|
PR CLTX CARPAL BONE FX W/MNPJ EACH BONE
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$1,016.45 |
| Rate for Payer: Aetna Commercial |
$560.87
|
| Rate for Payer: Aetna Medicare |
$561.50
|
| Rate for Payer: BCBS Complete |
$297.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.45
|
| Rate for Payer: BCN Commercial |
$697.83
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Meridian Medicaid |
$297.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$670.68
|
| Rate for Payer: Priority Health Narrow Network |
$670.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.82
|
| Rate for Payer: UHC Exchange |
$434.82
|
| Rate for Payer: UHCCP Medicaid |
$283.72
|
|
|
PR CLTX CARPAL BONE FX W/O MNPJ EACH BONE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$962.74 |
| Rate for Payer: Aetna Commercial |
$376.68
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$202.18
|
| Rate for Payer: BCBS Trust/PPO |
$962.74
|
| Rate for Payer: BCN Commercial |
$461.32
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Meridian Medicaid |
$202.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.39
|
| Rate for Payer: Priority Health Narrow Network |
$453.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.44
|
| Rate for Payer: UHC Exchange |
$298.44
|
| Rate for Payer: UHCCP Medicaid |
$192.55
|
|
|
PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 26641
|
| Min. Negotiated Rate |
$256.67 |
| Max. Negotiated Rate |
$628.93 |
| Rate for Payer: Aetna Commercial |
$505.26
|
| Rate for Payer: Aetna Medicare |
$375.50
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$628.93
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.57
|
| Rate for Payer: Priority Health Narrow Network |
$606.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.18
|
| Rate for Payer: UHC Exchange |
$368.18
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
|
|
PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 26645
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$661.70 |
| Rate for Payer: Aetna Commercial |
$526.41
|
| Rate for Payer: Aetna Medicare |
$509.00
|
| Rate for Payer: BCBS Complete |
$277.55
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$649.45
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Meridian Medicaid |
$277.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$625.38
|
| Rate for Payer: Priority Health Narrow Network |
$625.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.09
|
| Rate for Payer: UHC Exchange |
$421.09
|
| Rate for Payer: UHCCP Medicaid |
$264.33
|
|
|
PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26670
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$524.35 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Aetna Medicare |
$302.50
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$524.35
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$498.69
|
| Rate for Payer: Priority Health Narrow Network |
$498.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.31
|
| Rate for Payer: UHC Exchange |
$328.31
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$822.25 |
| Rate for Payer: Aetna Commercial |
$561.06
|
| Rate for Payer: Aetna Medicare |
$632.50
|
| Rate for Payer: BCBS Complete |
$296.78
|
| Rate for Payer: BCBS Trust/PPO |
$46.70
|
| Rate for Payer: BCN Commercial |
$692.95
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Meridian Medicaid |
$296.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$668.13
|
| Rate for Payer: Priority Health Narrow Network |
$668.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.60
|
| Rate for Payer: UHC Exchange |
$448.60
|
| Rate for Payer: UHCCP Medicaid |
$282.65
|
|
|
PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 27516
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$1,829.50 |
| Rate for Payer: Aetna Commercial |
$641.97
|
| Rate for Payer: Aetna Medicare |
$653.00
|
| Rate for Payer: BCBS Complete |
$339.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,829.50
|
| Rate for Payer: BCN Commercial |
$773.09
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Meridian Medicaid |
$339.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$763.81
|
| Rate for Payer: Priority Health Narrow Network |
$763.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.27
|
| Rate for Payer: UHC Exchange |
$520.27
|
| Rate for Payer: UHCCP Medicaid |
$322.91
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$256.45 |
| Max. Negotiated Rate |
$882.05 |
| Rate for Payer: Aetna Commercial |
$512.28
|
| Rate for Payer: Aetna Medicare |
$678.50
|
| Rate for Payer: BCBS Complete |
$269.27
|
| Rate for Payer: BCBS Trust/PPO |
$677.10
|
| Rate for Payer: BCN Commercial |
$637.72
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Meridian Medicaid |
$269.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$608.10
|
| Rate for Payer: Priority Health Narrow Network |
$608.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.54
|
| Rate for Payer: UHC Exchange |
$429.54
|
| Rate for Payer: UHCCP Medicaid |
$256.45
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$2,764.24 |
| Rate for Payer: Aetna Commercial |
$381.27
|
| Rate for Payer: Aetna Medicare |
$387.50
|
| Rate for Payer: BCBS Complete |
$201.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,764.24
|
| Rate for Payer: BCN Commercial |
$378.53
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Meridian Medicaid |
$201.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.45
|
| Rate for Payer: Priority Health Narrow Network |
$456.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.89
|
| Rate for Payer: UHC Exchange |
$306.89
|
| Rate for Payer: UHCCP Medicaid |
$192.34
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$1,776.67 |
| Rate for Payer: Aetna Commercial |
$366.59
|
| Rate for Payer: Aetna Medicare |
$275.00
|
| Rate for Payer: BCBS Complete |
$195.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,776.67
|
| Rate for Payer: BCN Commercial |
$482.81
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Meridian Medicaid |
$195.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.09
|
| Rate for Payer: Priority Health Narrow Network |
$436.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.61
|
| Rate for Payer: UHC Exchange |
$297.61
|
| Rate for Payer: UHCCP Medicaid |
$185.95
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 26750
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$945.13 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna Medicare |
$206.00
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS Trust/PPO |
$945.13
|
| Rate for Payer: BCN Commercial |
$283.92
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.32
|
| Rate for Payer: Priority Health Narrow Network |
$305.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.75
|
| Rate for Payer: UHC Exchange |
$190.75
|
| Rate for Payer: UHCCP Medicaid |
$129.93
|
|
|
PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 25600
|
| Min. Negotiated Rate |
$220.03 |
| Max. Negotiated Rate |
$579.96 |
| Rate for Payer: Aetna Commercial |
$422.71
|
| Rate for Payer: Aetna Medicare |
$377.00
|
| Rate for Payer: BCBS Complete |
$231.03
|
| Rate for Payer: BCBS Trust/PPO |
$579.96
|
| Rate for Payer: BCN Commercial |
$410.33
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Meridian Medicaid |
$231.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.03
|
| Rate for Payer: Priority Health Narrow Network |
$518.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.39
|
| Rate for Payer: UHC Exchange |
$283.39
|
| Rate for Payer: UHCCP Medicaid |
$220.03
|
|
|
PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 25605
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$681.17
|
| Rate for Payer: Aetna Medicare |
$694.00
|
| Rate for Payer: BCBS Complete |
$356.28
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$808.76
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Meridian Medicaid |
$356.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.02
|
| Rate for Payer: Priority Health Narrow Network |
$805.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$650.18
|
| Rate for Payer: UHC Exchange |
$650.18
|
| Rate for Payer: UHCCP Medicaid |
$339.31
|
|
|
PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 26432
|
| Min. Negotiated Rate |
$257.28 |
| Max. Negotiated Rate |
$843.18 |
| Rate for Payer: Aetna Commercial |
$712.43
|
| Rate for Payer: Aetna Medicare |
$523.50
|
| Rate for Payer: BCBS Complete |
$369.47
|
| Rate for Payer: BCBS Trust/PPO |
$257.28
|
| Rate for Payer: BCN Commercial |
$812.67
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Meridian Medicaid |
$369.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$843.18
|
| Rate for Payer: Priority Health Narrow Network |
$843.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.39
|
| Rate for Payer: UHC Exchange |
$542.39
|
| Rate for Payer: UHCCP Medicaid |
$351.88
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 27510
|
| Min. Negotiated Rate |
$444.11 |
| Max. Negotiated Rate |
$1,056.40 |
| Rate for Payer: Aetna Commercial |
$911.08
|
| Rate for Payer: Aetna Medicare |
$708.50
|
| Rate for Payer: BCBS Complete |
$466.32
|
| Rate for Payer: BCBS Trust/PPO |
$768.68
|
| Rate for Payer: BCN Commercial |
$1,005.70
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Meridian Medicaid |
$466.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,056.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,056.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.71
|
| Rate for Payer: UHC Exchange |
$797.71
|
| Rate for Payer: UHCCP Medicaid |
$444.11
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27508
|
| Min. Negotiated Rate |
$329.51 |
| Max. Negotiated Rate |
$781.39 |
| Rate for Payer: Aetna Commercial |
$663.27
|
| Rate for Payer: Aetna Medicare |
$550.00
|
| Rate for Payer: BCBS Complete |
$345.99
|
| Rate for Payer: BCBS Trust/PPO |
$738.04
|
| Rate for Payer: BCN Commercial |
$781.39
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Meridian Medicaid |
$345.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$780.09
|
| Rate for Payer: Priority Health Narrow Network |
$780.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.04
|
| Rate for Payer: UHC Exchange |
$551.04
|
| Rate for Payer: UHCCP Medicaid |
$329.51
|
|
|
PR CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 27232
|
| Min. Negotiated Rate |
$473.50 |
| Max. Negotiated Rate |
$1,117.45 |
| Rate for Payer: Aetna Commercial |
$995.08
|
| Rate for Payer: Aetna Medicare |
$686.50
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS Trust/PPO |
$835.77
|
| Rate for Payer: BCN Commercial |
$1,065.80
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$890.51
|
| Rate for Payer: UHC Exchange |
$890.51
|
| Rate for Payer: UHCCP Medicaid |
$473.50
|
|
|
PR CLTX FEM FX PROX END NCK W/O MANJ
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 27230
|
| Min. Negotiated Rate |
$315.67 |
| Max. Negotiated Rate |
$806.71 |
| Rate for Payer: Aetna Commercial |
$634.41
|
| Rate for Payer: Aetna Medicare |
$499.50
|
| Rate for Payer: BCBS Complete |
$331.45
|
| Rate for Payer: BCBS Trust/PPO |
$806.71
|
| Rate for Payer: BCN Commercial |
$723.73
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Meridian Medicaid |
$331.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.54
|
| Rate for Payer: Priority Health Narrow Network |
$749.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$522.94
|
| Rate for Payer: UHC Exchange |
$522.94
|
| Rate for Payer: UHCCP Medicaid |
$315.67
|
|
|
PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Professional
|
Both
|
$1,832.00
|
|
|
Service Code
|
HCPCS 27502
|
| Min. Negotiated Rate |
$490.54 |
| Max. Negotiated Rate |
$1,190.80 |
| Rate for Payer: Aetna Commercial |
$1,013.42
|
| Rate for Payer: Aetna Medicare |
$916.00
|
| Rate for Payer: BCBS Complete |
$515.07
|
| Rate for Payer: BCBS Trust/PPO |
$878.56
|
| Rate for Payer: BCN Commercial |
$1,111.74
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Meridian Medicaid |
$515.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,162.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,162.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$903.73
|
| Rate for Payer: UHC Exchange |
$903.73
|
| Rate for Payer: UHCCP Medicaid |
$490.54
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 28495
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$413.04 |
| Rate for Payer: Aetna Commercial |
$192.97
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS Trust/PPO |
$413.04
|
| Rate for Payer: BCN Commercial |
$263.88
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.10
|
| Rate for Payer: Priority Health Narrow Network |
$235.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.38
|
| Rate for Payer: UHC Exchange |
$165.38
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
28490
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,548.98 |
| Rate for Payer: Aetna Commercial |
$160.73
|
| Rate for Payer: Aetna Medicare |
$151.50
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.98
|
| Rate for Payer: BCN Commercial |
$210.62
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.93
|
| Rate for Payer: Priority Health Narrow Network |
$196.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.58
|
| Rate for Payer: UHC Exchange |
$131.58
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 28490
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,548.98 |
| Rate for Payer: Aetna Commercial |
$160.73
|
| Rate for Payer: Aetna Medicare |
$151.50
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.98
|
| Rate for Payer: BCN Commercial |
$210.62
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.93
|
| Rate for Payer: Priority Health Narrow Network |
$196.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.58
|
| Rate for Payer: UHC Exchange |
$131.58
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
28490
|
| Min. Negotiated Rate |
$196.95 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: ASR ASR |
$293.91
|
| Rate for Payer: ASR Commercial |
$293.91
|
| Rate for Payer: BCBS Trust/PPO |
$246.91
|
| Rate for Payer: BCN Commercial |
$234.92
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$284.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.40
|
| Rate for Payer: Healthscope Commercial |
$303.00
|
| Rate for Payer: Healthscope Whirlpool |
$293.91
|
| Rate for Payer: Mclaren Commercial |
$272.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.55
|
| Rate for Payer: Nomi Health Commercial |
$248.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.64
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
28490
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$364.30 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$293.91
|
| Rate for Payer: ASR Commercial |
$293.91
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$248.13
|
| Rate for Payer: BCN Commercial |
$234.92
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$284.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$303.00
|
| Rate for Payer: Healthscope Whirlpool |
$293.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$272.70
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.55
|
| Rate for Payer: Nomi Health Commercial |
$248.46
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.06
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$218.45
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 28515
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: Aetna Medicare |
$185.00
|
| Rate for Payer: BCBS Complete |
$100.19
|
| Rate for Payer: BCBS Trust/PPO |
$423.70
|
| Rate for Payer: BCN Commercial |
$242.88
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Meridian Medicaid |
$100.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.44
|
| Rate for Payer: Priority Health Narrow Network |
$226.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.70
|
| Rate for Payer: UHC Exchange |
$155.70
|
| Rate for Payer: UHCCP Medicaid |
$95.42
|
|
