|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,629.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$1,807.79 |
| Rate for Payer: Aetna Commercial |
$1,329.36
|
| Rate for Payer: Aetna Medicare |
$992.06
|
| Rate for Payer: BCBS Complete |
$691.97
|
| Rate for Payer: BCBS MAPPO |
$992.06
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: BCN Commercial |
$1,509.04
|
| Rate for Payer: BCN Medicare Advantage |
$992.06
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cofinity Commercial |
$1,428.57
|
| Rate for Payer: Cofinity Commercial |
$1,329.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.06
|
| Rate for Payer: Healthscope Commercial |
$1,190.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,190.47
|
| Rate for Payer: Meridian Medicaid |
$691.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,041.66
|
| Rate for Payer: PACE SWMI |
$992.06
|
| Rate for Payer: PHP Medicare Advantage |
$992.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,807.79
|
| Rate for Payer: Priority Health Medicare |
$992.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,807.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,021.82
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,501.96 |
| Rate for Payer: Aetna Commercial |
$769.04
|
| Rate for Payer: Aetna Medicare |
$573.91
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS MAPPO |
$573.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.96
|
| Rate for Payer: BCN Commercial |
$848.84
|
| Rate for Payer: BCN Medicare Advantage |
$573.91
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cofinity Commercial |
$826.43
|
| Rate for Payer: Cofinity Commercial |
$769.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.91
|
| Rate for Payer: Healthscope Commercial |
$688.69
|
| Rate for Payer: Healthscope Whirlpool |
$688.69
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$602.61
|
| Rate for Payer: PACE SWMI |
$573.91
|
| Rate for Payer: PHP Medicare Advantage |
$573.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.60
|
| Rate for Payer: Priority Health Medicare |
$573.91
|
| Rate for Payer: Priority Health Narrow Network |
$938.60
|
| Rate for Payer: UHC Medicare Advantage |
$591.13
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$2,667.39 |
| Rate for Payer: Aetna Commercial |
$665.95
|
| Rate for Payer: Aetna Medicare |
$496.98
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS MAPPO |
$496.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,667.39
|
| Rate for Payer: BCN Commercial |
$736.93
|
| Rate for Payer: BCN Medicare Advantage |
$496.98
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$715.65
|
| Rate for Payer: Cofinity Commercial |
$665.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.98
|
| Rate for Payer: Healthscope Commercial |
$596.38
|
| Rate for Payer: Healthscope Whirlpool |
$596.38
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.83
|
| Rate for Payer: PACE SWMI |
$496.98
|
| Rate for Payer: PHP Medicare Advantage |
$496.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.86
|
| Rate for Payer: Priority Health Medicare |
$496.98
|
| Rate for Payer: Priority Health Narrow Network |
$814.86
|
| Rate for Payer: UHC Medicare Advantage |
$511.89
|
|
|
PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 54535
|
| Min. Negotiated Rate |
$474.14 |
| Max. Negotiated Rate |
$3,333.04 |
| Rate for Payer: Aetna Commercial |
$973.83
|
| Rate for Payer: Aetna Medicare |
$726.74
|
| Rate for Payer: BCBS Complete |
$497.85
|
| Rate for Payer: BCBS MAPPO |
$726.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,333.04
|
| Rate for Payer: BCN Commercial |
$1,073.63
|
| Rate for Payer: BCN Medicare Advantage |
$726.74
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cofinity Commercial |
$1,046.51
|
| Rate for Payer: Cofinity Commercial |
$973.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.74
|
| Rate for Payer: Healthscope Commercial |
$872.09
|
| Rate for Payer: Healthscope Whirlpool |
$872.09
|
| Rate for Payer: Meridian Medicaid |
$497.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$763.08
|
| Rate for Payer: PACE SWMI |
$726.74
|
| Rate for Payer: PHP Medicare Advantage |
$726.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,187.16
|
| Rate for Payer: Priority Health Medicare |
$726.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,187.16
|
| Rate for Payer: UHC Medicare Advantage |
$748.54
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$2,233.12 |
| Rate for Payer: Aetna Commercial |
$429.09
|
| Rate for Payer: Aetna Medicare |
$320.22
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS MAPPO |
$320.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.12
|
| Rate for Payer: BCN Commercial |
$475.49
|
| Rate for Payer: BCN Medicare Advantage |
$320.22
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$461.12
|
| Rate for Payer: Cofinity Commercial |
$429.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.22
|
| Rate for Payer: Healthscope Commercial |
$384.26
|
| Rate for Payer: Healthscope Whirlpool |
$384.26
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.23
|
| Rate for Payer: PACE SWMI |
$320.22
|
| Rate for Payer: PHP Medicare Advantage |
$320.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.76
|
| Rate for Payer: Priority Health Medicare |
$320.22
|
| Rate for Payer: Priority Health Narrow Network |
$525.76
|
| Rate for Payer: UHC Medicare Advantage |
$329.83
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$454.54 |
| Max. Negotiated Rate |
$2,517.35 |
| Rate for Payer: Aetna Commercial |
$931.94
|
| Rate for Payer: Aetna Medicare |
$695.48
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS MAPPO |
$695.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.35
|
| Rate for Payer: BCN Commercial |
$1,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$695.48
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cofinity Commercial |
$931.94
|
| Rate for Payer: Cofinity Commercial |
$1,001.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.48
|
| Rate for Payer: Healthscope Commercial |
$834.58
|
| Rate for Payer: Healthscope Whirlpool |
$834.58
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$730.25
|
| Rate for Payer: PACE SWMI |
$695.48
|
| Rate for Payer: PHP Medicare Advantage |
$695.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.46
|
| Rate for Payer: Priority Health Medicare |
$695.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.46
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$2,048.75 |
| Rate for Payer: Aetna Commercial |
$566.43
|
| Rate for Payer: Aetna Medicare |
$422.71
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS MAPPO |
$422.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.75
|
| Rate for Payer: BCN Commercial |
$623.55
|
| Rate for Payer: BCN Medicare Advantage |
$422.71
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$566.43
|
| Rate for Payer: Cofinity Commercial |
$608.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.71
|
| Rate for Payer: Healthscope Commercial |
$507.25
|
| Rate for Payer: Healthscope Whirlpool |
$507.25
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$443.85
|
| Rate for Payer: PACE SWMI |
$422.71
|
| Rate for Payer: PHP Medicare Advantage |
$422.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.50
|
| Rate for Payer: Priority Health Medicare |
$422.71
|
| Rate for Payer: Priority Health Narrow Network |
$689.50
|
| Rate for Payer: UHC Medicare Advantage |
$435.39
|
|
|
PR ORPHENADRINE INJECTION
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS J2360
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$16.54
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$9.88
|
| Rate for Payer: BCN Commercial |
$5.01
|
| Rate for Payer: BCN Medicare Advantage |
$16.54
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$22.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Whirlpool |
$19.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.36
|
| Rate for Payer: PACE SWMI |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Medicare |
$16.54
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
|
|
PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 97760
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$466.49 |
| Rate for Payer: Aetna Commercial |
$62.08
|
| Rate for Payer: Aetna Medicare |
$46.33
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS MAPPO |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$466.49
|
| Rate for Payer: BCN Commercial |
$70.86
|
| Rate for Payer: BCN Medicare Advantage |
$46.33
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$62.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.33
|
| Rate for Payer: Healthscope Commercial |
$55.60
|
| Rate for Payer: Healthscope Whirlpool |
$55.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.65
|
| Rate for Payer: PACE SWMI |
$46.33
|
| Rate for Payer: PHP Medicare Advantage |
$46.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$46.33
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$47.72
|
|
|
PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 97763
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$674.11 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$50.59
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$77.70
|
| Rate for Payer: BCN Medicare Advantage |
$50.59
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$72.85
|
| Rate for Payer: Cofinity Commercial |
$67.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$60.71
|
| Rate for Payer: Healthscope Whirlpool |
$60.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.12
|
| Rate for Payer: PACE SWMI |
$50.59
|
| Rate for Payer: PHP Medicare Advantage |
$50.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$50.59
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$22,051.42
|
|
|
Service Code
|
MS-DRG 666
|
| Min. Negotiated Rate |
$15,410.08 |
| Max. Negotiated Rate |
$22,051.42 |
| Rate for Payer: Aetna Medicare |
$16,221.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,276.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,276.42
|
| Rate for Payer: BCBS MAPPO |
$16,221.14
|
| Rate for Payer: BCN Medicare Advantage |
$16,221.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,221.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,221.14
|
| Rate for Payer: Mclaren Medicare |
$16,221.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,032.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,654.31
|
| Rate for Payer: PACE Medicare |
$15,410.08
|
| Rate for Payer: PACE SWMI |
$16,221.14
|
| Rate for Payer: PHP Commercial |
$17,843.25
|
| Rate for Payer: PHP Medicare Advantage |
$16,221.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,051.42
|
| Rate for Payer: Priority Health Medicare |
$16,221.14
|
| Rate for Payer: Priority Health Narrow Network |
$17,641.14
|
| Rate for Payer: Railroad Medicare Medicare |
$16,221.14
|
| Rate for Payer: UHC Medicare Advantage |
$16,707.77
|
| Rate for Payer: VA VA |
$16,221.14
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$39,664.04
|
|
|
Service Code
|
MS-DRG 665
|
| Min. Negotiated Rate |
$26,442.77 |
| Max. Negotiated Rate |
$39,664.04 |
| Rate for Payer: Aetna Medicare |
$27,834.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,793.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,793.11
|
| Rate for Payer: BCBS MAPPO |
$27,834.49
|
| Rate for Payer: BCN Medicare Advantage |
$27,834.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,834.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,834.49
|
| Rate for Payer: Mclaren Medicare |
$27,834.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,226.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,009.66
|
| Rate for Payer: PACE Medicare |
$26,442.77
|
| Rate for Payer: PACE SWMI |
$27,834.49
|
| Rate for Payer: PHP Commercial |
$30,617.94
|
| Rate for Payer: PHP Medicare Advantage |
$27,834.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,664.04
|
| Rate for Payer: Priority Health Medicare |
$27,834.49
|
| Rate for Payer: Priority Health Narrow Network |
$31,731.23
|
| Rate for Payer: Railroad Medicare Medicare |
$27,834.49
|
| Rate for Payer: UHC Medicare Advantage |
$28,669.52
|
| Rate for Payer: VA VA |
$27,834.49
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$13,476.86
|
|
|
Service Code
|
MS-DRG 667
|
| Min. Negotiated Rate |
$10,038.90 |
| Max. Negotiated Rate |
$13,476.86 |
| Rate for Payer: Aetna Medicare |
$10,567.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,209.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,209.08
|
| Rate for Payer: BCBS MAPPO |
$10,567.26
|
| Rate for Payer: BCN Medicare Advantage |
$10,567.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,567.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,567.26
|
| Rate for Payer: Mclaren Medicare |
$10,567.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,095.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,152.35
|
| Rate for Payer: PACE Medicare |
$10,038.90
|
| Rate for Payer: PACE SWMI |
$10,567.26
|
| Rate for Payer: PHP Commercial |
$11,623.99
|
| Rate for Payer: PHP Medicare Advantage |
$10,567.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,476.86
|
| Rate for Payer: Priority Health Medicare |
$10,567.26
|
| Rate for Payer: Priority Health Narrow Network |
$10,781.49
|
| Rate for Payer: Railroad Medicare Medicare |
$10,567.26
|
| Rate for Payer: UHC Medicare Advantage |
$10,884.28
|
| Rate for Payer: VA VA |
$10,567.26
|
|
|
PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 28114
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$1,554.48 |
| Rate for Payer: Aetna Commercial |
$1,095.24
|
| Rate for Payer: Aetna Medicare |
$817.34
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS MAPPO |
$817.34
|
| Rate for Payer: BCBS Trust/PPO |
$864.83
|
| Rate for Payer: BCN Commercial |
$1,554.48
|
| Rate for Payer: BCN Medicare Advantage |
$817.34
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,095.24
|
| Rate for Payer: Cofinity Commercial |
$1,176.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$817.34
|
| Rate for Payer: Healthscope Commercial |
$980.81
|
| Rate for Payer: Healthscope Whirlpool |
$980.81
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$858.21
|
| Rate for Payer: PACE SWMI |
$817.34
|
| Rate for Payer: PHP Medicare Advantage |
$817.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,277.14
|
| Rate for Payer: Priority Health Medicare |
$817.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,277.14
|
| Rate for Payer: UHC Medicare Advantage |
$841.86
|
|
|
PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 28288
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$877.67 |
| Rate for Payer: Aetna Commercial |
$565.32
|
| Rate for Payer: Aetna Medicare |
$421.88
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: BCBS MAPPO |
$421.88
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$877.67
|
| Rate for Payer: BCN Medicare Advantage |
$421.88
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$607.51
|
| Rate for Payer: Cofinity Commercial |
$565.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.88
|
| Rate for Payer: Healthscope Commercial |
$506.26
|
| Rate for Payer: Healthscope Whirlpool |
$506.26
|
| Rate for Payer: Meridian Medicaid |
$295.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$442.97
|
| Rate for Payer: PACE SWMI |
$421.88
|
| Rate for Payer: PHP Medicare Advantage |
$421.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.81
|
| Rate for Payer: Priority Health Medicare |
$421.88
|
| Rate for Payer: Priority Health Narrow Network |
$661.81
|
| Rate for Payer: UHC Medicare Advantage |
$434.54
|
|
|
PR OSTECTOMY CALCANEUS
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 28118
|
| Min. Negotiated Rate |
$273.07 |
| Max. Negotiated Rate |
$2,262.71 |
| Rate for Payer: Aetna Commercial |
$550.69
|
| Rate for Payer: Aetna Medicare |
$410.96
|
| Rate for Payer: BCBS Complete |
$286.72
|
| Rate for Payer: BCBS MAPPO |
$410.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.71
|
| Rate for Payer: BCN Commercial |
$877.67
|
| Rate for Payer: BCN Medicare Advantage |
$410.96
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cofinity Commercial |
$591.78
|
| Rate for Payer: Cofinity Commercial |
$550.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.96
|
| Rate for Payer: Healthscope Commercial |
$493.15
|
| Rate for Payer: Healthscope Whirlpool |
$493.15
|
| Rate for Payer: Meridian Medicaid |
$286.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$431.51
|
| Rate for Payer: PACE SWMI |
$410.96
|
| Rate for Payer: PHP Medicare Advantage |
$410.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.88
|
| Rate for Payer: Priority Health Medicare |
$410.96
|
| Rate for Payer: Priority Health Narrow Network |
$641.88
|
| Rate for Payer: UHC Medicare Advantage |
$423.29
|
|
|
PR OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS
|
Professional
|
Both
|
$1,198.00
|
|
|
Service Code
|
HCPCS 28119
|
| Min. Negotiated Rate |
$235.37 |
| Max. Negotiated Rate |
$838.60 |
| Rate for Payer: Aetna Commercial |
$475.08
|
| Rate for Payer: Aetna Medicare |
$354.54
|
| Rate for Payer: BCBS Complete |
$247.14
|
| Rate for Payer: BCBS MAPPO |
$354.54
|
| Rate for Payer: BCBS Trust/PPO |
$811.47
|
| Rate for Payer: BCN Commercial |
$761.85
|
| Rate for Payer: BCN Medicare Advantage |
$354.54
|
| Rate for Payer: Cash Price |
$958.40
|
| Rate for Payer: Cash Price |
$958.40
|
| Rate for Payer: Cofinity Commercial |
$510.54
|
| Rate for Payer: Cofinity Commercial |
$475.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.54
|
| Rate for Payer: Healthscope Commercial |
$425.45
|
| Rate for Payer: Healthscope Whirlpool |
$425.45
|
| Rate for Payer: Meridian Medicaid |
$247.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.27
|
| Rate for Payer: PACE SWMI |
$354.54
|
| Rate for Payer: PHP Medicare Advantage |
$354.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.55
|
| Rate for Payer: Priority Health Medicare |
$354.54
|
| Rate for Payer: Priority Health Narrow Network |
$553.55
|
| Rate for Payer: UHC Medicare Advantage |
$365.18
|
|
|
PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 28111
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$693.44 |
| Rate for Payer: Aetna Commercial |
$419.02
|
| Rate for Payer: Aetna Medicare |
$312.70
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$312.70
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: BCN Medicare Advantage |
$312.70
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cofinity Commercial |
$450.29
|
| Rate for Payer: Cofinity Commercial |
$419.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.70
|
| Rate for Payer: Healthscope Commercial |
$375.24
|
| Rate for Payer: Healthscope Whirlpool |
$375.24
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$328.34
|
| Rate for Payer: PACE SWMI |
$312.70
|
| Rate for Payer: PHP Medicare Advantage |
$312.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.66
|
| Rate for Payer: Priority Health Medicare |
$312.70
|
| Rate for Payer: Priority Health Narrow Network |
$486.66
|
| Rate for Payer: UHC Medicare Advantage |
$322.08
|
|
|
PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD
|
Professional
|
Both
|
$1,014.00
|
|
|
Service Code
|
HCPCS 28113
|
| Min. Negotiated Rate |
$275.41 |
| Max. Negotiated Rate |
$850.30 |
| Rate for Payer: Aetna Commercial |
$554.89
|
| Rate for Payer: Aetna Medicare |
$414.10
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCBS MAPPO |
$414.10
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$850.30
|
| Rate for Payer: BCN Medicare Advantage |
$414.10
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cofinity Commercial |
$554.89
|
| Rate for Payer: Cofinity Commercial |
$596.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.10
|
| Rate for Payer: Healthscope Commercial |
$496.92
|
| Rate for Payer: Healthscope Whirlpool |
$496.92
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.80
|
| Rate for Payer: PACE SWMI |
$414.10
|
| Rate for Payer: PHP Medicare Advantage |
$414.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.04
|
| Rate for Payer: Priority Health Medicare |
$414.10
|
| Rate for Payer: Priority Health Narrow Network |
$649.04
|
| Rate for Payer: UHC Medicare Advantage |
$426.52
|
|
|
PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 28112
|
| Min. Negotiated Rate |
$202.14 |
| Max. Negotiated Rate |
$1,106.26 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna Medicare |
$305.77
|
| Rate for Payer: BCBS Complete |
$212.25
|
| Rate for Payer: BCBS MAPPO |
$305.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.26
|
| Rate for Payer: BCN Commercial |
$702.23
|
| Rate for Payer: BCN Medicare Advantage |
$305.77
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$440.31
|
| Rate for Payer: Cofinity Commercial |
$409.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.77
|
| Rate for Payer: Healthscope Commercial |
$366.92
|
| Rate for Payer: Healthscope Whirlpool |
$366.92
|
| Rate for Payer: Meridian Medicaid |
$212.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$321.06
|
| Rate for Payer: PACE SWMI |
$305.77
|
| Rate for Payer: PHP Medicare Advantage |
$305.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.96
|
| Rate for Payer: Priority Health Medicare |
$305.77
|
| Rate for Payer: Priority Health Narrow Network |
$477.96
|
| Rate for Payer: UHC Medicare Advantage |
$314.94
|
|
|
PR OSTECTOMY PRTL 5TH METAR HEAD SPX
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
HCPCS 28110
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$667.54 |
| Rate for Payer: Aetna Commercial |
$380.17
|
| Rate for Payer: Aetna Medicare |
$283.71
|
| Rate for Payer: BCBS Complete |
$199.27
|
| Rate for Payer: BCBS MAPPO |
$283.71
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$667.54
|
| Rate for Payer: BCN Medicare Advantage |
$283.71
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Cash Price |
$716.80
|
| Rate for Payer: Cofinity Commercial |
$380.17
|
| Rate for Payer: Cofinity Commercial |
$408.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.71
|
| Rate for Payer: Healthscope Commercial |
$340.45
|
| Rate for Payer: Healthscope Whirlpool |
$340.45
|
| Rate for Payer: Meridian Medicaid |
$199.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$297.90
|
| Rate for Payer: PACE SWMI |
$283.71
|
| Rate for Payer: PHP Medicare Advantage |
$283.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.27
|
| Rate for Payer: Priority Health Medicare |
$283.71
|
| Rate for Payer: Priority Health Narrow Network |
$444.27
|
| Rate for Payer: UHC Medicare Advantage |
$292.22
|
|
|
PR OSTECTOMY STERNUM PARTIAL
|
Professional
|
Both
|
$3,875.00
|
|
|
Service Code
|
HCPCS 21620
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$666.58
|
| Rate for Payer: Aetna Medicare |
$497.45
|
| Rate for Payer: BCBS Complete |
$339.06
|
| Rate for Payer: BCBS MAPPO |
$497.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$737.90
|
| Rate for Payer: BCN Medicare Advantage |
$497.45
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cofinity Commercial |
$716.33
|
| Rate for Payer: Cofinity Commercial |
$666.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.45
|
| Rate for Payer: Healthscope Commercial |
$596.94
|
| Rate for Payer: Healthscope Whirlpool |
$596.94
|
| Rate for Payer: Meridian Medicaid |
$339.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$522.32
|
| Rate for Payer: PACE SWMI |
$497.45
|
| Rate for Payer: PHP Medicare Advantage |
$497.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$771.09
|
| Rate for Payer: Priority Health Medicare |
$497.45
|
| Rate for Payer: Priority Health Narrow Network |
$771.09
|
| Rate for Payer: UHC Medicare Advantage |
$512.37
|
|
|
PR OSTECTOMY TARSAL COALITION
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 28116
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,784.07 |
| Rate for Payer: Aetna Commercial |
$774.71
|
| Rate for Payer: Aetna Medicare |
$578.14
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS MAPPO |
$578.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,784.07
|
| Rate for Payer: BCN Commercial |
$1,138.62
|
| Rate for Payer: BCN Medicare Advantage |
$578.14
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$832.52
|
| Rate for Payer: Cofinity Commercial |
$774.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.14
|
| Rate for Payer: Healthscope Commercial |
$693.77
|
| Rate for Payer: Healthscope Whirlpool |
$693.77
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$607.05
|
| Rate for Payer: PACE SWMI |
$578.14
|
| Rate for Payer: PHP Medicare Advantage |
$578.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.27
|
| Rate for Payer: Priority Health Medicare |
$578.14
|
| Rate for Payer: Priority Health Narrow Network |
$900.27
|
| Rate for Payer: UHC Medicare Advantage |
$595.48
|
|
|
PR OSTEOCHONDRAL ALLOGRAFT KNEE OPEN
|
Professional
|
Both
|
$4,485.00
|
|
|
Service Code
|
HCPCS 27415
|
| Min. Negotiated Rate |
$709.51 |
| Max. Negotiated Rate |
$3,139.50 |
| Rate for Payer: Aetna Commercial |
$1,810.81
|
| Rate for Payer: Aetna Medicare |
$1,351.35
|
| Rate for Payer: BCBS Complete |
$925.91
|
| Rate for Payer: BCBS MAPPO |
$1,351.35
|
| Rate for Payer: BCBS Trust/PPO |
$709.51
|
| Rate for Payer: BCN Commercial |
$2,007.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,351.35
|
| Rate for Payer: Cash Price |
$3,588.00
|
| Rate for Payer: Cash Price |
$3,588.00
|
| Rate for Payer: Cofinity Commercial |
$1,945.94
|
| Rate for Payer: Cofinity Commercial |
$1,810.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,351.35
|
| Rate for Payer: Healthscope Commercial |
$1,621.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,621.62
|
| Rate for Payer: Meridian Medicaid |
$925.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,418.92
|
| Rate for Payer: PACE SWMI |
$1,351.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,351.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$881.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,139.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,098.27
|
| Rate for Payer: Priority Health Medicare |
$1,351.35
|
| Rate for Payer: Priority Health Narrow Network |
$2,098.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,391.89
|
|
|
PR OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY
|
Professional
|
Both
|
$3,036.00
|
|
|
Service Code
|
HCPCS 27416
|
| Min. Negotiated Rate |
$631.55 |
| Max. Negotiated Rate |
$2,125.20 |
| Rate for Payer: Aetna Commercial |
$1,296.52
|
| Rate for Payer: Aetna Medicare |
$967.55
|
| Rate for Payer: BCBS Complete |
$663.13
|
| Rate for Payer: BCBS MAPPO |
$967.55
|
| Rate for Payer: BCBS Trust/PPO |
$852.15
|
| Rate for Payer: BCN Commercial |
$1,438.67
|
| Rate for Payer: BCN Medicare Advantage |
$967.55
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cofinity Commercial |
$1,393.27
|
| Rate for Payer: Cofinity Commercial |
$1,296.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$967.55
|
| Rate for Payer: Healthscope Commercial |
$1,161.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.06
|
| Rate for Payer: Meridian Medicaid |
$663.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,015.93
|
| Rate for Payer: PACE SWMI |
$967.55
|
| Rate for Payer: PHP Medicare Advantage |
$967.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$631.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,503.35
|
| Rate for Payer: Priority Health Medicare |
$967.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,503.35
|
| Rate for Payer: UHC Medicare Advantage |
$996.58
|
|
