|
PR CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
HCPCS 53520
|
| Min. Negotiated Rate |
$461.20 |
| Max. Negotiated Rate |
$770.04 |
| Rate for Payer: Aetna Commercial |
$716.57
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: BCBS Complete |
$461.20
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cash Price |
$922.40
|
| Rate for Payer: Cofinity Commercial |
$770.04
|
| Rate for Payer: Cofinity Commercial |
$716.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$641.70
|
| Rate for Payer: Healthscope Whirlpool |
$641.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Nomi Health Commercial |
$641.70
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.45
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
|
|
PR CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 57311
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$762.03 |
| Rate for Payer: Aetna Commercial |
$709.11
|
| Rate for Payer: Aetna Medicare |
$529.19
|
| Rate for Payer: BCBS Complete |
$441.20
|
| Rate for Payer: BCBS MAPPO |
$529.19
|
| Rate for Payer: BCN Medicare Advantage |
$529.19
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$762.03
|
| Rate for Payer: Cofinity Commercial |
$709.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.19
|
| Rate for Payer: Healthscope Commercial |
$635.03
|
| Rate for Payer: Healthscope Whirlpool |
$635.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.65
|
| Rate for Payer: Nomi Health Commercial |
$635.03
|
| Rate for Payer: PACE SWMI |
$529.19
|
| Rate for Payer: PHP Medicare Advantage |
$529.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health Medicare |
$529.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.19
|
| Rate for Payer: UHC Medicare Advantage |
$529.19
|
| Rate for Payer: UHCCP DNSP |
$529.19
|
|
|
PR CLSR VESICOVAGINAL FISTUL AABDL APPROACH
|
Professional
|
Both
|
$3,916.00
|
|
|
Service Code
|
HCPCS 51900
|
| Min. Negotiated Rate |
$788.00 |
| Max. Negotiated Rate |
$2,545.40 |
| Rate for Payer: Aetna Commercial |
$1,055.92
|
| Rate for Payer: Aetna Medicare |
$788.00
|
| Rate for Payer: BCBS Complete |
$1,566.40
|
| Rate for Payer: BCBS MAPPO |
$788.00
|
| Rate for Payer: BCN Medicare Advantage |
$788.00
|
| Rate for Payer: Cash Price |
$3,132.80
|
| Rate for Payer: Cash Price |
$3,132.80
|
| Rate for Payer: Cofinity Commercial |
$1,134.72
|
| Rate for Payer: Cofinity Commercial |
$1,055.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$788.00
|
| Rate for Payer: Healthscope Commercial |
$945.60
|
| Rate for Payer: Healthscope Whirlpool |
$945.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$827.40
|
| Rate for Payer: Nomi Health Commercial |
$945.60
|
| Rate for Payer: PACE SWMI |
$788.00
|
| Rate for Payer: PHP Medicare Advantage |
$788.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,545.40
|
| Rate for Payer: Priority Health Medicare |
$788.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$788.00
|
| Rate for Payer: UHC Medicare Advantage |
$788.00
|
| Rate for Payer: UHCCP DNSP |
$788.00
|
|
|
PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$2,274.00
|
|
|
Service Code
|
HCPCS 27222
|
| Min. Negotiated Rate |
$909.60 |
| Max. Negotiated Rate |
$1,478.10 |
| Rate for Payer: Aetna Commercial |
$1,267.84
|
| Rate for Payer: Aetna Medicare |
$946.15
|
| Rate for Payer: BCBS Complete |
$909.60
|
| Rate for Payer: BCBS MAPPO |
$946.15
|
| Rate for Payer: BCN Medicare Advantage |
$946.15
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.46
|
| Rate for Payer: Cofinity Commercial |
$1,267.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.15
|
| Rate for Payer: Healthscope Commercial |
$1,135.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.46
|
| Rate for Payer: Nomi Health Commercial |
$1,135.38
|
| Rate for Payer: PACE SWMI |
$946.15
|
| Rate for Payer: PHP Medicare Advantage |
$946.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,478.10
|
| Rate for Payer: Priority Health Medicare |
$946.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.15
|
| Rate for Payer: UHC Medicare Advantage |
$946.15
|
| Rate for Payer: UHCCP DNSP |
$946.15
|
|
|
PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,679.00
|
|
|
Service Code
|
HCPCS 27220
|
| Min. Negotiated Rate |
$400.45 |
| Max. Negotiated Rate |
$1,091.35 |
| Rate for Payer: Aetna Commercial |
$536.60
|
| Rate for Payer: Aetna Medicare |
$400.45
|
| Rate for Payer: BCBS Complete |
$671.60
|
| Rate for Payer: BCBS MAPPO |
$400.45
|
| Rate for Payer: BCN Medicare Advantage |
$400.45
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cofinity Commercial |
$576.65
|
| Rate for Payer: Cofinity Commercial |
$536.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.45
|
| Rate for Payer: Healthscope Commercial |
$480.54
|
| Rate for Payer: Healthscope Whirlpool |
$480.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$420.47
|
| Rate for Payer: Nomi Health Commercial |
$480.54
|
| Rate for Payer: PACE SWMI |
$400.45
|
| Rate for Payer: PHP Medicare Advantage |
$400.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,091.35
|
| Rate for Payer: Priority Health Medicare |
$400.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.45
|
| Rate for Payer: UHC Medicare Advantage |
$400.45
|
| Rate for Payer: UHCCP DNSP |
$400.45
|
|
|
PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$477.98 |
| Max. Negotiated Rate |
$919.10 |
| Rate for Payer: Aetna Commercial |
$640.49
|
| Rate for Payer: Aetna Medicare |
$477.98
|
| Rate for Payer: BCBS Complete |
$565.60
|
| Rate for Payer: BCBS MAPPO |
$477.98
|
| Rate for Payer: BCN Medicare Advantage |
$477.98
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cofinity Commercial |
$688.29
|
| Rate for Payer: Cofinity Commercial |
$640.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.98
|
| Rate for Payer: Healthscope Commercial |
$573.58
|
| Rate for Payer: Healthscope Whirlpool |
$573.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.88
|
| Rate for Payer: Nomi Health Commercial |
$573.58
|
| Rate for Payer: PACE SWMI |
$477.98
|
| Rate for Payer: PHP Medicare Advantage |
$477.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health Medicare |
$477.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.98
|
| Rate for Payer: UHC Medicare Advantage |
$477.98
|
| Rate for Payer: UHCCP DNSP |
$477.98
|
|
|
PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$328.81 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$440.61
|
| Rate for Payer: Aetna Medicare |
$328.81
|
| Rate for Payer: BCBS Complete |
$374.00
|
| Rate for Payer: BCBS MAPPO |
$328.81
|
| Rate for Payer: BCN Medicare Advantage |
$328.81
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$473.49
|
| Rate for Payer: Cofinity Commercial |
$440.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.81
|
| Rate for Payer: Healthscope Commercial |
$394.57
|
| Rate for Payer: Healthscope Whirlpool |
$394.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.25
|
| Rate for Payer: Nomi Health Commercial |
$394.57
|
| Rate for Payer: PACE SWMI |
$328.81
|
| Rate for Payer: PHP Medicare Advantage |
$328.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health Medicare |
$328.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.81
|
| Rate for Payer: UHC Medicare Advantage |
$328.81
|
| Rate for Payer: UHCCP DNSP |
$328.81
|
|
|
PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 26740
|
| Min. Negotiated Rate |
$217.01 |
| Max. Negotiated Rate |
$410.80 |
| Rate for Payer: Aetna Commercial |
$290.79
|
| Rate for Payer: Aetna Medicare |
$217.01
|
| Rate for Payer: BCBS Complete |
$252.80
|
| Rate for Payer: BCBS MAPPO |
$217.01
|
| Rate for Payer: BCN Medicare Advantage |
$217.01
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$312.49
|
| Rate for Payer: Cofinity Commercial |
$290.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.01
|
| Rate for Payer: Healthscope Commercial |
$260.41
|
| Rate for Payer: Healthscope Whirlpool |
$260.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.86
|
| Rate for Payer: Nomi Health Commercial |
$260.41
|
| Rate for Payer: PACE SWMI |
$217.01
|
| Rate for Payer: PHP Medicare Advantage |
$217.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: Priority Health Medicare |
$217.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.01
|
| Rate for Payer: UHC Medicare Advantage |
$217.01
|
| Rate for Payer: UHCCP DNSP |
$217.01
|
|
|
PR CLTX CARPAL BONE FX W/MNPJ EACH BONE
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
HCPCS 25635
|
| Min. Negotiated Rate |
$413.75 |
| Max. Negotiated Rate |
$729.95 |
| Rate for Payer: Aetna Commercial |
$554.42
|
| Rate for Payer: Aetna Medicare |
$413.75
|
| Rate for Payer: BCBS Complete |
$449.20
|
| Rate for Payer: BCBS MAPPO |
$413.75
|
| Rate for Payer: BCN Medicare Advantage |
$413.75
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cash Price |
$898.40
|
| Rate for Payer: Cofinity Commercial |
$595.80
|
| Rate for Payer: Cofinity Commercial |
$554.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.75
|
| Rate for Payer: Healthscope Commercial |
$496.50
|
| Rate for Payer: Healthscope Whirlpool |
$496.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.44
|
| Rate for Payer: Nomi Health Commercial |
$496.50
|
| Rate for Payer: PACE SWMI |
$413.75
|
| Rate for Payer: PHP Medicare Advantage |
$413.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.95
|
| Rate for Payer: Priority Health Medicare |
$413.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.75
|
| Rate for Payer: UHC Medicare Advantage |
$413.75
|
| Rate for Payer: UHCCP DNSP |
$413.75
|
|
|
PR CLTX CARPAL BONE FX W/O MNPJ EACH BONE
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 25630
|
| Min. Negotiated Rate |
$280.11 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Commercial |
$375.35
|
| Rate for Payer: Aetna Medicare |
$280.11
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: BCBS MAPPO |
$280.11
|
| Rate for Payer: BCN Medicare Advantage |
$280.11
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$403.36
|
| Rate for Payer: Cofinity Commercial |
$375.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.11
|
| Rate for Payer: Healthscope Commercial |
$336.13
|
| Rate for Payer: Healthscope Whirlpool |
$336.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.12
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PACE SWMI |
$280.11
|
| Rate for Payer: PHP Medicare Advantage |
$280.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$280.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.11
|
| Rate for Payer: UHC Medicare Advantage |
$280.11
|
| Rate for Payer: UHCCP DNSP |
$280.11
|
|
|
PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 26641
|
| Min. Negotiated Rate |
$300.40 |
| Max. Negotiated Rate |
$538.69 |
| Rate for Payer: Aetna Commercial |
$501.28
|
| Rate for Payer: Aetna Medicare |
$374.09
|
| Rate for Payer: BCBS Complete |
$300.40
|
| Rate for Payer: BCBS MAPPO |
$374.09
|
| Rate for Payer: BCN Medicare Advantage |
$374.09
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$538.69
|
| Rate for Payer: Cofinity Commercial |
$501.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.09
|
| Rate for Payer: Healthscope Commercial |
$448.91
|
| Rate for Payer: Healthscope Whirlpool |
$448.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.79
|
| Rate for Payer: Nomi Health Commercial |
$448.91
|
| Rate for Payer: PACE SWMI |
$374.09
|
| Rate for Payer: PHP Medicare Advantage |
$374.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.15
|
| Rate for Payer: Priority Health Medicare |
$374.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.09
|
| Rate for Payer: UHC Medicare Advantage |
$374.09
|
| Rate for Payer: UHCCP DNSP |
$374.09
|
|
|
PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 26645
|
| Min. Negotiated Rate |
$386.68 |
| Max. Negotiated Rate |
$661.70 |
| Rate for Payer: Aetna Commercial |
$518.15
|
| Rate for Payer: Aetna Medicare |
$386.68
|
| Rate for Payer: BCBS Complete |
$407.20
|
| Rate for Payer: BCBS MAPPO |
$386.68
|
| Rate for Payer: BCN Medicare Advantage |
$386.68
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$556.82
|
| Rate for Payer: Cofinity Commercial |
$518.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.68
|
| Rate for Payer: Healthscope Commercial |
$464.02
|
| Rate for Payer: Healthscope Whirlpool |
$464.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.01
|
| Rate for Payer: Nomi Health Commercial |
$464.02
|
| Rate for Payer: PACE SWMI |
$386.68
|
| Rate for Payer: PHP Medicare Advantage |
$386.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.70
|
| Rate for Payer: Priority Health Medicare |
$386.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.68
|
| Rate for Payer: UHC Medicare Advantage |
$386.68
|
| Rate for Payer: UHCCP DNSP |
$386.68
|
|
|
PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26670
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$449.01 |
| Rate for Payer: Aetna Commercial |
$417.83
|
| Rate for Payer: Aetna Medicare |
$311.81
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$311.81
|
| Rate for Payer: BCN Medicare Advantage |
$311.81
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$449.01
|
| Rate for Payer: Cofinity Commercial |
$417.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.81
|
| Rate for Payer: Healthscope Commercial |
$374.17
|
| Rate for Payer: Healthscope Whirlpool |
$374.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.40
|
| Rate for Payer: Nomi Health Commercial |
$374.17
|
| Rate for Payer: PACE SWMI |
$311.81
|
| Rate for Payer: PHP Medicare Advantage |
$311.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$311.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.81
|
| Rate for Payer: UHC Medicare Advantage |
$311.81
|
| Rate for Payer: UHCCP DNSP |
$311.81
|
|
|
PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 26675
|
| Min. Negotiated Rate |
$413.33 |
| Max. Negotiated Rate |
$822.25 |
| Rate for Payer: Aetna Commercial |
$553.86
|
| Rate for Payer: Aetna Medicare |
$413.33
|
| Rate for Payer: BCBS Complete |
$506.00
|
| Rate for Payer: BCBS MAPPO |
$413.33
|
| Rate for Payer: BCN Medicare Advantage |
$413.33
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cofinity Commercial |
$595.20
|
| Rate for Payer: Cofinity Commercial |
$553.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.33
|
| Rate for Payer: Healthscope Commercial |
$496.00
|
| Rate for Payer: Healthscope Whirlpool |
$496.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.00
|
| Rate for Payer: Nomi Health Commercial |
$496.00
|
| Rate for Payer: PACE SWMI |
$413.33
|
| Rate for Payer: PHP Medicare Advantage |
$413.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.25
|
| Rate for Payer: Priority Health Medicare |
$413.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.33
|
| Rate for Payer: UHC Medicare Advantage |
$413.33
|
| Rate for Payer: UHCCP DNSP |
$413.33
|
|
|
PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 27516
|
| Min. Negotiated Rate |
$472.57 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$633.24
|
| Rate for Payer: Aetna Medicare |
$472.57
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: BCBS MAPPO |
$472.57
|
| Rate for Payer: BCN Medicare Advantage |
$472.57
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$680.50
|
| Rate for Payer: Cofinity Commercial |
$633.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.57
|
| Rate for Payer: Healthscope Commercial |
$567.08
|
| Rate for Payer: Healthscope Whirlpool |
$567.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.20
|
| Rate for Payer: Nomi Health Commercial |
$567.08
|
| Rate for Payer: PACE SWMI |
$472.57
|
| Rate for Payer: PHP Medicare Advantage |
$472.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health Medicare |
$472.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.57
|
| Rate for Payer: UHC Medicare Advantage |
$472.57
|
| Rate for Payer: UHCCP DNSP |
$472.57
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 27788
|
| Min. Negotiated Rate |
$375.69 |
| Max. Negotiated Rate |
$882.05 |
| Rate for Payer: Aetna Commercial |
$503.42
|
| Rate for Payer: Aetna Medicare |
$375.69
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS MAPPO |
$375.69
|
| Rate for Payer: BCN Medicare Advantage |
$375.69
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$540.99
|
| Rate for Payer: Cofinity Commercial |
$503.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.69
|
| Rate for Payer: Healthscope Commercial |
$450.83
|
| Rate for Payer: Healthscope Whirlpool |
$450.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$394.47
|
| Rate for Payer: Nomi Health Commercial |
$450.83
|
| Rate for Payer: PACE SWMI |
$375.69
|
| Rate for Payer: PHP Medicare Advantage |
$375.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.05
|
| Rate for Payer: Priority Health Medicare |
$375.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.69
|
| Rate for Payer: UHC Medicare Advantage |
$375.69
|
| Rate for Payer: UHCCP DNSP |
$375.69
|
|
|
PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27786
|
| Min. Negotiated Rate |
$279.28 |
| Max. Negotiated Rate |
$503.75 |
| Rate for Payer: Aetna Commercial |
$374.24
|
| Rate for Payer: Aetna Medicare |
$279.28
|
| Rate for Payer: BCBS Complete |
$310.00
|
| Rate for Payer: BCBS MAPPO |
$279.28
|
| Rate for Payer: BCN Medicare Advantage |
$279.28
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cofinity Commercial |
$402.16
|
| Rate for Payer: Cofinity Commercial |
$374.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.28
|
| Rate for Payer: Healthscope Commercial |
$335.14
|
| Rate for Payer: Healthscope Whirlpool |
$335.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.24
|
| Rate for Payer: Nomi Health Commercial |
$335.14
|
| Rate for Payer: PACE SWMI |
$279.28
|
| Rate for Payer: PHP Medicare Advantage |
$279.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.75
|
| Rate for Payer: Priority Health Medicare |
$279.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.28
|
| Rate for Payer: UHC Medicare Advantage |
$279.28
|
| Rate for Payer: UHCCP DNSP |
$279.28
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 26755
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$391.65 |
| Rate for Payer: Aetna Commercial |
$364.45
|
| Rate for Payer: Aetna Medicare |
$271.98
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS MAPPO |
$271.98
|
| Rate for Payer: BCN Medicare Advantage |
$271.98
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$391.65
|
| Rate for Payer: Cofinity Commercial |
$364.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.98
|
| Rate for Payer: Healthscope Commercial |
$326.38
|
| Rate for Payer: Healthscope Whirlpool |
$326.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.58
|
| Rate for Payer: Nomi Health Commercial |
$326.38
|
| Rate for Payer: PACE SWMI |
$271.98
|
| Rate for Payer: PHP Medicare Advantage |
$271.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health Medicare |
$271.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.98
|
| Rate for Payer: UHC Medicare Advantage |
$271.98
|
| Rate for Payer: UHCCP DNSP |
$271.98
|
|
|
PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 26750
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$251.91
|
| Rate for Payer: Aetna Medicare |
$187.99
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$187.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.99
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$270.71
|
| Rate for Payer: Cofinity Commercial |
$251.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.99
|
| Rate for Payer: Healthscope Commercial |
$225.59
|
| Rate for Payer: Healthscope Whirlpool |
$225.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.39
|
| Rate for Payer: Nomi Health Commercial |
$225.59
|
| Rate for Payer: PACE SWMI |
$187.99
|
| Rate for Payer: PHP Medicare Advantage |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$187.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.99
|
| Rate for Payer: UHC Medicare Advantage |
$187.99
|
| Rate for Payer: UHCCP DNSP |
$187.99
|
|
|
PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 25600
|
| Min. Negotiated Rate |
$301.60 |
| Max. Negotiated Rate |
$490.10 |
| Rate for Payer: Aetna Commercial |
$424.75
|
| Rate for Payer: Aetna Medicare |
$316.98
|
| Rate for Payer: BCBS Complete |
$301.60
|
| Rate for Payer: BCBS MAPPO |
$316.98
|
| Rate for Payer: BCN Medicare Advantage |
$316.98
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$456.45
|
| Rate for Payer: Cofinity Commercial |
$424.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.98
|
| Rate for Payer: Healthscope Commercial |
$380.38
|
| Rate for Payer: Healthscope Whirlpool |
$380.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.83
|
| Rate for Payer: Nomi Health Commercial |
$380.38
|
| Rate for Payer: PACE SWMI |
$316.98
|
| Rate for Payer: PHP Medicare Advantage |
$316.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health Medicare |
$316.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.98
|
| Rate for Payer: UHC Medicare Advantage |
$316.98
|
| Rate for Payer: UHCCP DNSP |
$316.98
|
|
|
PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MNPJ
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 25605
|
| Min. Negotiated Rate |
$498.18 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$667.56
|
| Rate for Payer: Aetna Medicare |
$498.18
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$498.18
|
| Rate for Payer: BCN Medicare Advantage |
$498.18
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$717.38
|
| Rate for Payer: Cofinity Commercial |
$667.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.18
|
| Rate for Payer: Healthscope Commercial |
$597.82
|
| Rate for Payer: Healthscope Whirlpool |
$597.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.09
|
| Rate for Payer: Nomi Health Commercial |
$597.82
|
| Rate for Payer: PACE SWMI |
$498.18
|
| Rate for Payer: PHP Medicare Advantage |
$498.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$498.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.18
|
| Rate for Payer: UHC Medicare Advantage |
$498.18
|
| Rate for Payer: UHCCP DNSP |
$498.18
|
|
|
PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
HCPCS 26432
|
| Min. Negotiated Rate |
$418.80 |
| Max. Negotiated Rate |
$728.01 |
| Rate for Payer: Aetna Commercial |
$677.45
|
| Rate for Payer: Aetna Medicare |
$505.56
|
| Rate for Payer: BCBS Complete |
$418.80
|
| Rate for Payer: BCBS MAPPO |
$505.56
|
| Rate for Payer: BCN Medicare Advantage |
$505.56
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cash Price |
$837.60
|
| Rate for Payer: Cofinity Commercial |
$728.01
|
| Rate for Payer: Cofinity Commercial |
$677.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.56
|
| Rate for Payer: Healthscope Commercial |
$606.67
|
| Rate for Payer: Healthscope Whirlpool |
$606.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$530.84
|
| Rate for Payer: Nomi Health Commercial |
$606.67
|
| Rate for Payer: PACE SWMI |
$505.56
|
| Rate for Payer: PHP Medicare Advantage |
$505.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.55
|
| Rate for Payer: Priority Health Medicare |
$505.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.56
|
| Rate for Payer: UHC Medicare Advantage |
$505.56
|
| Rate for Payer: UHCCP DNSP |
$505.56
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 27510
|
| Min. Negotiated Rate |
$566.80 |
| Max. Negotiated Rate |
$950.01 |
| Rate for Payer: Aetna Commercial |
$884.04
|
| Rate for Payer: Aetna Medicare |
$659.73
|
| Rate for Payer: BCBS Complete |
$566.80
|
| Rate for Payer: BCBS MAPPO |
$659.73
|
| Rate for Payer: BCN Medicare Advantage |
$659.73
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$950.01
|
| Rate for Payer: Cofinity Commercial |
$884.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.73
|
| Rate for Payer: Healthscope Commercial |
$791.68
|
| Rate for Payer: Healthscope Whirlpool |
$791.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.72
|
| Rate for Payer: Nomi Health Commercial |
$791.68
|
| Rate for Payer: PACE SWMI |
$659.73
|
| Rate for Payer: PHP Medicare Advantage |
$659.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health Medicare |
$659.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$659.73
|
| Rate for Payer: UHC Medicare Advantage |
$659.73
|
| Rate for Payer: UHCCP DNSP |
$659.73
|
|
|
PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27508
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna Medicare |
$484.31
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: BCBS MAPPO |
$484.31
|
| Rate for Payer: BCN Medicare Advantage |
$484.31
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$697.41
|
| Rate for Payer: Cofinity Commercial |
$648.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.31
|
| Rate for Payer: Healthscope Commercial |
$581.17
|
| Rate for Payer: Healthscope Whirlpool |
$581.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.53
|
| Rate for Payer: Nomi Health Commercial |
$581.17
|
| Rate for Payer: PACE SWMI |
$484.31
|
| Rate for Payer: PHP Medicare Advantage |
$484.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health Medicare |
$484.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.31
|
| Rate for Payer: UHC Medicare Advantage |
$484.31
|
| Rate for Payer: UHCCP DNSP |
$484.31
|
|
|
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 |
$549.20 |
| Max. Negotiated Rate |
$1,021.29 |
| Rate for Payer: Aetna Commercial |
$950.37
|
| Rate for Payer: Aetna Medicare |
$709.23
|
| Rate for Payer: BCBS Complete |
$549.20
|
| Rate for Payer: BCBS MAPPO |
$709.23
|
| Rate for Payer: BCN Medicare Advantage |
$709.23
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$950.37
|
| Rate for Payer: Cofinity Commercial |
$1,021.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.23
|
| Rate for Payer: Healthscope Commercial |
$851.08
|
| Rate for Payer: Healthscope Whirlpool |
$851.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.69
|
| Rate for Payer: Nomi Health Commercial |
$851.08
|
| Rate for Payer: PACE SWMI |
$709.23
|
| Rate for Payer: PHP Medicare Advantage |
$709.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Medicare |
$709.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.23
|
| Rate for Payer: UHC Medicare Advantage |
$709.23
|
| Rate for Payer: UHCCP DNSP |
$709.23
|
|
