|
PR CLTX FEM FX PROX END NCK W/O MANJ
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
HCPCS 27230
|
| Min. Negotiated Rate |
$399.60 |
| Max. Negotiated Rate |
$667.22 |
| Rate for Payer: Aetna Commercial |
$620.89
|
| Rate for Payer: Aetna Medicare |
$463.35
|
| Rate for Payer: BCBS Complete |
$399.60
|
| Rate for Payer: BCBS MAPPO |
$463.35
|
| Rate for Payer: BCN Medicare Advantage |
$463.35
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cofinity Commercial |
$667.22
|
| Rate for Payer: Cofinity Commercial |
$620.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.35
|
| Rate for Payer: Healthscope Commercial |
$556.02
|
| Rate for Payer: Healthscope Whirlpool |
$556.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$486.52
|
| Rate for Payer: Nomi Health Commercial |
$556.02
|
| Rate for Payer: PACE SWMI |
$463.35
|
| Rate for Payer: PHP Medicare Advantage |
$463.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.35
|
| Rate for Payer: Priority Health Medicare |
$463.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$463.35
|
| Rate for Payer: UHC Medicare Advantage |
$463.35
|
| Rate for Payer: UHCCP DNSP |
$463.35
|
|
|
PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ
|
Professional
|
Both
|
$1,832.00
|
|
|
Service Code
|
HCPCS 27502
|
| Min. Negotiated Rate |
$731.09 |
| Max. Negotiated Rate |
$1,190.80 |
| Rate for Payer: Aetna Commercial |
$979.66
|
| Rate for Payer: Aetna Medicare |
$731.09
|
| Rate for Payer: BCBS Complete |
$732.80
|
| Rate for Payer: BCBS MAPPO |
$731.09
|
| Rate for Payer: BCN Medicare Advantage |
$731.09
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cash Price |
$1,465.60
|
| Rate for Payer: Cofinity Commercial |
$979.66
|
| Rate for Payer: Cofinity Commercial |
$1,052.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.09
|
| Rate for Payer: Healthscope Commercial |
$877.31
|
| Rate for Payer: Healthscope Whirlpool |
$877.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$767.64
|
| Rate for Payer: Nomi Health Commercial |
$877.31
|
| Rate for Payer: PACE SWMI |
$731.09
|
| Rate for Payer: PHP Medicare Advantage |
$731.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.80
|
| Rate for Payer: Priority Health Medicare |
$731.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.09
|
| Rate for Payer: UHC Medicare Advantage |
$731.09
|
| Rate for Payer: UHCCP DNSP |
$731.09
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/MANJ
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 28495
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$208.60 |
| Rate for Payer: Aetna Commercial |
$194.11
|
| Rate for Payer: Aetna Medicare |
$144.86
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$144.86
|
| Rate for Payer: BCN Medicare Advantage |
$144.86
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$208.60
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.86
|
| Rate for Payer: Healthscope Commercial |
$173.83
|
| Rate for Payer: Healthscope Whirlpool |
$173.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.10
|
| Rate for Payer: Nomi Health Commercial |
$173.83
|
| Rate for Payer: PACE SWMI |
$144.86
|
| Rate for Payer: PHP Medicare Advantage |
$144.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health Medicare |
$144.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.86
|
| Rate for Payer: UHC Medicare Advantage |
$144.86
|
| Rate for Payer: UHCCP DNSP |
$144.86
|
|
|
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 28490
|
| Min. Negotiated Rate |
$120.53 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Commercial |
$161.51
|
| Rate for Payer: Aetna Medicare |
$120.53
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$120.53
|
| Rate for Payer: BCN Medicare Advantage |
$120.53
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$161.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.53
|
| Rate for Payer: Healthscope Commercial |
$144.64
|
| Rate for Payer: Healthscope Whirlpool |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.56
|
| Rate for Payer: Nomi Health Commercial |
$144.64
|
| Rate for Payer: PACE SWMI |
$120.53
|
| Rate for Payer: PHP Medicare Advantage |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$120.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.53
|
| Rate for Payer: UHC Medicare Advantage |
$120.53
|
| Rate for Payer: UHCCP DNSP |
$120.53
|
|
|
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 |
$125.40 |
| Max. Negotiated Rate |
$362.62 |
| Rate for Payer: Aetna Commercial |
$272.70
|
| Rate for Payer: Aetna Medicare |
$233.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: ASR ASR |
$293.91
|
| Rate for Payer: ASR Commercial |
$293.91
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCBS Trust/PPO |
$248.13
|
| Rate for Payer: BCN Commercial |
$234.92
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| 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 |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$303.00
|
| Rate for Payer: Healthscope Whirlpool |
$293.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$233.95
|
| Rate for Payer: Mclaren Commercial |
$272.70
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.55
|
| Rate for Payer: Nomi Health Commercial |
$248.46
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$257.35
|
| Rate for Payer: PHP Medicaid |
$125.40
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.49
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health Narrow Network |
$212.40
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$362.62
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP DNSP |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
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 |
$120.53 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Commercial |
$161.51
|
| Rate for Payer: Aetna Medicare |
$120.53
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$120.53
|
| Rate for Payer: BCN Medicare Advantage |
$120.53
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$161.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.53
|
| Rate for Payer: Healthscope Commercial |
$144.64
|
| Rate for Payer: Healthscope Whirlpool |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.56
|
| Rate for Payer: Nomi Health Commercial |
$144.64
|
| Rate for Payer: PACE SWMI |
$120.53
|
| Rate for Payer: PHP Medicare Advantage |
$120.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$120.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.53
|
| Rate for Payer: UHC Medicare Advantage |
$120.53
|
| Rate for Payer: UHCCP DNSP |
$120.53
|
|
|
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 PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 28515
|
| Min. Negotiated Rate |
$137.86 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$184.73
|
| Rate for Payer: Aetna Medicare |
$137.86
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$137.86
|
| Rate for Payer: BCN Medicare Advantage |
$137.86
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$198.52
|
| Rate for Payer: Cofinity Commercial |
$184.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.86
|
| Rate for Payer: Healthscope Commercial |
$165.43
|
| Rate for Payer: Healthscope Whirlpool |
$165.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.75
|
| Rate for Payer: Nomi Health Commercial |
$165.43
|
| Rate for Payer: PACE SWMI |
$137.86
|
| Rate for Payer: PHP Medicare Advantage |
$137.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$137.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.86
|
| Rate for Payer: UHC Medicare Advantage |
$137.86
|
| Rate for Payer: UHCCP DNSP |
$137.86
|
|
|
PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 28510
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Aetna Medicare |
$116.62
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$116.62
|
| Rate for Payer: BCN Medicare Advantage |
$116.62
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$167.93
|
| Rate for Payer: Cofinity Commercial |
$156.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.62
|
| Rate for Payer: Healthscope Commercial |
$139.94
|
| Rate for Payer: Healthscope Whirlpool |
$139.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.45
|
| Rate for Payer: Nomi Health Commercial |
$139.94
|
| Rate for Payer: PACE SWMI |
$116.62
|
| Rate for Payer: PHP Medicare Advantage |
$116.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$116.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.62
|
| Rate for Payer: UHC Medicare Advantage |
$116.62
|
| Rate for Payer: UHCCP DNSP |
$116.62
|
|
|
PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 27824
|
| Min. Negotiated Rate |
$298.94 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$400.58
|
| Rate for Payer: Aetna Medicare |
$298.94
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$298.94
|
| Rate for Payer: BCN Medicare Advantage |
$298.94
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$430.47
|
| Rate for Payer: Cofinity Commercial |
$400.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.94
|
| Rate for Payer: Healthscope Commercial |
$358.73
|
| Rate for Payer: Healthscope Whirlpool |
$358.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.89
|
| Rate for Payer: Nomi Health Commercial |
$358.73
|
| Rate for Payer: PACE SWMI |
$298.94
|
| Rate for Payer: PHP Medicare Advantage |
$298.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$298.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.94
|
| Rate for Payer: UHC Medicare Advantage |
$298.94
|
| Rate for Payer: UHCCP DNSP |
$298.94
|
|
|
PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 27825
|
| Min. Negotiated Rate |
$482.35 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$646.35
|
| Rate for Payer: Aetna Medicare |
$482.35
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$482.35
|
| Rate for Payer: BCN Medicare Advantage |
$482.35
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$694.58
|
| Rate for Payer: Cofinity Commercial |
$646.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.35
|
| Rate for Payer: Healthscope Commercial |
$578.82
|
| Rate for Payer: Healthscope Whirlpool |
$578.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$506.47
|
| Rate for Payer: Nomi Health Commercial |
$578.82
|
| Rate for Payer: PACE SWMI |
$482.35
|
| Rate for Payer: PHP Medicare Advantage |
$482.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$482.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.35
|
| Rate for Payer: UHC Medicare Advantage |
$482.35
|
| Rate for Payer: UHCCP DNSP |
$482.35
|
|
|
PR CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
HCPCS 23620
|
| Min. Negotiated Rate |
$254.69 |
| Max. Negotiated Rate |
$446.55 |
| Rate for Payer: Aetna Commercial |
$341.28
|
| Rate for Payer: Aetna Medicare |
$254.69
|
| Rate for Payer: BCBS Complete |
$274.80
|
| Rate for Payer: BCBS MAPPO |
$254.69
|
| Rate for Payer: BCN Medicare Advantage |
$254.69
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cofinity Commercial |
$366.75
|
| Rate for Payer: Cofinity Commercial |
$341.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: Healthscope Whirlpool |
$305.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.42
|
| Rate for Payer: Nomi Health Commercial |
$305.63
|
| Rate for Payer: PACE SWMI |
$254.69
|
| Rate for Payer: PHP Medicare Advantage |
$254.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.55
|
| Rate for Payer: Priority Health Medicare |
$254.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.69
|
| Rate for Payer: UHC Medicare Advantage |
$254.69
|
| Rate for Payer: UHCCP DNSP |
$254.69
|
|
|
PR CLTX GREATER HUMRL TUBEROSITY FX W/MANIPULATION
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 23625
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$492.80 |
| Rate for Payer: Aetna Commercial |
$458.57
|
| Rate for Payer: Aetna Medicare |
$342.22
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS MAPPO |
$342.22
|
| Rate for Payer: BCN Medicare Advantage |
$342.22
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$458.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.22
|
| Rate for Payer: Healthscope Commercial |
$410.66
|
| Rate for Payer: Healthscope Whirlpool |
$410.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.33
|
| Rate for Payer: Nomi Health Commercial |
$410.66
|
| Rate for Payer: PACE SWMI |
$342.22
|
| Rate for Payer: PHP Medicare Advantage |
$342.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health Medicare |
$342.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.22
|
| Rate for Payer: UHC Medicare Advantage |
$342.22
|
| Rate for Payer: UHCCP DNSP |
$342.22
|
|
|
PR CLTX GREATER TROCHANTERIC FX W/O MANJ
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
HCPCS 27246
|
| Min. Negotiated Rate |
$358.40 |
| Max. Negotiated Rate |
$582.40 |
| Rate for Payer: Aetna Commercial |
$505.18
|
| Rate for Payer: Aetna Medicare |
$377.00
|
| Rate for Payer: BCBS Complete |
$358.40
|
| Rate for Payer: BCBS MAPPO |
$377.00
|
| Rate for Payer: BCN Medicare Advantage |
$377.00
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Cofinity Commercial |
$542.88
|
| Rate for Payer: Cofinity Commercial |
$505.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.00
|
| Rate for Payer: Healthscope Commercial |
$452.40
|
| Rate for Payer: Healthscope Whirlpool |
$452.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.85
|
| Rate for Payer: Nomi Health Commercial |
$452.40
|
| Rate for Payer: PACE SWMI |
$377.00
|
| Rate for Payer: PHP Medicare Advantage |
$377.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.40
|
| Rate for Payer: Priority Health Medicare |
$377.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$377.00
|
| Rate for Payer: UHC Medicare Advantage |
$377.00
|
| Rate for Payer: UHCCP DNSP |
$377.00
|
|
|
PR CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Professional
|
Both
|
$1,958.00
|
|
|
Service Code
|
HCPCS 27252
|
| Min. Negotiated Rate |
$722.01 |
| Max. Negotiated Rate |
$1,272.70 |
| Rate for Payer: Aetna Commercial |
$967.49
|
| Rate for Payer: Aetna Medicare |
$722.01
|
| Rate for Payer: BCBS Complete |
$783.20
|
| Rate for Payer: BCBS MAPPO |
$722.01
|
| Rate for Payer: BCN Medicare Advantage |
$722.01
|
| Rate for Payer: Cash Price |
$1,566.40
|
| Rate for Payer: Cash Price |
$1,566.40
|
| Rate for Payer: Cofinity Commercial |
$967.49
|
| Rate for Payer: Cofinity Commercial |
$1,039.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.01
|
| Rate for Payer: Healthscope Commercial |
$866.41
|
| Rate for Payer: Healthscope Whirlpool |
$866.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.11
|
| Rate for Payer: Nomi Health Commercial |
$866.41
|
| Rate for Payer: PACE SWMI |
$722.01
|
| Rate for Payer: PHP Medicare Advantage |
$722.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,272.70
|
| Rate for Payer: Priority Health Medicare |
$722.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.01
|
| Rate for Payer: UHC Medicare Advantage |
$722.01
|
| Rate for Payer: UHCCP DNSP |
$722.01
|
|
|
PR CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 27250
|
| Min. Negotiated Rate |
$176.61 |
| Max. Negotiated Rate |
$479.70 |
| Rate for Payer: Aetna Commercial |
$236.66
|
| Rate for Payer: Aetna Medicare |
$176.61
|
| Rate for Payer: BCBS Complete |
$295.20
|
| Rate for Payer: BCBS MAPPO |
$176.61
|
| Rate for Payer: BCN Medicare Advantage |
$176.61
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cofinity Commercial |
$254.32
|
| Rate for Payer: Cofinity Commercial |
$236.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.61
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Healthscope Whirlpool |
$211.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.44
|
| Rate for Payer: Nomi Health Commercial |
$211.93
|
| Rate for Payer: PACE SWMI |
$176.61
|
| Rate for Payer: PHP Medicare Advantage |
$176.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.70
|
| Rate for Payer: Priority Health Medicare |
$176.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.61
|
| Rate for Payer: UHC Medicare Advantage |
$176.61
|
| Rate for Payer: UHCCP DNSP |
$176.61
|
|
|
PR CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 24576
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$441.92 |
| Rate for Payer: Aetna Commercial |
$411.23
|
| Rate for Payer: Aetna Medicare |
$306.89
|
| Rate for Payer: BCBS Complete |
$271.60
|
| Rate for Payer: BCBS MAPPO |
$306.89
|
| Rate for Payer: BCN Medicare Advantage |
$306.89
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$441.92
|
| Rate for Payer: Cofinity Commercial |
$411.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.89
|
| Rate for Payer: Healthscope Commercial |
$368.27
|
| Rate for Payer: Healthscope Whirlpool |
$368.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.23
|
| Rate for Payer: Nomi Health Commercial |
$368.27
|
| Rate for Payer: PACE SWMI |
$306.89
|
| Rate for Payer: PHP Medicare Advantage |
$306.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health Medicare |
$306.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.89
|
| Rate for Payer: UHC Medicare Advantage |
$306.89
|
| Rate for Payer: UHCCP DNSP |
$306.89
|
|
|
PR CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 24560
|
| Min. Negotiated Rate |
$288.89 |
| Max. Negotiated Rate |
$533.00 |
| Rate for Payer: Aetna Commercial |
$387.11
|
| Rate for Payer: Aetna Medicare |
$288.89
|
| Rate for Payer: BCBS Complete |
$328.00
|
| Rate for Payer: BCBS MAPPO |
$288.89
|
| Rate for Payer: BCN Medicare Advantage |
$288.89
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$387.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.89
|
| Rate for Payer: Healthscope Commercial |
$346.67
|
| Rate for Payer: Healthscope Whirlpool |
$346.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.33
|
| Rate for Payer: Nomi Health Commercial |
$346.67
|
| Rate for Payer: PACE SWMI |
$288.89
|
| Rate for Payer: PHP Medicare Advantage |
$288.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.00
|
| Rate for Payer: Priority Health Medicare |
$288.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.89
|
| Rate for Payer: UHC Medicare Advantage |
$288.89
|
| Rate for Payer: UHCCP DNSP |
$288.89
|
|
|
PR CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 24505
|
| Min. Negotiated Rate |
$440.92 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$590.83
|
| Rate for Payer: Aetna Medicare |
$440.92
|
| Rate for Payer: BCBS Complete |
$515.20
|
| Rate for Payer: BCBS MAPPO |
$440.92
|
| Rate for Payer: BCN Medicare Advantage |
$440.92
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$634.92
|
| Rate for Payer: Cofinity Commercial |
$590.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.92
|
| Rate for Payer: Healthscope Commercial |
$529.10
|
| Rate for Payer: Healthscope Whirlpool |
$529.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.97
|
| Rate for Payer: Nomi Health Commercial |
$529.10
|
| Rate for Payer: PACE SWMI |
$440.92
|
| Rate for Payer: PHP Medicare Advantage |
$440.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.20
|
| Rate for Payer: Priority Health Medicare |
$440.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.92
|
| Rate for Payer: UHC Medicare Advantage |
$440.92
|
| Rate for Payer: UHCCP DNSP |
$440.92
|
|
|
PR CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
HCPCS 27538
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$630.46 |
| Rate for Payer: Aetna Commercial |
$586.68
|
| Rate for Payer: Aetna Medicare |
$437.82
|
| Rate for Payer: BCBS Complete |
$381.20
|
| Rate for Payer: BCBS MAPPO |
$437.82
|
| Rate for Payer: BCN Medicare Advantage |
$437.82
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cofinity Commercial |
$630.46
|
| Rate for Payer: Cofinity Commercial |
$586.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.82
|
| Rate for Payer: Healthscope Commercial |
$525.38
|
| Rate for Payer: Healthscope Whirlpool |
$525.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.71
|
| Rate for Payer: Nomi Health Commercial |
$525.38
|
| Rate for Payer: PACE SWMI |
$437.82
|
| Rate for Payer: PHP Medicare Advantage |
$437.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.45
|
| Rate for Payer: Priority Health Medicare |
$437.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.82
|
| Rate for Payer: UHC Medicare Advantage |
$437.82
|
| Rate for Payer: UHCCP DNSP |
$437.82
|
|
|
PR CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 27238
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$653.70 |
| Rate for Payer: Aetna Commercial |
$608.31
|
| Rate for Payer: Aetna Medicare |
$453.96
|
| Rate for Payer: BCBS Complete |
$380.80
|
| Rate for Payer: BCBS MAPPO |
$453.96
|
| Rate for Payer: BCN Medicare Advantage |
$453.96
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$653.70
|
| Rate for Payer: Cofinity Commercial |
$608.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.96
|
| Rate for Payer: Healthscope Commercial |
$544.75
|
| Rate for Payer: Healthscope Whirlpool |
$544.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$476.66
|
| Rate for Payer: Nomi Health Commercial |
$544.75
|
| Rate for Payer: PACE SWMI |
$453.96
|
| Rate for Payer: PHP Medicare Advantage |
$453.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health Medicare |
$453.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.96
|
| Rate for Payer: UHC Medicare Advantage |
$453.96
|
| Rate for Payer: UHCCP DNSP |
$453.96
|
|
|
PR CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 28665
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$161.16
|
| Rate for Payer: Aetna Medicare |
$120.27
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$120.27
|
| Rate for Payer: BCN Medicare Advantage |
$120.27
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$173.19
|
| Rate for Payer: Cofinity Commercial |
$161.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.27
|
| Rate for Payer: Healthscope Commercial |
$144.32
|
| Rate for Payer: Healthscope Whirlpool |
$144.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.28
|
| Rate for Payer: Nomi Health Commercial |
$144.32
|
| Rate for Payer: PACE SWMI |
$120.27
|
| Rate for Payer: PHP Medicare Advantage |
$120.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$120.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.27
|
| Rate for Payer: UHC Medicare Advantage |
$120.27
|
| Rate for Payer: UHCCP DNSP |
$120.27
|
|
|
PR CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 28660
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Commercial |
$121.67
|
| Rate for Payer: Aetna Medicare |
$90.80
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS MAPPO |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$90.80
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$130.75
|
| Rate for Payer: Cofinity Commercial |
$121.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.80
|
| Rate for Payer: Healthscope Commercial |
$108.96
|
| Rate for Payer: Healthscope Whirlpool |
$108.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.34
|
| Rate for Payer: Nomi Health Commercial |
$108.96
|
| Rate for Payer: PACE SWMI |
$90.80
|
| Rate for Payer: PHP Medicare Advantage |
$90.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: Priority Health Medicare |
$90.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.80
|
| Rate for Payer: UHC Medicare Advantage |
$90.80
|
| Rate for Payer: UHCCP DNSP |
$90.80
|
|
|
PR CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 27240
|
| Min. Negotiated Rate |
$794.00 |
| Max. Negotiated Rate |
$1,328.96 |
| Rate for Payer: Aetna Commercial |
$1,236.67
|
| Rate for Payer: Aetna Medicare |
$922.89
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$922.89
|
| Rate for Payer: BCN Medicare Advantage |
$922.89
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,328.96
|
| Rate for Payer: Cofinity Commercial |
$1,236.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$922.89
|
| Rate for Payer: Healthscope Commercial |
$1,107.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,107.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.03
|
| Rate for Payer: Nomi Health Commercial |
$1,107.47
|
| Rate for Payer: PACE SWMI |
$922.89
|
| Rate for Payer: PHP Medicare Advantage |
$922.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$922.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$922.89
|
| Rate for Payer: UHC Medicare Advantage |
$922.89
|
| Rate for Payer: UHCCP DNSP |
$922.89
|
|
|
PR CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 26775
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$464.79
|
| Rate for Payer: Aetna Medicare |
$346.86
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$346.86
|
| Rate for Payer: BCN Medicare Advantage |
$346.86
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$499.48
|
| Rate for Payer: Cofinity Commercial |
$464.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.86
|
| Rate for Payer: Healthscope Commercial |
$416.23
|
| Rate for Payer: Healthscope Whirlpool |
$416.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.20
|
| Rate for Payer: Nomi Health Commercial |
$416.23
|
| Rate for Payer: PACE SWMI |
$346.86
|
| Rate for Payer: PHP Medicare Advantage |
$346.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$346.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.86
|
| Rate for Payer: UHC Medicare Advantage |
$346.86
|
| Rate for Payer: UHCCP DNSP |
$346.86
|
|
