|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$439.90 |
| Max. Negotiated Rate |
$989.30 |
| Rate for Payer: Aetna Commercial |
$589.47
|
| Rate for Payer: Aetna Medicare |
$439.90
|
| Rate for Payer: BCBS Complete |
$608.80
|
| Rate for Payer: BCBS MAPPO |
$439.90
|
| Rate for Payer: BCN Medicare Advantage |
$439.90
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cofinity Commercial |
$633.46
|
| Rate for Payer: Cofinity Commercial |
$589.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.90
|
| Rate for Payer: Healthscope Commercial |
$527.88
|
| Rate for Payer: Healthscope Whirlpool |
$527.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.89
|
| Rate for Payer: Nomi Health Commercial |
$527.88
|
| Rate for Payer: PACE SWMI |
$439.90
|
| Rate for Payer: PHP Medicare Advantage |
$439.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.30
|
| Rate for Payer: Priority Health Medicare |
$439.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.90
|
| Rate for Payer: UHC Medicare Advantage |
$439.90
|
| Rate for Payer: UHCCP DNSP |
$439.90
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$569.72 |
| Max. Negotiated Rate |
$929.50 |
| Rate for Payer: Aetna Commercial |
$763.42
|
| Rate for Payer: Aetna Medicare |
$569.72
|
| Rate for Payer: BCBS Complete |
$572.00
|
| Rate for Payer: BCBS MAPPO |
$569.72
|
| Rate for Payer: BCN Medicare Advantage |
$569.72
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$820.40
|
| Rate for Payer: Cofinity Commercial |
$763.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.72
|
| Rate for Payer: Healthscope Commercial |
$683.66
|
| Rate for Payer: Healthscope Whirlpool |
$683.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.21
|
| Rate for Payer: Nomi Health Commercial |
$683.66
|
| Rate for Payer: PACE SWMI |
$569.72
|
| Rate for Payer: PHP Medicare Advantage |
$569.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.50
|
| Rate for Payer: Priority Health Medicare |
$569.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.72
|
| Rate for Payer: UHC Medicare Advantage |
$569.72
|
| Rate for Payer: UHCCP DNSP |
$569.72
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$2,957.00
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$637.10 |
| Max. Negotiated Rate |
$1,922.05 |
| Rate for Payer: Aetna Commercial |
$853.71
|
| Rate for Payer: Aetna Medicare |
$637.10
|
| Rate for Payer: BCBS Complete |
$1,182.80
|
| Rate for Payer: BCBS MAPPO |
$637.10
|
| Rate for Payer: BCN Medicare Advantage |
$637.10
|
| Rate for Payer: Cash Price |
$2,365.60
|
| Rate for Payer: Cash Price |
$2,365.60
|
| Rate for Payer: Cofinity Commercial |
$917.42
|
| Rate for Payer: Cofinity Commercial |
$853.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.10
|
| Rate for Payer: Healthscope Commercial |
$764.52
|
| Rate for Payer: Healthscope Whirlpool |
$764.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.96
|
| Rate for Payer: Nomi Health Commercial |
$764.52
|
| Rate for Payer: PACE SWMI |
$637.10
|
| Rate for Payer: PHP Medicare Advantage |
$637.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,922.05
|
| Rate for Payer: Priority Health Medicare |
$637.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.10
|
| Rate for Payer: UHC Medicare Advantage |
$637.10
|
| Rate for Payer: UHCCP DNSP |
$637.10
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,082.04 |
| Rate for Payer: Aetna Commercial |
$1,006.90
|
| Rate for Payer: Aetna Medicare |
$751.42
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$751.42
|
| Rate for Payer: BCN Medicare Advantage |
$751.42
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,082.04
|
| Rate for Payer: Cofinity Commercial |
$1,006.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.42
|
| Rate for Payer: Healthscope Commercial |
$901.70
|
| Rate for Payer: Healthscope Whirlpool |
$901.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.99
|
| Rate for Payer: Nomi Health Commercial |
$901.70
|
| Rate for Payer: PACE SWMI |
$751.42
|
| Rate for Payer: PHP Medicare Advantage |
$751.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health Medicare |
$751.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.42
|
| Rate for Payer: UHC Medicare Advantage |
$751.42
|
| Rate for Payer: UHCCP DNSP |
$751.42
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$3,099.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$886.87 |
| Max. Negotiated Rate |
$2,014.35 |
| Rate for Payer: Aetna Commercial |
$1,188.41
|
| Rate for Payer: Aetna Medicare |
$886.87
|
| Rate for Payer: BCBS Complete |
$1,239.60
|
| Rate for Payer: BCBS MAPPO |
$886.87
|
| Rate for Payer: BCN Medicare Advantage |
$886.87
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cofinity Commercial |
$1,277.09
|
| Rate for Payer: Cofinity Commercial |
$1,188.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.87
|
| Rate for Payer: Healthscope Commercial |
$1,064.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$931.21
|
| Rate for Payer: Nomi Health Commercial |
$1,064.24
|
| Rate for Payer: PACE SWMI |
$886.87
|
| Rate for Payer: PHP Medicare Advantage |
$886.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,014.35
|
| Rate for Payer: Priority Health Medicare |
$886.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.87
|
| Rate for Payer: UHC Medicare Advantage |
$886.87
|
| Rate for Payer: UHCCP DNSP |
$886.87
|
|
|
PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 36600
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna Commercial |
$18.84
|
| Rate for Payer: Aetna Medicare |
$14.06
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS MAPPO |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$14.06
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Whirlpool |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.76
|
| Rate for Payer: Nomi Health Commercial |
$16.87
|
| Rate for Payer: PACE SWMI |
$14.06
|
| Rate for Payer: PHP Medicare Advantage |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Medicare |
$14.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.06
|
| Rate for Payer: UHC Medicare Advantage |
$14.06
|
| Rate for Payer: UHCCP DNSP |
$14.06
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$630.80 |
| Max. Negotiated Rate |
$1,454.70 |
| Rate for Payer: Aetna Commercial |
$845.27
|
| Rate for Payer: Aetna Medicare |
$630.80
|
| Rate for Payer: BCBS Complete |
$895.20
|
| Rate for Payer: BCBS MAPPO |
$630.80
|
| Rate for Payer: BCN Medicare Advantage |
$630.80
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cofinity Commercial |
$908.35
|
| Rate for Payer: Cofinity Commercial |
$845.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.80
|
| Rate for Payer: Healthscope Commercial |
$756.96
|
| Rate for Payer: Healthscope Whirlpool |
$756.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$662.34
|
| Rate for Payer: Nomi Health Commercial |
$756.96
|
| Rate for Payer: PACE SWMI |
$630.80
|
| Rate for Payer: PHP Medicare Advantage |
$630.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.70
|
| Rate for Payer: Priority Health Medicare |
$630.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$630.80
|
| Rate for Payer: UHC Medicare Advantage |
$630.80
|
| Rate for Payer: UHCCP DNSP |
$630.80
|
|
|
PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 33987
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Aetna Commercial |
$265.21
|
| Rate for Payer: Aetna Medicare |
$197.92
|
| Rate for Payer: BCBS Complete |
$176.80
|
| Rate for Payer: BCBS MAPPO |
$197.92
|
| Rate for Payer: BCN Medicare Advantage |
$197.92
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$285.00
|
| Rate for Payer: Cofinity Commercial |
$265.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.92
|
| Rate for Payer: Healthscope Commercial |
$237.50
|
| Rate for Payer: Healthscope Whirlpool |
$237.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.82
|
| Rate for Payer: Nomi Health Commercial |
$237.50
|
| Rate for Payer: PACE SWMI |
$197.92
|
| Rate for Payer: PHP Medicare Advantage |
$197.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health Medicare |
$197.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.92
|
| Rate for Payer: UHC Medicare Advantage |
$197.92
|
| Rate for Payer: UHCCP DNSP |
$197.92
|
|
|
PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$4,416.00
|
|
|
Service Code
|
HCPCS 22551
|
| Min. Negotiated Rate |
$1,666.04 |
| Max. Negotiated Rate |
$2,870.40 |
| Rate for Payer: Aetna Commercial |
$2,232.49
|
| Rate for Payer: Aetna Medicare |
$1,666.04
|
| Rate for Payer: BCBS Complete |
$1,766.40
|
| Rate for Payer: BCBS MAPPO |
$1,666.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.04
|
| Rate for Payer: Cash Price |
$3,532.80
|
| Rate for Payer: Cash Price |
$3,532.80
|
| Rate for Payer: Cofinity Commercial |
$2,399.10
|
| Rate for Payer: Cofinity Commercial |
$2,232.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.04
|
| Rate for Payer: Healthscope Commercial |
$1,999.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,999.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,749.34
|
| Rate for Payer: Nomi Health Commercial |
$1,999.25
|
| Rate for Payer: PACE SWMI |
$1,666.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,870.40
|
| Rate for Payer: Priority Health Medicare |
$1,666.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.04
|
| Rate for Payer: UHCCP DNSP |
$1,666.04
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$4,916.00
|
|
|
Service Code
|
HCPCS 22554
|
| Min. Negotiated Rate |
$1,235.93 |
| Max. Negotiated Rate |
$3,195.40 |
| Rate for Payer: Aetna Commercial |
$1,656.15
|
| Rate for Payer: Aetna Medicare |
$1,235.93
|
| Rate for Payer: BCBS Complete |
$1,966.40
|
| Rate for Payer: BCBS MAPPO |
$1,235.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,235.93
|
| Rate for Payer: Cash Price |
$3,932.80
|
| Rate for Payer: Cash Price |
$3,932.80
|
| Rate for Payer: Cofinity Commercial |
$1,779.74
|
| Rate for Payer: Cofinity Commercial |
$1,656.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,235.93
|
| Rate for Payer: Healthscope Commercial |
$1,483.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,483.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,297.73
|
| Rate for Payer: Nomi Health Commercial |
$1,483.12
|
| Rate for Payer: PACE SWMI |
$1,235.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,235.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,195.40
|
| Rate for Payer: Priority Health Medicare |
$1,235.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,235.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,235.93
|
| Rate for Payer: UHCCP DNSP |
$1,235.93
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC LUMBAR
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 22558
|
| Min. Negotiated Rate |
$1,276.00 |
| Max. Negotiated Rate |
$2,140.80 |
| Rate for Payer: Aetna Commercial |
$1,992.14
|
| Rate for Payer: Aetna Medicare |
$1,486.67
|
| Rate for Payer: BCBS Complete |
$1,276.00
|
| Rate for Payer: BCBS MAPPO |
$1,486.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,486.67
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cofinity Commercial |
$2,140.80
|
| Rate for Payer: Cofinity Commercial |
$1,992.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,486.67
|
| Rate for Payer: Healthscope Commercial |
$1,784.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,784.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,561.00
|
| Rate for Payer: Nomi Health Commercial |
$1,784.00
|
| Rate for Payer: PACE SWMI |
$1,486.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,486.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.50
|
| Rate for Payer: Priority Health Medicare |
$1,486.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,486.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,486.67
|
| Rate for Payer: UHCCP DNSP |
$1,486.67
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC THORACIC
|
Professional
|
Both
|
$5,983.00
|
|
|
Service Code
|
HCPCS 22556
|
| Min. Negotiated Rate |
$1,647.67 |
| Max. Negotiated Rate |
$3,888.95 |
| Rate for Payer: Aetna Commercial |
$2,207.88
|
| Rate for Payer: Aetna Medicare |
$1,647.67
|
| Rate for Payer: BCBS Complete |
$2,393.20
|
| Rate for Payer: BCBS MAPPO |
$1,647.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,647.67
|
| Rate for Payer: Cash Price |
$4,786.40
|
| Rate for Payer: Cash Price |
$4,786.40
|
| Rate for Payer: Cofinity Commercial |
$2,372.64
|
| Rate for Payer: Cofinity Commercial |
$2,207.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,647.67
|
| Rate for Payer: Healthscope Commercial |
$1,977.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,977.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,730.05
|
| Rate for Payer: Nomi Health Commercial |
$1,977.20
|
| Rate for Payer: PACE SWMI |
$1,647.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,647.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.95
|
| Rate for Payer: Priority Health Medicare |
$1,647.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,647.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,647.67
|
| Rate for Payer: UHCCP DNSP |
$1,647.67
|
|
|
PR ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 22552
|
| Min. Negotiated Rate |
$387.64 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$519.44
|
| Rate for Payer: Aetna Medicare |
$387.64
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$387.64
|
| Rate for Payer: BCN Medicare Advantage |
$387.64
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$558.20
|
| Rate for Payer: Cofinity Commercial |
$519.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.64
|
| Rate for Payer: Healthscope Commercial |
$465.17
|
| Rate for Payer: Healthscope Whirlpool |
$465.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.02
|
| Rate for Payer: Nomi Health Commercial |
$465.17
|
| Rate for Payer: PACE SWMI |
$387.64
|
| Rate for Payer: PHP Medicare Advantage |
$387.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$387.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.64
|
| Rate for Payer: UHC Medicare Advantage |
$387.64
|
| Rate for Payer: UHCCP DNSP |
$387.64
|
|
|
PR ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 22585
|
| Min. Negotiated Rate |
$315.88 |
| Max. Negotiated Rate |
$1,083.55 |
| Rate for Payer: Aetna Commercial |
$423.28
|
| Rate for Payer: Aetna Medicare |
$315.88
|
| Rate for Payer: BCBS Complete |
$666.80
|
| Rate for Payer: BCBS MAPPO |
$315.88
|
| Rate for Payer: BCN Medicare Advantage |
$315.88
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cofinity Commercial |
$454.87
|
| Rate for Payer: Cofinity Commercial |
$423.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.88
|
| Rate for Payer: Healthscope Commercial |
$379.06
|
| Rate for Payer: Healthscope Whirlpool |
$379.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.67
|
| Rate for Payer: Nomi Health Commercial |
$379.06
|
| Rate for Payer: PACE SWMI |
$315.88
|
| Rate for Payer: PHP Medicare Advantage |
$315.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.55
|
| Rate for Payer: Priority Health Medicare |
$315.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.88
|
| Rate for Payer: UHC Medicare Advantage |
$315.88
|
| Rate for Payer: UHCCP DNSP |
$315.88
|
|
|
PR ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH
|
Professional
|
Both
|
$3,111.00
|
|
|
Service Code
|
HCPCS 26843
|
| Min. Negotiated Rate |
$734.26 |
| Max. Negotiated Rate |
$2,022.15 |
| Rate for Payer: Aetna Commercial |
$983.91
|
| Rate for Payer: Aetna Medicare |
$734.26
|
| Rate for Payer: BCBS Complete |
$1,244.40
|
| Rate for Payer: BCBS MAPPO |
$734.26
|
| Rate for Payer: BCN Medicare Advantage |
$734.26
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cofinity Commercial |
$983.91
|
| Rate for Payer: Cofinity Commercial |
$1,057.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$734.26
|
| Rate for Payer: Healthscope Commercial |
$881.11
|
| Rate for Payer: Healthscope Whirlpool |
$881.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.97
|
| Rate for Payer: Nomi Health Commercial |
$881.11
|
| Rate for Payer: PACE SWMI |
$734.26
|
| Rate for Payer: PHP Medicare Advantage |
$734.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,022.15
|
| Rate for Payer: Priority Health Medicare |
$734.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$734.26
|
| Rate for Payer: UHC Medicare Advantage |
$734.26
|
| Rate for Payer: UHCCP DNSP |
$734.26
|
|
|
PR ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT
|
Professional
|
Both
|
$3,348.00
|
|
|
Service Code
|
HCPCS 26844
|
| Min. Negotiated Rate |
$810.55 |
| Max. Negotiated Rate |
$2,176.20 |
| Rate for Payer: Aetna Commercial |
$1,086.14
|
| Rate for Payer: Aetna Medicare |
$810.55
|
| Rate for Payer: BCBS Complete |
$1,339.20
|
| Rate for Payer: BCBS MAPPO |
$810.55
|
| Rate for Payer: BCN Medicare Advantage |
$810.55
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.19
|
| Rate for Payer: Cofinity Commercial |
$1,086.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.55
|
| Rate for Payer: Healthscope Commercial |
$972.66
|
| Rate for Payer: Healthscope Whirlpool |
$972.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.08
|
| Rate for Payer: Nomi Health Commercial |
$972.66
|
| Rate for Payer: PACE SWMI |
$810.55
|
| Rate for Payer: PHP Medicare Advantage |
$810.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.20
|
| Rate for Payer: Priority Health Medicare |
$810.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.55
|
| Rate for Payer: UHC Medicare Advantage |
$810.55
|
| Rate for Payer: UHCCP DNSP |
$810.55
|
|
|
PR ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ
|
Professional
|
Both
|
$3,111.00
|
|
|
Service Code
|
HCPCS 26841
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$2,022.15 |
| Rate for Payer: Aetna Commercial |
$970.16
|
| Rate for Payer: Aetna Medicare |
$724.00
|
| Rate for Payer: BCBS Complete |
$1,244.40
|
| Rate for Payer: BCBS MAPPO |
$724.00
|
| Rate for Payer: BCN Medicare Advantage |
$724.00
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cofinity Commercial |
$970.16
|
| Rate for Payer: Cofinity Commercial |
$1,042.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.00
|
| Rate for Payer: Healthscope Commercial |
$868.80
|
| Rate for Payer: Healthscope Whirlpool |
$868.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.20
|
| Rate for Payer: Nomi Health Commercial |
$868.80
|
| Rate for Payer: PACE SWMI |
$724.00
|
| Rate for Payer: PHP Medicare Advantage |
$724.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,022.15
|
| Rate for Payer: Priority Health Medicare |
$724.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.00
|
| Rate for Payer: UHC Medicare Advantage |
$724.00
|
| Rate for Payer: UHCCP DNSP |
$724.00
|
|
|
PR ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 26842
|
| Min. Negotiated Rate |
$783.25 |
| Max. Negotiated Rate |
$2,145.00 |
| Rate for Payer: Aetna Commercial |
$1,049.56
|
| Rate for Payer: Aetna Medicare |
$783.25
|
| Rate for Payer: BCBS Complete |
$1,320.00
|
| Rate for Payer: BCBS MAPPO |
$783.25
|
| Rate for Payer: BCN Medicare Advantage |
$783.25
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,127.88
|
| Rate for Payer: Cofinity Commercial |
$1,049.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$783.25
|
| Rate for Payer: Healthscope Commercial |
$939.90
|
| Rate for Payer: Healthscope Whirlpool |
$939.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$822.41
|
| Rate for Payer: Nomi Health Commercial |
$939.90
|
| Rate for Payer: PACE SWMI |
$783.25
|
| Rate for Payer: PHP Medicare Advantage |
$783.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,145.00
|
| Rate for Payer: Priority Health Medicare |
$783.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$783.25
|
| Rate for Payer: UHC Medicare Advantage |
$783.25
|
| Rate for Payer: UHCCP DNSP |
$783.25
|
|
|
PR ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
HCPCS 25830
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$1,394.97 |
| Rate for Payer: Aetna Commercial |
$1,298.10
|
| Rate for Payer: Aetna Medicare |
$968.73
|
| Rate for Payer: BCBS Complete |
$674.40
|
| Rate for Payer: BCBS MAPPO |
$968.73
|
| Rate for Payer: BCN Medicare Advantage |
$968.73
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cofinity Commercial |
$1,394.97
|
| Rate for Payer: Cofinity Commercial |
$1,298.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.73
|
| Rate for Payer: Healthscope Commercial |
$1,162.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,162.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,017.17
|
| Rate for Payer: Nomi Health Commercial |
$1,162.48
|
| Rate for Payer: PACE SWMI |
$968.73
|
| Rate for Payer: PHP Medicare Advantage |
$968.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.90
|
| Rate for Payer: Priority Health Medicare |
$968.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.73
|
| Rate for Payer: UHC Medicare Advantage |
$968.73
|
| Rate for Payer: UHCCP DNSP |
$968.73
|
|
|
PR ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT
|
Professional
|
Both
|
$2,872.00
|
|
|
Service Code
|
HCPCS 28735
|
| Min. Negotiated Rate |
$749.18 |
| Max. Negotiated Rate |
$1,866.80 |
| Rate for Payer: Aetna Commercial |
$1,003.90
|
| Rate for Payer: Aetna Medicare |
$749.18
|
| Rate for Payer: BCBS Complete |
$1,148.80
|
| Rate for Payer: BCBS MAPPO |
$749.18
|
| Rate for Payer: BCN Medicare Advantage |
$749.18
|
| Rate for Payer: Cash Price |
$2,297.60
|
| Rate for Payer: Cash Price |
$2,297.60
|
| Rate for Payer: Cofinity Commercial |
$1,078.82
|
| Rate for Payer: Cofinity Commercial |
$1,003.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.18
|
| Rate for Payer: Healthscope Commercial |
$899.02
|
| Rate for Payer: Healthscope Whirlpool |
$899.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.64
|
| Rate for Payer: Nomi Health Commercial |
$899.02
|
| Rate for Payer: PACE SWMI |
$749.18
|
| Rate for Payer: PHP Medicare Advantage |
$749.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.80
|
| Rate for Payer: Priority Health Medicare |
$749.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$749.18
|
| Rate for Payer: UHC Medicare Advantage |
$749.18
|
| Rate for Payer: UHCCP DNSP |
$749.18
|
|
|
PR ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS
|
Professional
|
Both
|
$2,783.00
|
|
|
Service Code
|
HCPCS 28730
|
| Min. Negotiated Rate |
$694.84 |
| Max. Negotiated Rate |
$1,808.95 |
| Rate for Payer: Aetna Commercial |
$931.09
|
| Rate for Payer: Aetna Medicare |
$694.84
|
| Rate for Payer: BCBS Complete |
$1,113.20
|
| Rate for Payer: BCBS MAPPO |
$694.84
|
| Rate for Payer: BCN Medicare Advantage |
$694.84
|
| Rate for Payer: Cash Price |
$2,226.40
|
| Rate for Payer: Cash Price |
$2,226.40
|
| Rate for Payer: Cofinity Commercial |
$931.09
|
| Rate for Payer: Cofinity Commercial |
$1,000.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.84
|
| Rate for Payer: Healthscope Commercial |
$833.81
|
| Rate for Payer: Healthscope Whirlpool |
$833.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.58
|
| Rate for Payer: Nomi Health Commercial |
$833.81
|
| Rate for Payer: PACE SWMI |
$694.84
|
| Rate for Payer: PHP Medicare Advantage |
$694.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,808.95
|
| Rate for Payer: Priority Health Medicare |
$694.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.84
|
| Rate for Payer: UHC Medicare Advantage |
$694.84
|
| Rate for Payer: UHCCP DNSP |
$694.84
|
|
|
PR ARTHRD PST/PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT
|
Professional
|
Both
|
$4,367.00
|
|
|
Service Code
|
HCPCS 22600
|
| Min. Negotiated Rate |
$1,279.19 |
| Max. Negotiated Rate |
$2,838.55 |
| Rate for Payer: Aetna Commercial |
$1,714.11
|
| Rate for Payer: Aetna Medicare |
$1,279.19
|
| Rate for Payer: BCBS Complete |
$1,746.80
|
| Rate for Payer: BCBS MAPPO |
$1,279.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.19
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cash Price |
$3,493.60
|
| Rate for Payer: Cofinity Commercial |
$1,842.03
|
| Rate for Payer: Cofinity Commercial |
$1,714.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.19
|
| Rate for Payer: Healthscope Commercial |
$1,535.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,535.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.15
|
| Rate for Payer: Nomi Health Commercial |
$1,535.03
|
| Rate for Payer: PACE SWMI |
$1,279.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.55
|
| Rate for Payer: Priority Health Medicare |
$1,279.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.19
|
| Rate for Payer: UHCCP DNSP |
$1,279.19
|
|
|
PR ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 28737
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$948.27 |
| Rate for Payer: Aetna Commercial |
$882.42
|
| Rate for Payer: Aetna Medicare |
$658.52
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: BCBS MAPPO |
$658.52
|
| Rate for Payer: BCN Medicare Advantage |
$658.52
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Commercial |
$948.27
|
| Rate for Payer: Cofinity Commercial |
$882.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.52
|
| Rate for Payer: Healthscope Commercial |
$790.22
|
| Rate for Payer: Healthscope Whirlpool |
$790.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.45
|
| Rate for Payer: Nomi Health Commercial |
$790.22
|
| Rate for Payer: PACE SWMI |
$658.52
|
| Rate for Payer: PHP Medicare Advantage |
$658.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
| Rate for Payer: Priority Health Medicare |
$658.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.52
|
| Rate for Payer: UHC Medicare Advantage |
$658.52
|
| Rate for Payer: UHCCP DNSP |
$658.52
|
|
|
PR ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 28760
|
| Min. Negotiated Rate |
$546.43 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$732.22
|
| Rate for Payer: Aetna Medicare |
$546.43
|
| Rate for Payer: BCBS Complete |
$588.80
|
| Rate for Payer: BCBS MAPPO |
$546.43
|
| Rate for Payer: BCN Medicare Advantage |
$546.43
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cofinity Commercial |
$786.86
|
| Rate for Payer: Cofinity Commercial |
$732.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.43
|
| Rate for Payer: Healthscope Commercial |
$655.72
|
| Rate for Payer: Healthscope Whirlpool |
$655.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.75
|
| Rate for Payer: Nomi Health Commercial |
$655.72
|
| Rate for Payer: PACE SWMI |
$546.43
|
| Rate for Payer: PHP Medicare Advantage |
$546.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: Priority Health Medicare |
$546.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.43
|
| Rate for Payer: UHC Medicare Advantage |
$546.43
|
| Rate for Payer: UHCCP DNSP |
$546.43
|
|
|
PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 20605
|
| Min. Negotiated Rate |
$35.05 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Aetna Medicare |
$35.05
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$35.05
|
| Rate for Payer: BCN Medicare Advantage |
$35.05
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.05
|
| Rate for Payer: Healthscope Commercial |
$42.06
|
| Rate for Payer: Healthscope Whirlpool |
$42.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.80
|
| Rate for Payer: Nomi Health Commercial |
$42.06
|
| Rate for Payer: PACE SWMI |
$35.05
|
| Rate for Payer: PHP Medicare Advantage |
$35.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Medicare |
$35.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.05
|
| Rate for Payer: UHC Medicare Advantage |
$35.05
|
| Rate for Payer: UHCCP DNSP |
$35.05
|
|
