|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,639.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$544.22 |
| Max. Negotiated Rate |
$3,247.30 |
| Rate for Payer: Aetna Commercial |
$1,126.06
|
| Rate for Payer: Aetna Medicare |
$840.34
|
| Rate for Payer: BCBS Complete |
$571.43
|
| Rate for Payer: BCBS MAPPO |
$840.34
|
| Rate for Payer: BCBS Trust/PPO |
$575.32
|
| Rate for Payer: BCN Commercial |
$1,234.88
|
| Rate for Payer: BCN Medicare Advantage |
$840.34
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$1,210.09
|
| Rate for Payer: Cofinity Commercial |
$1,126.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.34
|
| Rate for Payer: Healthscope Commercial |
$1,008.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.41
|
| Rate for Payer: Meridian Medicaid |
$571.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$882.36
|
| Rate for Payer: PACE SWMI |
$840.34
|
| Rate for Payer: PHP Medicare Advantage |
$840.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.26
|
| Rate for Payer: Priority Health Medicare |
$840.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.26
|
| Rate for Payer: UHC Medicare Advantage |
$865.55
|
|
|
PR REPAIR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$245.90
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: BCBS Complete |
$126.81
|
| Rate for Payer: BCBS MAPPO |
$183.51
|
| Rate for Payer: BCBS Trust/PPO |
$363.47
|
| Rate for Payer: BCN Commercial |
$377.75
|
| Rate for Payer: BCN Medicare Advantage |
$183.51
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$264.25
|
| Rate for Payer: Cofinity Commercial |
$245.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.51
|
| Rate for Payer: Healthscope Commercial |
$220.21
|
| Rate for Payer: Healthscope Whirlpool |
$220.21
|
| Rate for Payer: Meridian Medicaid |
$126.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$192.69
|
| Rate for Payer: PACE SWMI |
$183.51
|
| Rate for Payer: PHP Medicare Advantage |
$183.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.02
|
| Rate for Payer: Priority Health Medicare |
$183.51
|
| Rate for Payer: Priority Health Narrow Network |
$331.02
|
| Rate for Payer: UHC Medicare Advantage |
$189.02
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$622.34 |
| Rate for Payer: Aetna Commercial |
$340.36
|
| Rate for Payer: Aetna Medicare |
$254.00
|
| Rate for Payer: BCBS Complete |
$174.45
|
| Rate for Payer: BCBS MAPPO |
$254.00
|
| Rate for Payer: BCBS Trust/PPO |
$622.34
|
| Rate for Payer: BCN Commercial |
$487.70
|
| Rate for Payer: BCN Medicare Advantage |
$254.00
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$340.36
|
| Rate for Payer: Cofinity Commercial |
$365.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.00
|
| Rate for Payer: Healthscope Commercial |
$304.80
|
| Rate for Payer: Healthscope Whirlpool |
$304.80
|
| Rate for Payer: Meridian Medicaid |
$174.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$266.70
|
| Rate for Payer: PACE SWMI |
$254.00
|
| Rate for Payer: PHP Medicare Advantage |
$254.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.69
|
| Rate for Payer: Priority Health Medicare |
$254.00
|
| Rate for Payer: Priority Health Narrow Network |
$455.69
|
| Rate for Payer: UHC Medicare Advantage |
$261.62
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,577.10 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Aetna Medicare |
$703.92
|
| Rate for Payer: BCBS Complete |
$487.78
|
| Rate for Payer: BCBS MAPPO |
$703.92
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$1,055.06
|
| Rate for Payer: BCN Medicare Advantage |
$703.92
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cofinity Commercial |
$943.25
|
| Rate for Payer: Cofinity Commercial |
$1,013.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.92
|
| Rate for Payer: Healthscope Commercial |
$844.70
|
| Rate for Payer: Healthscope Whirlpool |
$844.70
|
| Rate for Payer: Meridian Medicaid |
$487.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$739.12
|
| Rate for Payer: PACE SWMI |
$703.92
|
| Rate for Payer: PHP Medicare Advantage |
$703.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,102.49
|
| Rate for Payer: Priority Health Medicare |
$703.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,102.49
|
| Rate for Payer: UHC Medicare Advantage |
$725.04
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$3,768.36 |
| Rate for Payer: Aetna Commercial |
$906.44
|
| Rate for Payer: Aetna Medicare |
$676.45
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS MAPPO |
$676.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,768.36
|
| Rate for Payer: BCN Commercial |
$996.41
|
| Rate for Payer: BCN Medicare Advantage |
$676.45
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$974.09
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.45
|
| Rate for Payer: Healthscope Commercial |
$811.74
|
| Rate for Payer: Healthscope Whirlpool |
$811.74
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$710.27
|
| Rate for Payer: PACE SWMI |
$676.45
|
| Rate for Payer: PHP Medicare Advantage |
$676.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,198.88
|
| Rate for Payer: Priority Health Medicare |
$676.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,198.88
|
| Rate for Payer: UHC Medicare Advantage |
$696.74
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$595.76 |
| Max. Negotiated Rate |
$1,617.00 |
| Rate for Payer: Aetna Commercial |
$1,249.24
|
| Rate for Payer: Aetna Medicare |
$932.27
|
| Rate for Payer: BCBS Complete |
$625.55
|
| Rate for Payer: BCBS MAPPO |
$932.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.01
|
| Rate for Payer: BCN Commercial |
$1,367.81
|
| Rate for Payer: BCN Medicare Advantage |
$932.27
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cofinity Commercial |
$1,342.47
|
| Rate for Payer: Cofinity Commercial |
$1,249.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$932.27
|
| Rate for Payer: Healthscope Commercial |
$1,118.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,118.72
|
| Rate for Payer: Meridian Medicaid |
$625.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$978.88
|
| Rate for Payer: PACE SWMI |
$932.27
|
| Rate for Payer: PHP Medicare Advantage |
$932.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,296.06
|
| Rate for Payer: Priority Health Medicare |
$932.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,296.06
|
| Rate for Payer: UHC Medicare Advantage |
$960.24
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,253.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$1,577.10 |
| Rate for Payer: Aetna Commercial |
$938.36
|
| Rate for Payer: Aetna Medicare |
$700.27
|
| Rate for Payer: BCBS Complete |
$485.54
|
| Rate for Payer: BCBS MAPPO |
$700.27
|
| Rate for Payer: BCBS Trust/PPO |
$241.43
|
| Rate for Payer: BCN Commercial |
$1,049.19
|
| Rate for Payer: BCN Medicare Advantage |
$700.27
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cash Price |
$1,802.40
|
| Rate for Payer: Cofinity Commercial |
$1,008.39
|
| Rate for Payer: Cofinity Commercial |
$938.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.27
|
| Rate for Payer: Healthscope Commercial |
$840.32
|
| Rate for Payer: Healthscope Whirlpool |
$840.32
|
| Rate for Payer: Meridian Medicaid |
$485.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.28
|
| Rate for Payer: PACE SWMI |
$700.27
|
| Rate for Payer: PHP Medicare Advantage |
$700.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,096.37
|
| Rate for Payer: Priority Health Medicare |
$700.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.37
|
| Rate for Payer: UHC Medicare Advantage |
$721.28
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,371.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$856.47 |
| Max. Negotiated Rate |
$3,059.70 |
| Rate for Payer: Aetna Commercial |
$1,770.01
|
| Rate for Payer: Aetna Medicare |
$1,320.90
|
| Rate for Payer: BCBS Complete |
$899.29
|
| Rate for Payer: BCBS MAPPO |
$1,320.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.65
|
| Rate for Payer: BCN Commercial |
$2,141.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,320.90
|
| Rate for Payer: Cash Price |
$3,496.80
|
| Rate for Payer: Cash Price |
$3,496.80
|
| Rate for Payer: Cofinity Commercial |
$1,902.10
|
| Rate for Payer: Cofinity Commercial |
$1,770.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,320.90
|
| Rate for Payer: Healthscope Commercial |
$1,585.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,585.08
|
| Rate for Payer: Meridian Medicaid |
$899.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,386.94
|
| Rate for Payer: PACE SWMI |
$1,320.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,320.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$856.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,059.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,253.57
|
| Rate for Payer: Priority Health Medicare |
$1,320.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,253.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,360.53
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,992.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,087.15 |
| Max. Negotiated Rate |
$3,494.40 |
| Rate for Payer: Aetna Commercial |
$2,248.56
|
| Rate for Payer: Aetna Medicare |
$1,678.03
|
| Rate for Payer: BCBS Complete |
$1,141.51
|
| Rate for Payer: BCBS MAPPO |
$1,678.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.73
|
| Rate for Payer: BCN Commercial |
$2,718.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,678.03
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cofinity Commercial |
$2,248.56
|
| Rate for Payer: Cofinity Commercial |
$2,416.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,678.03
|
| Rate for Payer: Healthscope Commercial |
$2,013.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,013.64
|
| Rate for Payer: Meridian Medicaid |
$1,141.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,761.93
|
| Rate for Payer: PACE SWMI |
$1,678.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,678.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,494.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,860.56
|
| Rate for Payer: Priority Health Medicare |
$1,678.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,860.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,728.37
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,256.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,205.37 |
| Max. Negotiated Rate |
$3,679.20 |
| Rate for Payer: Aetna Commercial |
$2,497.63
|
| Rate for Payer: Aetna Medicare |
$1,863.90
|
| Rate for Payer: BCBS Complete |
$1,265.64
|
| Rate for Payer: BCBS MAPPO |
$1,863.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.41
|
| Rate for Payer: BCN Commercial |
$2,738.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,863.90
|
| Rate for Payer: Cash Price |
$4,204.80
|
| Rate for Payer: Cash Price |
$4,204.80
|
| Rate for Payer: Cofinity Commercial |
$2,497.63
|
| Rate for Payer: Cofinity Commercial |
$2,684.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,863.90
|
| Rate for Payer: Healthscope Commercial |
$2,236.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,236.68
|
| Rate for Payer: Meridian Medicaid |
$1,265.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,957.10
|
| Rate for Payer: PACE SWMI |
$1,863.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,863.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,205.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,679.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,173.12
|
| Rate for Payer: Priority Health Medicare |
$1,863.90
|
| Rate for Payer: Priority Health Narrow Network |
$3,173.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,919.82
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$511.72 |
| Rate for Payer: Aetna Commercial |
$144.10
|
| Rate for Payer: Aetna Medicare |
$107.54
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS MAPPO |
$107.54
|
| Rate for Payer: BCBS Trust/PPO |
$511.72
|
| Rate for Payer: BCN Commercial |
$274.15
|
| Rate for Payer: BCN Medicare Advantage |
$107.54
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$144.10
|
| Rate for Payer: Cofinity Commercial |
$154.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.54
|
| Rate for Payer: Healthscope Commercial |
$129.05
|
| Rate for Payer: Healthscope Whirlpool |
$129.05
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.92
|
| Rate for Payer: PACE SWMI |
$107.54
|
| Rate for Payer: PHP Medicare Advantage |
$107.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.23
|
| Rate for Payer: Priority Health Medicare |
$107.54
|
| Rate for Payer: Priority Health Narrow Network |
$135.23
|
| Rate for Payer: UHC Medicare Advantage |
$110.77
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$1,246.00 |
| Rate for Payer: Aetna Commercial |
$880.06
|
| Rate for Payer: Aetna Medicare |
$656.76
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS MAPPO |
$656.76
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: BCN Commercial |
$995.44
|
| Rate for Payer: BCN Medicare Advantage |
$656.76
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$945.73
|
| Rate for Payer: Cofinity Commercial |
$880.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.76
|
| Rate for Payer: Healthscope Commercial |
$788.11
|
| Rate for Payer: Healthscope Whirlpool |
$788.11
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$689.60
|
| Rate for Payer: PACE SWMI |
$656.76
|
| Rate for Payer: PHP Medicare Advantage |
$656.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$943.22
|
| Rate for Payer: Priority Health Medicare |
$656.76
|
| Rate for Payer: Priority Health Narrow Network |
$943.22
|
| Rate for Payer: UHC Medicare Advantage |
$676.46
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$522.49 |
| Max. Negotiated Rate |
$1,519.78 |
| Rate for Payer: Aetna Commercial |
$1,349.82
|
| Rate for Payer: Aetna Medicare |
$1,007.33
|
| Rate for Payer: BCBS Complete |
$693.32
|
| Rate for Payer: BCBS MAPPO |
$1,007.33
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$1,519.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.33
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cash Price |
$1,323.20
|
| Rate for Payer: Cofinity Commercial |
$1,450.56
|
| Rate for Payer: Cofinity Commercial |
$1,349.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.33
|
| Rate for Payer: Healthscope Commercial |
$1,208.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,208.80
|
| Rate for Payer: Meridian Medicaid |
$693.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,057.70
|
| Rate for Payer: PACE SWMI |
$1,007.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$660.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,440.07
|
| Rate for Payer: Priority Health Medicare |
$1,007.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,440.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.55
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,512.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$432.68 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$1,423.32
|
| Rate for Payer: Aetna Medicare |
$1,062.18
|
| Rate for Payer: BCBS Complete |
$732.23
|
| Rate for Payer: BCBS MAPPO |
$1,062.18
|
| Rate for Payer: BCBS Trust/PPO |
$432.68
|
| Rate for Payer: BCN Commercial |
$1,583.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,062.18
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,423.32
|
| Rate for Payer: Cofinity Commercial |
$1,529.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,062.18
|
| Rate for Payer: Healthscope Commercial |
$1,274.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,274.62
|
| Rate for Payer: Meridian Medicaid |
$732.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,115.29
|
| Rate for Payer: PACE SWMI |
$1,062.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,062.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,158.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,655.01
|
| Rate for Payer: Priority Health Medicare |
$1,062.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,655.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,094.05
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,834.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$335.47 |
| Max. Negotiated Rate |
$1,983.80 |
| Rate for Payer: Aetna Commercial |
$1,394.55
|
| Rate for Payer: Aetna Medicare |
$1,040.71
|
| Rate for Payer: BCBS Complete |
$713.66
|
| Rate for Payer: BCBS MAPPO |
$1,040.71
|
| Rate for Payer: BCBS Trust/PPO |
$335.47
|
| Rate for Payer: BCN Commercial |
$1,548.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.71
|
| Rate for Payer: Cash Price |
$2,267.20
|
| Rate for Payer: Cash Price |
$2,267.20
|
| Rate for Payer: Cofinity Commercial |
$1,498.62
|
| Rate for Payer: Cofinity Commercial |
$1,394.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.71
|
| Rate for Payer: Healthscope Commercial |
$1,248.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,248.85
|
| Rate for Payer: Meridian Medicaid |
$713.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,092.75
|
| Rate for Payer: PACE SWMI |
$1,040.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,983.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,617.74
|
| Rate for Payer: Priority Health Medicare |
$1,040.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,617.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.93
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$1,212.79 |
| Rate for Payer: Aetna Commercial |
$1,042.90
|
| Rate for Payer: Aetna Medicare |
$778.28
|
| Rate for Payer: BCBS Complete |
$535.87
|
| Rate for Payer: BCBS MAPPO |
$778.28
|
| Rate for Payer: BCBS Trust/PPO |
$448.70
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: BCN Medicare Advantage |
$778.28
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cofinity Commercial |
$1,042.90
|
| Rate for Payer: Cofinity Commercial |
$1,120.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$778.28
|
| Rate for Payer: Healthscope Commercial |
$933.94
|
| Rate for Payer: Healthscope Whirlpool |
$933.94
|
| Rate for Payer: Meridian Medicaid |
$535.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$817.19
|
| Rate for Payer: PACE SWMI |
$778.28
|
| Rate for Payer: PHP Medicare Advantage |
$778.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,212.79
|
| Rate for Payer: Priority Health Medicare |
$778.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,212.79
|
| Rate for Payer: UHC Medicare Advantage |
$801.63
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,292.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$2,281.73 |
| Rate for Payer: Aetna Commercial |
$805.76
|
| Rate for Payer: Aetna Medicare |
$601.31
|
| Rate for Payer: BCBS Complete |
$417.77
|
| Rate for Payer: BCBS MAPPO |
$601.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,281.73
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: BCN Medicare Advantage |
$601.31
|
| Rate for Payer: Cash Price |
$1,033.60
|
| Rate for Payer: Cash Price |
$1,033.60
|
| Rate for Payer: Cofinity Commercial |
$865.89
|
| Rate for Payer: Cofinity Commercial |
$805.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.31
|
| Rate for Payer: Healthscope Commercial |
$721.57
|
| Rate for Payer: Healthscope Whirlpool |
$721.57
|
| Rate for Payer: Meridian Medicaid |
$417.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$631.38
|
| Rate for Payer: PACE SWMI |
$601.31
|
| Rate for Payer: PHP Medicare Advantage |
$601.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$904.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.51
|
| Rate for Payer: Priority Health Medicare |
$601.31
|
| Rate for Payer: Priority Health Narrow Network |
$935.51
|
| Rate for Payer: UHC Medicare Advantage |
$619.35
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,826.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$562.75 |
| Max. Negotiated Rate |
$2,678.20 |
| Rate for Payer: Aetna Commercial |
$1,152.71
|
| Rate for Payer: Aetna Medicare |
$860.23
|
| Rate for Payer: BCBS Complete |
$590.89
|
| Rate for Payer: BCBS MAPPO |
$860.23
|
| Rate for Payer: BCBS Trust/PPO |
$677.28
|
| Rate for Payer: BCN Commercial |
$1,281.80
|
| Rate for Payer: BCN Medicare Advantage |
$860.23
|
| Rate for Payer: Cash Price |
$3,060.80
|
| Rate for Payer: Cash Price |
$3,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,152.71
|
| Rate for Payer: Cofinity Commercial |
$1,238.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.23
|
| Rate for Payer: Healthscope Commercial |
$1,032.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.28
|
| Rate for Payer: Meridian Medicaid |
$590.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$903.24
|
| Rate for Payer: PACE SWMI |
$860.23
|
| Rate for Payer: PHP Medicare Advantage |
$860.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$562.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,339.43
|
| Rate for Payer: Priority Health Medicare |
$860.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,339.43
|
| Rate for Payer: UHC Medicare Advantage |
$886.04
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,752.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$578.08 |
| Max. Negotiated Rate |
$2,626.40 |
| Rate for Payer: Aetna Commercial |
$1,181.26
|
| Rate for Payer: Aetna Medicare |
$881.54
|
| Rate for Payer: BCBS Complete |
$606.98
|
| Rate for Payer: BCBS MAPPO |
$881.54
|
| Rate for Payer: BCBS Trust/PPO |
$635.54
|
| Rate for Payer: BCN Commercial |
$1,314.06
|
| Rate for Payer: BCN Medicare Advantage |
$881.54
|
| Rate for Payer: Cash Price |
$3,001.60
|
| Rate for Payer: Cash Price |
$3,001.60
|
| Rate for Payer: Cofinity Commercial |
$1,269.42
|
| Rate for Payer: Cofinity Commercial |
$1,181.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.54
|
| Rate for Payer: Healthscope Commercial |
$1,057.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,057.85
|
| Rate for Payer: Meridian Medicaid |
$606.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$925.62
|
| Rate for Payer: PACE SWMI |
$881.54
|
| Rate for Payer: PHP Medicare Advantage |
$881.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,626.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,373.14
|
| Rate for Payer: Priority Health Medicare |
$881.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.14
|
| Rate for Payer: UHC Medicare Advantage |
$907.99
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$1,755.01 |
| Rate for Payer: Aetna Commercial |
$886.09
|
| Rate for Payer: Aetna Medicare |
$661.26
|
| Rate for Payer: BCBS Complete |
$455.35
|
| Rate for Payer: BCBS MAPPO |
$661.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,755.01
|
| Rate for Payer: BCN Commercial |
$979.80
|
| Rate for Payer: BCN Medicare Advantage |
$661.26
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cofinity Commercial |
$952.21
|
| Rate for Payer: Cofinity Commercial |
$886.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.26
|
| Rate for Payer: Healthscope Commercial |
$793.51
|
| Rate for Payer: Healthscope Whirlpool |
$793.51
|
| Rate for Payer: Meridian Medicaid |
$455.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$694.32
|
| Rate for Payer: PACE SWMI |
$661.26
|
| Rate for Payer: PHP Medicare Advantage |
$661.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,083.42
|
| Rate for Payer: Priority Health Medicare |
$661.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,083.42
|
| Rate for Payer: UHC Medicare Advantage |
$681.10
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS LIGATION
|
Professional
|
Both
|
$4,316.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$610.46 |
| Max. Negotiated Rate |
$3,021.20 |
| Rate for Payer: Aetna Commercial |
$1,276.54
|
| Rate for Payer: Aetna Medicare |
$952.64
|
| Rate for Payer: BCBS Complete |
$640.98
|
| Rate for Payer: BCBS MAPPO |
$952.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,613.43
|
| Rate for Payer: BCN Commercial |
$1,392.74
|
| Rate for Payer: BCN Medicare Advantage |
$952.64
|
| Rate for Payer: Cash Price |
$3,452.80
|
| Rate for Payer: Cash Price |
$3,452.80
|
| Rate for Payer: Cofinity Commercial |
$1,371.80
|
| Rate for Payer: Cofinity Commercial |
$1,276.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$952.64
|
| Rate for Payer: Healthscope Commercial |
$1,143.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.17
|
| Rate for Payer: Meridian Medicaid |
$640.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,000.27
|
| Rate for Payer: PACE SWMI |
$952.64
|
| Rate for Payer: PHP Medicare Advantage |
$952.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$610.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,021.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,516.09
|
| Rate for Payer: Priority Health Medicare |
$952.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,516.09
|
| Rate for Payer: UHC Medicare Advantage |
$981.22
|
|
|
PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC
|
Professional
|
Both
|
$4,060.00
|
|
|
Service Code
|
HCPCS 21743
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$3,437.80 |
| Rate for Payer: Aetna Commercial |
$2,118.84
|
| Rate for Payer: BCBS Complete |
$451.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,437.80
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Meridian Medicaid |
$451.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,842.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,424.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,424.56
|
|
|
PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN
|
Professional
|
Both
|
$4,060.00
|
|
|
Service Code
|
HCPCS 21740
|
| Min. Negotiated Rate |
$651.57 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,359.78
|
| Rate for Payer: Aetna Medicare |
$1,014.76
|
| Rate for Payer: BCBS Complete |
$684.15
|
| Rate for Payer: BCBS MAPPO |
$1,014.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,485.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.76
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Cofinity Commercial |
$1,359.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.76
|
| Rate for Payer: Healthscope Commercial |
$1,217.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.71
|
| Rate for Payer: Meridian Medicaid |
$684.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,065.50
|
| Rate for Payer: PACE SWMI |
$1,014.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$651.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,842.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,551.86
|
| Rate for Payer: Priority Health Medicare |
$1,014.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,551.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,045.20
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
IP
|
$2,551.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$1,785.70 |
| Max. Negotiated Rate |
$2,551.00 |
| Rate for Payer: Aetna Commercial |
$2,295.90
|
| Rate for Payer: ASR ASR |
$2,474.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,977.79
|
| Rate for Payer: BCN Commercial |
$1,977.79
|
| Rate for Payer: Cash Price |
$2,040.80
|
| Rate for Payer: Cofinity Commercial |
$2,397.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.80
|
| Rate for Payer: Healthscope Commercial |
$2,551.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,474.47
|
| Rate for Payer: Mclaren Commercial |
$2,295.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,168.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,785.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,244.88
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,551.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$424.72 |
| Max. Negotiated Rate |
$1,785.70 |
| Rate for Payer: Aetna Commercial |
$865.47
|
| Rate for Payer: Aetna Medicare |
$645.87
|
| Rate for Payer: BCBS Complete |
$445.96
|
| Rate for Payer: BCBS MAPPO |
$645.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.05
|
| Rate for Payer: BCN Commercial |
$1,063.77
|
| Rate for Payer: BCN Medicare Advantage |
$645.87
|
| Rate for Payer: Cash Price |
$2,040.80
|
| Rate for Payer: Cash Price |
$2,040.80
|
| Rate for Payer: Cofinity Commercial |
$930.05
|
| Rate for Payer: Cofinity Commercial |
$865.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$645.87
|
| Rate for Payer: Healthscope Commercial |
$775.04
|
| Rate for Payer: Healthscope Whirlpool |
$775.04
|
| Rate for Payer: Meridian Medicaid |
$445.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$678.16
|
| Rate for Payer: PACE SWMI |
$645.87
|
| Rate for Payer: PHP Medicare Advantage |
$645.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,785.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.56
|
| Rate for Payer: Priority Health Medicare |
$645.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,009.56
|
| Rate for Payer: UHC Medicare Advantage |
$665.25
|
|
