|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$108.82
|
| Rate for Payer: Aetna Medicare |
$81.21
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$81.21
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$81.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$108.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.21
|
| Rate for Payer: Healthscope Commercial |
$97.45
|
| Rate for Payer: Healthscope Whirlpool |
$97.45
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.27
|
| Rate for Payer: PACE SWMI |
$81.21
|
| Rate for Payer: PHP Medicare Advantage |
$81.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Medicare |
$81.21
|
| Rate for Payer: Priority Health Narrow Network |
$100.70
|
| Rate for Payer: UHC Medicare Advantage |
$83.65
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: ASR ASR |
$266.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.21
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$258.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$275.00
|
| Rate for Payer: Healthscope Whirlpool |
$266.75
|
| Rate for Payer: Mclaren Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.00
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$108.82
|
| Rate for Payer: Aetna Medicare |
$81.21
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$81.21
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$81.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$108.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.21
|
| Rate for Payer: Healthscope Commercial |
$97.45
|
| Rate for Payer: Healthscope Whirlpool |
$97.45
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.27
|
| Rate for Payer: PACE SWMI |
$81.21
|
| Rate for Payer: PHP Medicare Advantage |
$81.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Medicare |
$81.21
|
| Rate for Payer: Priority Health Narrow Network |
$100.70
|
| Rate for Payer: UHC Medicare Advantage |
$83.65
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
13122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: ASR ASR |
$266.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$213.21
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$258.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$275.00
|
| Rate for Payer: Healthscope Whirlpool |
$266.75
|
| Rate for Payer: Mclaren Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.00
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$501.39 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Aetna Medicare |
$194.80
|
| Rate for Payer: BCBS Complete |
$133.74
|
| Rate for Payer: BCBS MAPPO |
$194.80
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$501.39
|
| Rate for Payer: BCN Medicare Advantage |
$194.80
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cofinity Commercial |
$280.51
|
| Rate for Payer: Cofinity Commercial |
$261.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.80
|
| Rate for Payer: Healthscope Commercial |
$233.76
|
| Rate for Payer: Healthscope Whirlpool |
$233.76
|
| Rate for Payer: Meridian Medicaid |
$133.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.54
|
| Rate for Payer: PACE SWMI |
$194.80
|
| Rate for Payer: PHP Medicare Advantage |
$194.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.57
|
| Rate for Payer: Priority Health Medicare |
$194.80
|
| Rate for Payer: Priority Health Narrow Network |
$244.57
|
| Rate for Payer: UHC Medicare Advantage |
$200.64
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$320.85
|
| Rate for Payer: Aetna Medicare |
$239.44
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS MAPPO |
$239.44
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: BCN Medicare Advantage |
$239.44
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$344.79
|
| Rate for Payer: Cofinity Commercial |
$320.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.44
|
| Rate for Payer: Healthscope Commercial |
$287.33
|
| Rate for Payer: Healthscope Whirlpool |
$287.33
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.41
|
| Rate for Payer: PACE SWMI |
$239.44
|
| Rate for Payer: PHP Medicare Advantage |
$239.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.70
|
| Rate for Payer: Priority Health Medicare |
$239.44
|
| Rate for Payer: Priority Health Narrow Network |
$301.70
|
| Rate for Payer: UHC Medicare Advantage |
$246.62
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Aetna Commercial |
$94.14
|
| Rate for Payer: Aetna Medicare |
$70.25
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS MAPPO |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$70.25
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cofinity Commercial |
$101.16
|
| Rate for Payer: Cofinity Commercial |
$94.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$84.30
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.76
|
| Rate for Payer: PACE SWMI |
$70.25
|
| Rate for Payer: PHP Medicare Advantage |
$70.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.14
|
| Rate for Payer: Priority Health Medicare |
$70.25
|
| Rate for Payer: Priority Health Narrow Network |
$87.14
|
| Rate for Payer: UHC Medicare Advantage |
$72.36
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$324.80 |
| Rate for Payer: Aetna Commercial |
$179.85
|
| Rate for Payer: Aetna Medicare |
$134.22
|
| Rate for Payer: BCBS Complete |
$90.58
|
| Rate for Payer: BCBS MAPPO |
$134.22
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$271.70
|
| Rate for Payer: BCN Medicare Advantage |
$134.22
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Commercial |
$179.85
|
| Rate for Payer: Cofinity Commercial |
$193.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$161.06
|
| Rate for Payer: Healthscope Whirlpool |
$161.06
|
| Rate for Payer: Meridian Medicaid |
$90.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.93
|
| Rate for Payer: PACE SWMI |
$134.22
|
| Rate for Payer: PHP Medicare Advantage |
$134.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.47
|
| Rate for Payer: Priority Health Medicare |
$134.22
|
| Rate for Payer: Priority Health Narrow Network |
$166.47
|
| Rate for Payer: UHC Medicare Advantage |
$138.25
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,913.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$517.47 |
| Max. Negotiated Rate |
$1,479.35 |
| Rate for Payer: Aetna Commercial |
$1,274.54
|
| Rate for Payer: Aetna Medicare |
$951.15
|
| Rate for Payer: BCBS Complete |
$652.61
|
| Rate for Payer: BCBS MAPPO |
$951.15
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: BCN Commercial |
$1,415.70
|
| Rate for Payer: BCN Medicare Advantage |
$951.15
|
| Rate for Payer: Cash Price |
$1,530.40
|
| Rate for Payer: Cash Price |
$1,530.40
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Cofinity Commercial |
$1,369.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$951.15
|
| Rate for Payer: Healthscope Commercial |
$1,141.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,141.38
|
| Rate for Payer: Meridian Medicaid |
$652.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$998.71
|
| Rate for Payer: PACE SWMI |
$951.15
|
| Rate for Payer: PHP Medicare Advantage |
$951.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.35
|
| Rate for Payer: Priority Health Medicare |
$951.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.35
|
| Rate for Payer: UHC Medicare Advantage |
$979.68
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$3,872.44 |
| Rate for Payer: Aetna Commercial |
$799.00
|
| Rate for Payer: Aetna Medicare |
$596.27
|
| Rate for Payer: BCBS Complete |
$413.75
|
| Rate for Payer: BCBS MAPPO |
$596.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,872.44
|
| Rate for Payer: BCN Commercial |
$889.88
|
| Rate for Payer: BCN Medicare Advantage |
$596.27
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cash Price |
$1,700.80
|
| Rate for Payer: Cofinity Commercial |
$858.63
|
| Rate for Payer: Cofinity Commercial |
$799.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$596.27
|
| Rate for Payer: Healthscope Commercial |
$715.52
|
| Rate for Payer: Healthscope Whirlpool |
$715.52
|
| Rate for Payer: Meridian Medicaid |
$413.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$626.08
|
| Rate for Payer: PACE SWMI |
$596.27
|
| Rate for Payer: PHP Medicare Advantage |
$596.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,488.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$929.90
|
| Rate for Payer: Priority Health Medicare |
$596.27
|
| Rate for Payer: Priority Health Narrow Network |
$929.90
|
| Rate for Payer: UHC Medicare Advantage |
$614.16
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$908.94 |
| Rate for Payer: Aetna Commercial |
$582.79
|
| Rate for Payer: Aetna Medicare |
$434.92
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$434.92
|
| Rate for Payer: BCBS Trust/PPO |
$744.37
|
| Rate for Payer: BCN Commercial |
$908.94
|
| Rate for Payer: BCN Medicare Advantage |
$434.92
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$582.79
|
| Rate for Payer: Cofinity Commercial |
$626.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.92
|
| Rate for Payer: Healthscope Commercial |
$521.90
|
| Rate for Payer: Healthscope Whirlpool |
$521.90
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$456.67
|
| Rate for Payer: PACE SWMI |
$434.92
|
| Rate for Payer: PHP Medicare Advantage |
$434.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$785.64
|
| Rate for Payer: Priority Health Medicare |
$434.92
|
| Rate for Payer: Priority Health Narrow Network |
$785.64
|
| Rate for Payer: UHC Medicare Advantage |
$447.97
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,023.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$522.28 |
| Max. Negotiated Rate |
$2,459.24 |
| Rate for Payer: Aetna Commercial |
$1,082.33
|
| Rate for Payer: Aetna Medicare |
$807.71
|
| Rate for Payer: BCBS Complete |
$548.39
|
| Rate for Payer: BCBS MAPPO |
$807.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.24
|
| Rate for Payer: BCN Commercial |
$1,193.84
|
| Rate for Payer: BCN Medicare Advantage |
$807.71
|
| Rate for Payer: Cash Price |
$1,618.40
|
| Rate for Payer: Cash Price |
$1,618.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.10
|
| Rate for Payer: Cofinity Commercial |
$1,082.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$807.71
|
| Rate for Payer: Healthscope Commercial |
$969.25
|
| Rate for Payer: Healthscope Whirlpool |
$969.25
|
| Rate for Payer: Meridian Medicaid |
$548.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$848.10
|
| Rate for Payer: PACE SWMI |
$807.71
|
| Rate for Payer: PHP Medicare Advantage |
$807.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.57
|
| Rate for Payer: Priority Health Medicare |
$807.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.57
|
| Rate for Payer: UHC Medicare Advantage |
$831.94
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$326.53 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$669.88
|
| Rate for Payer: Aetna Medicare |
$499.91
|
| Rate for Payer: BCBS Complete |
$342.86
|
| Rate for Payer: BCBS MAPPO |
$499.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: BCN Medicare Advantage |
$499.91
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$719.87
|
| Rate for Payer: Cofinity Commercial |
$669.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.91
|
| Rate for Payer: Healthscope Commercial |
$599.89
|
| Rate for Payer: Healthscope Whirlpool |
$599.89
|
| Rate for Payer: Meridian Medicaid |
$342.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$524.91
|
| Rate for Payer: PACE SWMI |
$499.91
|
| Rate for Payer: PHP Medicare Advantage |
$499.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.50
|
| Rate for Payer: Priority Health Medicare |
$499.91
|
| Rate for Payer: Priority Health Narrow Network |
$721.50
|
| Rate for Payer: UHC Medicare Advantage |
$514.91
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$198.73 |
| Max. Negotiated Rate |
$697.83 |
| Rate for Payer: Aetna Commercial |
$396.21
|
| Rate for Payer: Aetna Medicare |
$295.68
|
| Rate for Payer: BCBS Complete |
$208.67
|
| Rate for Payer: BCBS MAPPO |
$295.68
|
| Rate for Payer: BCBS Trust/PPO |
$584.83
|
| Rate for Payer: BCN Commercial |
$697.83
|
| Rate for Payer: BCN Medicare Advantage |
$295.68
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cofinity Commercial |
$396.21
|
| Rate for Payer: Cofinity Commercial |
$425.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.68
|
| Rate for Payer: Healthscope Commercial |
$354.82
|
| Rate for Payer: Healthscope Whirlpool |
$354.82
|
| Rate for Payer: Meridian Medicaid |
$208.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$310.46
|
| Rate for Payer: PACE SWMI |
$295.68
|
| Rate for Payer: PHP Medicare Advantage |
$295.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.00
|
| Rate for Payer: Priority Health Medicare |
$295.68
|
| Rate for Payer: Priority Health Narrow Network |
$538.00
|
| Rate for Payer: UHC Medicare Advantage |
$304.55
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$952.70 |
| Rate for Payer: Aetna Commercial |
$749.10
|
| Rate for Payer: Aetna Medicare |
$559.03
|
| Rate for Payer: BCBS Complete |
$389.37
|
| Rate for Payer: BCBS MAPPO |
$559.03
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$559.03
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cofinity Commercial |
$805.00
|
| Rate for Payer: Cofinity Commercial |
$749.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.03
|
| Rate for Payer: Healthscope Commercial |
$670.84
|
| Rate for Payer: Healthscope Whirlpool |
$670.84
|
| Rate for Payer: Meridian Medicaid |
$389.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.98
|
| Rate for Payer: PACE SWMI |
$559.03
|
| Rate for Payer: PHP Medicare Advantage |
$559.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.13
|
| Rate for Payer: Priority Health Medicare |
$559.03
|
| Rate for Payer: Priority Health Narrow Network |
$893.13
|
| Rate for Payer: UHC Medicare Advantage |
$575.80
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$1,227.10 |
| Rate for Payer: Aetna Commercial |
$973.38
|
| Rate for Payer: Aetna Medicare |
$726.40
|
| Rate for Payer: BCBS Complete |
$505.00
|
| Rate for Payer: BCBS MAPPO |
$726.40
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$1,105.38
|
| Rate for Payer: BCN Medicare Advantage |
$726.40
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cofinity Commercial |
$973.38
|
| Rate for Payer: Cofinity Commercial |
$1,046.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.40
|
| Rate for Payer: Healthscope Commercial |
$871.68
|
| Rate for Payer: Healthscope Whirlpool |
$871.68
|
| Rate for Payer: Meridian Medicaid |
$505.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$762.72
|
| Rate for Payer: PACE SWMI |
$726.40
|
| Rate for Payer: PHP Medicare Advantage |
$726.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,155.09
|
| Rate for Payer: Priority Health Medicare |
$726.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,155.09
|
| Rate for Payer: UHC Medicare Advantage |
$748.19
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$972.79 |
| Rate for Payer: Aetna Commercial |
$812.25
|
| Rate for Payer: Aetna Medicare |
$606.16
|
| Rate for Payer: BCBS Complete |
$425.83
|
| Rate for Payer: BCBS MAPPO |
$606.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: BCN Commercial |
$930.93
|
| Rate for Payer: BCN Medicare Advantage |
$606.16
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cofinity Commercial |
$872.87
|
| Rate for Payer: Cofinity Commercial |
$812.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.16
|
| Rate for Payer: Healthscope Commercial |
$727.39
|
| Rate for Payer: Healthscope Whirlpool |
$727.39
|
| Rate for Payer: Meridian Medicaid |
$425.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$636.47
|
| Rate for Payer: PACE SWMI |
$606.16
|
| Rate for Payer: PHP Medicare Advantage |
$606.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$972.79
|
| Rate for Payer: Priority Health Medicare |
$606.16
|
| Rate for Payer: Priority Health Narrow Network |
$972.79
|
| Rate for Payer: UHC Medicare Advantage |
$624.34
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,895.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,326.50 |
| Rate for Payer: Aetna Commercial |
$939.06
|
| Rate for Payer: Aetna Medicare |
$700.79
|
| Rate for Payer: BCBS Complete |
$486.66
|
| Rate for Payer: BCBS MAPPO |
$700.79
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,067.76
|
| Rate for Payer: BCN Medicare Advantage |
$700.79
|
| Rate for Payer: Cash Price |
$1,516.00
|
| Rate for Payer: Cash Price |
$1,516.00
|
| Rate for Payer: Cofinity Commercial |
$939.06
|
| Rate for Payer: Cofinity Commercial |
$1,009.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.79
|
| Rate for Payer: Healthscope Commercial |
$840.95
|
| Rate for Payer: Healthscope Whirlpool |
$840.95
|
| Rate for Payer: Meridian Medicaid |
$486.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.83
|
| Rate for Payer: PACE SWMI |
$700.79
|
| Rate for Payer: PHP Medicare Advantage |
$700.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$700.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.78
|
| Rate for Payer: UHC Medicare Advantage |
$721.81
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$937.55 |
| Rate for Payer: Aetna Commercial |
$785.45
|
| Rate for Payer: Aetna Medicare |
$586.16
|
| Rate for Payer: BCBS Complete |
$409.50
|
| Rate for Payer: BCBS MAPPO |
$586.16
|
| Rate for Payer: BCBS Trust/PPO |
$154.79
|
| Rate for Payer: BCN Commercial |
$897.21
|
| Rate for Payer: BCN Medicare Advantage |
$586.16
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$844.07
|
| Rate for Payer: Cofinity Commercial |
$785.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.16
|
| Rate for Payer: Healthscope Commercial |
$703.39
|
| Rate for Payer: Healthscope Whirlpool |
$703.39
|
| Rate for Payer: Meridian Medicaid |
$409.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$615.47
|
| Rate for Payer: PACE SWMI |
$586.16
|
| Rate for Payer: PHP Medicare Advantage |
$586.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$937.55
|
| Rate for Payer: Priority Health Medicare |
$586.16
|
| Rate for Payer: Priority Health Narrow Network |
$937.55
|
| Rate for Payer: UHC Medicare Advantage |
$603.74
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$221.09 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$454.54
|
| Rate for Payer: Aetna Medicare |
$339.21
|
| Rate for Payer: BCBS Complete |
$232.14
|
| Rate for Payer: BCBS MAPPO |
$339.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$789.70
|
| Rate for Payer: BCN Medicare Advantage |
$339.21
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cofinity Commercial |
$454.54
|
| Rate for Payer: Cofinity Commercial |
$488.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.21
|
| Rate for Payer: Healthscope Commercial |
$407.05
|
| Rate for Payer: Healthscope Whirlpool |
$407.05
|
| Rate for Payer: Meridian Medicaid |
$232.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.17
|
| Rate for Payer: PACE SWMI |
$339.21
|
| Rate for Payer: PHP Medicare Advantage |
$339.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.59
|
| Rate for Payer: Priority Health Medicare |
$339.21
|
| Rate for Payer: Priority Health Narrow Network |
$531.59
|
| Rate for Payer: UHC Medicare Advantage |
$349.39
|
|
|
PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION
|
Professional
|
Both
|
$3,954.00
|
|
|
Service Code
|
HCPCS 27726
|
| Min. Negotiated Rate |
$614.51 |
| Max. Negotiated Rate |
$2,767.80 |
| Rate for Payer: Aetna Commercial |
$1,266.33
|
| Rate for Payer: Aetna Medicare |
$945.02
|
| Rate for Payer: BCBS Complete |
$645.24
|
| Rate for Payer: BCBS MAPPO |
$945.02
|
| Rate for Payer: BCBS Trust/PPO |
$746.49
|
| Rate for Payer: BCN Commercial |
$1,403.48
|
| Rate for Payer: BCN Medicare Advantage |
$945.02
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cash Price |
$3,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,266.33
|
| Rate for Payer: Cofinity Commercial |
$1,360.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.02
|
| Rate for Payer: Healthscope Commercial |
$1,134.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.02
|
| Rate for Payer: Meridian Medicaid |
$645.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$992.27
|
| Rate for Payer: PACE SWMI |
$945.02
|
| Rate for Payer: PHP Medicare Advantage |
$945.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,767.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,466.59
|
| Rate for Payer: Priority Health Medicare |
$945.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,466.59
|
| Rate for Payer: UHC Medicare Advantage |
$973.37
|
|
|
PR REPAIR FIRST ABDOMINAL WALL HERNIA
|
Professional
|
Both
|
$2,065.00
|
|
|
Service Code
|
HCPCS 49560
|
| Min. Negotiated Rate |
$826.00 |
| Max. Negotiated Rate |
$1,445.50 |
| Rate for Payer: BCBS Complete |
$826.00
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.50
|
|
|
PR REPAIR FISTULA OROMAXILLARY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 30580
|
| Min. Negotiated Rate |
$294.79 |
| Max. Negotiated Rate |
$1,017.80 |
| Rate for Payer: Aetna Commercial |
$602.34
|
| Rate for Payer: Aetna Medicare |
$449.51
|
| Rate for Payer: BCBS Complete |
$309.53
|
| Rate for Payer: BCBS MAPPO |
$449.51
|
| Rate for Payer: BCBS Trust/PPO |
$804.60
|
| Rate for Payer: BCN Commercial |
$894.28
|
| Rate for Payer: BCN Medicare Advantage |
$449.51
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$602.34
|
| Rate for Payer: Cofinity Commercial |
$647.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.51
|
| Rate for Payer: Healthscope Commercial |
$539.41
|
| Rate for Payer: Healthscope Whirlpool |
$539.41
|
| Rate for Payer: Meridian Medicaid |
$309.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$471.99
|
| Rate for Payer: PACE SWMI |
$449.51
|
| Rate for Payer: PHP Medicare Advantage |
$449.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.15
|
| Rate for Payer: Priority Health Medicare |
$449.51
|
| Rate for Payer: Priority Health Narrow Network |
$637.15
|
| Rate for Payer: UHC Medicare Advantage |
$463.00
|
|
|
PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 27658
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Aetna Commercial |
$485.75
|
| Rate for Payer: Aetna Medicare |
$362.50
|
| Rate for Payer: BCBS Complete |
$251.38
|
| Rate for Payer: BCBS MAPPO |
$362.50
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$542.92
|
| Rate for Payer: BCN Medicare Advantage |
$362.50
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$522.00
|
| Rate for Payer: Cofinity Commercial |
$485.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.50
|
| Rate for Payer: Healthscope Commercial |
$435.00
|
| Rate for Payer: Healthscope Whirlpool |
$435.00
|
| Rate for Payer: Meridian Medicaid |
$251.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$380.62
|
| Rate for Payer: PACE SWMI |
$362.50
|
| Rate for Payer: PHP Medicare Advantage |
$362.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.34
|
| Rate for Payer: Priority Health Medicare |
$362.50
|
| Rate for Payer: Priority Health Narrow Network |
$567.34
|
| Rate for Payer: UHC Medicare Advantage |
$373.38
|
|
|
PR REPAIR INCOMPLETE CIRCUMCISION
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 54163
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$452.22 |
| Rate for Payer: Aetna Commercial |
$284.88
|
| Rate for Payer: Aetna Medicare |
$212.60
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS MAPPO |
$212.60
|
| Rate for Payer: BCBS Trust/PPO |
$452.22
|
| Rate for Payer: BCN Commercial |
$317.15
|
| Rate for Payer: BCN Medicare Advantage |
$212.60
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cofinity Commercial |
$306.14
|
| Rate for Payer: Cofinity Commercial |
$284.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.60
|
| Rate for Payer: Healthscope Commercial |
$255.12
|
| Rate for Payer: Healthscope Whirlpool |
$255.12
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$223.23
|
| Rate for Payer: PACE SWMI |
$212.60
|
| Rate for Payer: PHP Medicare Advantage |
$212.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.70
|
| Rate for Payer: Priority Health Medicare |
$212.60
|
| Rate for Payer: Priority Health Narrow Network |
$350.70
|
| Rate for Payer: UHC Medicare Advantage |
$218.98
|
|
