
$1,169.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,169.64
|
| Rate for Payer: Meridian Medicaid |
$658.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,023.44
|
| Rate for Payer: PACE SWMI |
$974.70
|
| Rate for Payer: PHP Medicare Advantage |
$974.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,398.97
|
| Rate for Payer: Priority Health Medicare |
$974.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,398.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.94
|
|
|
PR CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 57300
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$2,627.76 |
| Rate for Payer: Aetna Commercial |
$807.04
|
| Rate for Payer: Aetna Medicare |
$602.27
|
| Rate for Payer: BCBS Complete |
$414.88
|
| Rate for Payer: BCBS MAPPO |
$602.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,627.76
|
| Rate for Payer: BCN Commercial |
$898.67
|
| Rate for Payer: BCN Medicare Advantage |
$602.27
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cofinity Commercial |
$867.27
|
| Rate for Payer: Cofinity Commercial |
$807.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.27
|
| Rate for Payer: Healthscope Commercial |
$722.72
|
| Rate for Payer: Healthscope Whirlpool |
$722.72
|
| Rate for Payer: Meridian Medicaid |
$414.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$632.38
|
| Rate for Payer: PACE SWMI |
$602.27
|
| Rate for Payer: PHP Medicare Advantage |
$602.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.63
|
| Rate for Payer: Priority Health Medicare |
$602.27
|
| Rate for Payer: Priority Health Narrow Network |
$870.63
|
| Rate for Payer: UHC Medicare Advantage |
$620.34
|
|
|
PR CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 53520
|
| Min. Negotiated Rate |
$256.23 |
| Max. Negotiated Rate |
$893.75 |
| Rate for Payer: Aetna Commercial |
$731.00
|
| Rate for Payer: Aetna Medicare |
$545.52
|
| Rate for Payer: BCBS Complete |
$375.51
|
| Rate for Payer: BCBS MAPPO |
$545.52
|
| Rate for Payer: BCBS Trust/PPO |
$256.23
|
| Rate for Payer: BCN Commercial |
$808.27
|
| Rate for Payer: BCN Medicare Advantage |
$545.52
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cofinity Commercial |
$785.55
|
| Rate for Payer: Cofinity Commercial |
$731.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$545.52
|
| Rate for Payer: Healthscope Commercial |
$654.62
|
| Rate for Payer: Healthscope Whirlpool |
$654.62
|
| Rate for Payer: Meridian Medicaid |
$375.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$572.80
|
| Rate for Payer: PACE SWMI |
$545.52
|
| Rate for Payer: PHP Medicare Advantage |
$545.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.75
|
| Rate for Payer: Priority Health Medicare |
$545.52
|
| Rate for Payer: Priority Health Narrow Network |
$893.75
|
| Rate for Payer: UHC Medicare Advantage |
$561.89
|
|
|
PR CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
HCPCS 57311
|
| Min. Negotiated Rate |
$356.78 |
| Max. Negotiated Rate |
$2,101.05 |
| Rate for Payer: Aetna Commercial |
$728.17
|
| Rate for Payer: Aetna Medicare |
$543.41
|
| Rate for Payer: BCBS Complete |
$374.62
|
| Rate for Payer: BCBS MAPPO |
$543.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,101.05
|
| Rate for Payer: BCN Commercial |
$808.27
|
| Rate for Payer: BCN Medicare Advantage |
$543.41
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cofinity Commercial |
$782.51
|
| Rate for Payer: Cofinity Commercial |
$728.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$543.41
|
| Rate for Payer: Healthscope Commercial |
$652.09
|
| Rate for Payer: Healthscope Whirlpool |
$652.09
|
| Rate for Payer: Meridian Medicaid |
$374.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$570.58
|
| Rate for Payer: PACE SWMI |
$543.41
|
| Rate for Payer: PHP Medicare Advantage |
$543.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$356.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$783.04
|
| Rate for Payer: Priority Health Medicare |
$543.41
|
| Rate for Payer: Priority Health Narrow Network |
$783.04
|
| Rate for Payer: UHC Medicare Advantage |
$559.71
|
|
|
PR CLSR VESICOVAGINAL FISTUL AABDL APPROACH
|
Professional
|
Both
|
$3,839.00
|
|
|
Service Code
|
HCPCS 51900
|
| Min. Negotiated Rate |
$524.19 |
| Max. Negotiated Rate |
$2,687.30 |
| Rate for Payer: Aetna Commercial |
$1,077.80
|
| Rate for Payer: Aetna Medicare |
$804.33
|
| Rate for Payer: BCBS Complete |
$550.40
|
| Rate for Payer: BCBS MAPPO |
$804.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.35
|
| Rate for Payer: BCN Commercial |
$1,187.98
|
| Rate for Payer: BCN Medicare Advantage |
$804.33
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cofinity Commercial |
$1,158.24
|
| Rate for Payer: Cofinity Commercial |
$1,077.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.33
|
| Rate for Payer: Healthscope Commercial |
$965.20
|
| Rate for Payer: Healthscope Whirlpool |
$965.20
|
| Rate for Payer: Meridian Medicaid |
$550.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$844.55
|
| Rate for Payer: PACE SWMI |
$804.33
|
| Rate for Payer: PHP Medicare Advantage |
$804.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$524.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,687.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,313.61
|
| Rate for Payer: Priority Health Medicare |
$804.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,313.61
|
| Rate for Payer: UHC Medicare Advantage |
$828.46
|
|
|
PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 15155
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,166.47 |
| Rate for Payer: Aetna Commercial |
$956.57
|
| Rate for Payer: Aetna Medicare |
$713.86
|
| Rate for Payer: BCBS Complete |
$488.90
|
| Rate for Payer: BCBS MAPPO |
$713.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,166.47
|
| Rate for Payer: BCN Medicare Advantage |
$713.86
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$956.57
|
| Rate for Payer: Cofinity Commercial |
$1,027.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$713.86
|
| Rate for Payer: Healthscope Commercial |
$856.63
|
| Rate for Payer: Healthscope Whirlpool |
$856.63
|
| Rate for Payer: Meridian Medicaid |
$488.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$749.55
|
| Rate for Payer: PACE SWMI |
$713.86
|
| Rate for Payer: PHP Medicare Advantage |
$713.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$896.06
|
| Rate for Payer: Priority Health Medicare |
$713.86
|
| Rate for Payer: Priority Health Narrow Network |
$896.06
|
| Rate for Payer: UHC Medicare Advantage |
$735.28
|
|
|
PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 15156
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$200.37
|
| Rate for Payer: Aetna Medicare |
$149.53
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$149.53
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$231.63
|
| Rate for Payer: BCN Medicare Advantage |
$149.53
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$215.32
|
| Rate for Payer: Cofinity Commercial |
$200.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.53
|
| Rate for Payer: Healthscope Commercial |
$179.44
|
| Rate for Payer: Healthscope Whirlpool |
$179.44
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.01
|
| Rate for Payer: PACE SWMI |
$149.53
|
| Rate for Payer: PHP Medicare Advantage |
$149.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Medicare |
$149.53
|
| Rate for Payer: Priority Health Narrow Network |
$182.91
|
| Rate for Payer: UHC Medicare Advantage |
$154.02
|
|
|
PR CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 15151
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$206.12 |
| Rate for Payer: Aetna Commercial |
$146.35
|
| Rate for Payer: Aetna Medicare |
$109.22
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$109.22
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$172.50
|
| Rate for Payer: BCN Medicare Advantage |
$109.22
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.22
|
| Rate for Payer: Healthscope Commercial |
$131.06
|
| Rate for Payer: Healthscope Whirlpool |
$131.06
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.68
|
| Rate for Payer: PACE SWMI |
$109.22
|
| Rate for Payer: PHP Medicare Advantage |
$109.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.58
|
| Rate for Payer: Priority Health Medicare |
$109.22
|
| Rate for Payer: Priority Health Narrow Network |
$133.58
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
|
|
PR CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 15152
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: Aetna Medicare |
$139.74
|
| Rate for Payer: BCBS Complete |
$92.37
|
| Rate for Payer: BCBS MAPPO |
$139.74
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$218.44
|
| Rate for Payer: BCN Medicare Advantage |
$139.74
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$201.23
|
| Rate for Payer: Cofinity Commercial |
$187.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.74
|
| Rate for Payer: Healthscope Commercial |
$167.69
|
| Rate for Payer: Healthscope Whirlpool |
$167.69
|
| Rate for Payer: Meridian Medicaid |
$92.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.73
|
| Rate for Payer: PACE SWMI |
$139.74
|
| Rate for Payer: PHP Medicare Advantage |
$139.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.23
|
| Rate for Payer: Priority Health Medicare |
$139.74
|
| Rate for Payer: Priority Health Narrow Network |
$172.23
|
| Rate for Payer: UHC Medicare Advantage |
$143.93
|
|
|
PR CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
HCPCS 15150
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$1,035.02 |
| Rate for Payer: Aetna Commercial |
$846.99
|
| Rate for Payer: Aetna Medicare |
$632.08
|
| Rate for Payer: BCBS Complete |
$430.53
|
| Rate for Payer: BCBS MAPPO |
$632.08
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$1,035.02
|
| Rate for Payer: BCN Medicare Advantage |
$632.08
|
| Rate for Payer: Cash Price |
$944.80
|
| Rate for Payer: Cash Price |
$944.80
|
| Rate for Payer: Cofinity Commercial |
$846.99
|
| Rate for Payer: Cofinity Commercial |
$910.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.08
|
| Rate for Payer: Healthscope Commercial |
$758.50
|
| Rate for Payer: Healthscope Whirlpool |
$758.50
|
| Rate for Payer: Meridian Medicaid |
$430.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$663.68
|
| Rate for Payer: PACE SWMI |
$632.08
|
| Rate for Payer: PHP Medicare Advantage |
$632.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.31
|
| Rate for Payer: Priority Health Medicare |
$632.08
|
| Rate for Payer: Priority Health Narrow Network |
$786.31
|
| Rate for Payer: UHC Medicare Advantage |
$651.04
|
|
|
PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$2,229.00
|
|
|
Service Code
|
HCPCS 27222
|
| Min. Negotiated Rate |
$631.33 |
| Max. Negotiated Rate |
$2,011.24 |
| Rate for Payer: Aetna Commercial |
$1,303.34
|
| Rate for Payer: Aetna Medicare |
$972.64
|
| Rate for Payer: BCBS Complete |
$662.90
|
| Rate for Payer: BCBS MAPPO |
$972.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,011.24
|
| Rate for Payer: BCN Commercial |
$1,446.98
|
| Rate for Payer: BCN Medicare Advantage |
$972.64
|
| Rate for Payer: Cash Price |
$1,783.20
|
| Rate for Payer: Cash Price |
$1,783.20
|
| Rate for Payer: Cofinity Commercial |
$1,303.34
|
| Rate for Payer: Cofinity Commercial |
$1,400.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$972.64
|
| Rate for Payer: Healthscope Commercial |
$1,167.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,167.17
|
| Rate for Payer: Meridian Medicaid |
$662.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,021.27
|
| Rate for Payer: PACE SWMI |
$972.64
|
| Rate for Payer: PHP Medicare Advantage |
$972.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,560.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.03
|
| Rate for Payer: Priority Health Medicare |
$972.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,512.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,001.82
|
|
|
PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,646.00
|
|
|
Service Code
|
HCPCS 27220
|
| Min. Negotiated Rate |
$269.02 |
| Max. Negotiated Rate |
$2,011.24 |
| Rate for Payer: Aetna Commercial |
$547.63
|
| Rate for Payer: Aetna Medicare |
$408.68
|
| Rate for Payer: BCBS Complete |
$282.47
|
| Rate for Payer: BCBS MAPPO |
$408.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,011.24
|
| Rate for Payer: BCN Commercial |
$620.13
|
| Rate for Payer: BCN Medicare Advantage |
$408.68
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Cofinity Commercial |
$547.63
|
| Rate for Payer: Cofinity Commercial |
$588.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.68
|
| Rate for Payer: Healthscope Commercial |
$490.42
|
| Rate for Payer: Healthscope Whirlpool |
$490.42
|
| Rate for Payer: Meridian Medicaid |
$282.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$429.11
|
| Rate for Payer: PACE SWMI |
$408.68
|
| Rate for Payer: PHP Medicare Advantage |
$408.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.31
|
| Rate for Payer: Priority Health Medicare |
$408.68
|
| Rate for Payer: Priority Health Narrow Network |
$638.31
|
| Rate for Payer: UHC Medicare Advantage |
$420.94
|
|
|
PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$1,704.38 |
| Rate for Payer: Aetna Commercial |
$651.07
|
| Rate for Payer: Aetna Medicare |
$485.87
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$485.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.38
|
| Rate for Payer: BCN Commercial |
$727.64
|
| Rate for Payer: BCN Medicare Advantage |
$485.87
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cofinity Commercial |
$699.65
|
| Rate for Payer: Cofinity Commercial |
$651.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.87
|
| Rate for Payer: Healthscope Commercial |
$583.04
|
| Rate for Payer: Healthscope Whirlpool |
$583.04
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$510.16
|
| Rate for Payer: PACE SWMI |
$485.87
|
| Rate for Payer: PHP Medicare Advantage |
$485.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.36
|
| Rate for Payer: Priority Health Medicare |
$485.87
|
| Rate for Payer: Priority Health Narrow Network |
$760.36
|
| Rate for Payer: UHC Medicare Advantage |
$500.45
|
|
|
PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$917.00
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$183.81 |
| Max. Negotiated Rate |
$641.90 |
| Rate for Payer: Aetna Commercial |
$449.22
|
| Rate for Payer: Aetna Medicare |
$335.24
|
| Rate for Payer: BCBS Complete |
$233.49
|
| Rate for Payer: BCBS MAPPO |
$335.24
|
| Rate for Payer: BCBS Trust/PPO |
$183.81
|
| Rate for Payer: BCN Commercial |
$562.96
|
| Rate for Payer: BCN Medicare Advantage |
$335.24
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cofinity Commercial |
$449.22
|
| Rate for Payer: Cofinity Commercial |
$482.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.24
|
| Rate for Payer: Healthscope Commercial |
$402.29
|
| Rate for Payer: Healthscope Whirlpool |
$402.29
|
| Rate for Payer: Meridian Medicaid |
$233.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$352.00
|
| Rate for Payer: PACE SWMI |
$335.24
|
| Rate for Payer: PHP Medicare Advantage |
$335.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.49
|
| Rate for Payer: Priority Health Medicare |
$335.24
|
| Rate for Payer: Priority Health Narrow Network |
$527.49
|
| Rate for Payer: UHC Medicare Advantage |
$345.30
|
|
|
PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$434.00 |
| Rate for Payer: Aetna Commercial |
$292.44
|
| Rate for Payer: Aetna Medicare |
$218.24
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS MAPPO |
$218.24
|
| Rate for Payer: BCBS Trust/PPO |
$153.74
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$218.24
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cofinity Commercial |
$314.27
|
| Rate for Payer: Cofinity Commercial |
$292.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.24
|
| Rate for Payer: Healthscope Commercial |
$261.89
|
| Rate for Payer: Healthscope Whirlpool |
$261.89
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$229.15
|
| Rate for Payer: PACE SWMI |
$218.24
|
| Rate for Payer: PHP Medicare Advantage |
$218.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.24
|
| Rate for Payer: Priority Health Medicare |
$218.24
|
| Rate for Payer: Priority Health Narrow Network |
$347.24
|
| Rate for Payer: UHC Medicare Advantage |
$224.79
|
|
|
PR CLTX CARPAL BONE FX W/MANJ EACH BONE
|
Professional
|
Both
|
$1,101.00
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$280.73 |
| Max. Negotiated Rate |
$1,016.45 |
| Rate for Payer: Aetna Commercial |
$561.15
|
| Rate for Payer: Aetna Medicare |
$418.77
|
| Rate for Payer: BCBS Complete |
$294.77
|
| Rate for Payer: BCBS MAPPO |
$418.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.45
|
| Rate for Payer: BCN Commercial |
$697.83
|
| Rate for Payer: BCN Medicare Advantage |
$418.77
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cofinity Commercial |
$603.03
|
| Rate for Payer: Cofinity Commercial |
$561.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.77
|
| Rate for Payer: Healthscope Commercial |
$502.52
|
| Rate for Payer: Healthscope Whirlpool |
$502.52
|
| Rate for Payer: Meridian Medicaid |
$294.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$439.71
|
| Rate for Payer: PACE SWMI |
$418.77
|
| Rate for Payer: PHP Medicare Advantage |
$418.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$280.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.29
|
| Rate for Payer: Priority Health Medicare |
$418.77
|
| Rate for Payer: Priority Health Narrow Network |
$661.29
|
| Rate for Payer: UHC Medicare Advantage |
$431.33
|
|
|
PR CLTX CARPAL BONE FX W/O MANJ EACH BONE
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$962.74 |
| Rate for Payer: Aetna Commercial |
$379.38
|
| Rate for Payer: Aetna Medicare |
$283.12
|
| Rate for Payer: BCBS Complete |
$199.27
|
| Rate for Payer: BCBS MAPPO |
$283.12
|
| Rate for Payer: BCBS Trust/PPO |
$962.74
|
| Rate for Payer: BCN Commercial |
$461.32
|
| Rate for Payer: BCN Medicare Advantage |
$283.12
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$379.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.12
|
| Rate for Payer: Healthscope Commercial |
$339.74
|
| Rate for Payer: Healthscope Whirlpool |
$339.74
|
| Rate for Payer: Meridian Medicaid |
$199.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$297.28
|
| Rate for Payer: PACE SWMI |
$283.12
|
| Rate for Payer: PHP Medicare Advantage |
$283.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.84
|
| Rate for Payer: Priority Health Medicare |
$283.12
|
| Rate for Payer: Priority Health Narrow Network |
$447.84
|
| Rate for Payer: UHC Medicare Advantage |
$291.61
|
|
|
PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 26641
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$628.93 |
| Rate for Payer: Aetna Commercial |
$507.24
|
| Rate for Payer: Aetna Medicare |
$378.54
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCBS MAPPO |
$378.54
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$628.93
|
| Rate for Payer: BCN Medicare Advantage |
$378.54
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$507.24
|
| Rate for Payer: Cofinity Commercial |
$545.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.54
|
| Rate for Payer: Healthscope Commercial |
$454.25
|
| Rate for Payer: Healthscope Whirlpool |
$454.25
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$397.47
|
| Rate for Payer: PACE SWMI |
$378.54
|
| Rate for Payer: PHP Medicare Advantage |
$378.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$597.97
|
| Rate for Payer: Priority Health Medicare |
$378.54
|
| Rate for Payer: Priority Health Narrow Network |
$597.97
|
| Rate for Payer: UHC Medicare Advantage |
$389.90
|
|
|
PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 26645
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$698.60 |
| Rate for Payer: Aetna Commercial |
$525.87
|
| Rate for Payer: Aetna Medicare |
$392.44
|
| Rate for Payer: BCBS Complete |
$274.87
|
| Rate for Payer: BCBS MAPPO |
$392.44
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$649.45
|
| Rate for Payer: BCN Medicare Advantage |
$392.44
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cofinity Commercial |
$565.11
|
| Rate for Payer: Cofinity Commercial |
$525.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.44
|
| Rate for Payer: Healthscope Commercial |
$470.93
|
| Rate for Payer: Healthscope Whirlpool |
$470.93
|
| Rate for Payer: Meridian Medicaid |
$274.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$412.06
|
| Rate for Payer: PACE SWMI |
$392.44
|
| Rate for Payer: PHP Medicare Advantage |
$392.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.89
|
| Rate for Payer: Priority Health Medicare |
$392.44
|
| Rate for Payer: Priority Health Narrow Network |
$617.89
|
| Rate for Payer: UHC Medicare Advantage |
$404.21
|
|
|
PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 26670
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$524.35 |
| Rate for Payer: Aetna Commercial |
$417.40
|
| Rate for Payer: Aetna Medicare |
$311.49
|
| Rate for Payer: BCBS Complete |
$219.18
|
| Rate for Payer: BCBS MAPPO |
$311.49
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$524.35
|
| Rate for Payer: BCN Medicare Advantage |
$311.49
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$448.55
|
| Rate for Payer: Cofinity Commercial |
$417.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.49
|
| Rate for Payer: Healthscope Commercial |
$373.79
|
| Rate for Payer: Healthscope Whirlpool |
$373.79
|
| Rate for Payer: Meridian Medicaid |
$219.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.06
|
| Rate for Payer: PACE SWMI |
$311.49
|
| Rate for Payer: PHP Medicare Advantage |
$311.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.20
|
| Rate for Payer: Priority Health Medicare |
$311.49
|
| Rate for Payer: Priority Health Narrow Network |
$489.20
|
| Rate for Payer: UHC Medicare Advantage |
$320.83
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Aetna Commercial |
$561.67
|
| Rate for Payer: Aetna Medicare |
$419.16
|
| Rate for Payer: BCBS Complete |
$293.65
|
| Rate for Payer: BCBS MAPPO |
$419.16
|
| Rate for Payer: BCBS Trust/PPO |
$46.70
|
| Rate for Payer: BCN Commercial |
$692.95
|
| Rate for Payer: BCN Medicare Advantage |
$419.16
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$561.67
|
| Rate for Payer: Cofinity Commercial |
$603.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.16
|
| Rate for Payer: Healthscope Commercial |
$502.99
|
| Rate for Payer: Healthscope Whirlpool |
$502.99
|
| Rate for Payer: Meridian Medicaid |
$293.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$440.12
|
| Rate for Payer: PACE SWMI |
$419.16
|
| Rate for Payer: PHP Medicare Advantage |
$419.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$660.27
|
| Rate for Payer: Priority Health Medicare |
$419.16
|
| Rate for Payer: Priority Health Narrow Network |
$660.27
|
| Rate for Payer: UHC Medicare Advantage |
$431.73
|
|
|
PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27516
|
| Min. Negotiated Rate |
$319.71 |
| Max. Negotiated Rate |
$1,829.50 |
| Rate for Payer: Aetna Commercial |
$642.88
|
| Rate for Payer: Aetna Medicare |
$479.76
|
| Rate for Payer: BCBS Complete |
$335.70
|
| Rate for Payer: BCBS MAPPO |
$479.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,829.50
|
| Rate for Payer: BCN Commercial |
$773.09
|
| Rate for Payer: BCN Medicare Advantage |
$479.76
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$690.85
|
| Rate for Payer: Cofinity Commercial |
$642.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.76
|
| Rate for Payer: Healthscope Commercial |
$575.71
|
| Rate for Payer: Healthscope Whirlpool |
$575.71
|
| Rate for Payer: Meridian Medicaid |
$335.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$503.75
|
| Rate for Payer: PACE SWMI |
$479.76
|
| Rate for Payer: PHP Medicare Advantage |
$479.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.25
|
| Rate for Payer: Priority Health Medicare |
$479.76
|
| Rate for Payer: Priority Health Narrow Network |
$755.25
|
| Rate for Payer: UHC Medicare Advantage |
$494.15
|
|
