|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM EA ADDL
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 22226
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$647.54 |
| Rate for Payer: Aetna Commercial |
$430.97
|
| Rate for Payer: Aetna Medicare |
$321.62
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS MAPPO |
$321.62
|
| Rate for Payer: BCN Commercial |
$591.38
|
| Rate for Payer: BCN Medicare Advantage |
$321.62
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$463.13
|
| Rate for Payer: Cofinity Commercial |
$430.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.62
|
| Rate for Payer: Healthscope Commercial |
$385.94
|
| Rate for Payer: Healthscope Whirlpool |
$385.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.70
|
| Rate for Payer: Meridian Medicaid |
$214.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$353.78
|
| Rate for Payer: Nomi Health Commercial |
$385.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.75
|
| Rate for Payer: PACE SWMI |
$321.62
|
| Rate for Payer: PHP Medicare Advantage |
$321.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$575.45
|
| Rate for Payer: Priority Health Medicare |
$321.62
|
| Rate for Payer: Priority Health Narrow Network |
$575.45
|
| Rate for Payer: Railroad Medicare Medicare |
$321.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$647.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$321.62
|
| Rate for Payer: UHC Exchange |
$647.54
|
| Rate for Payer: UHC Medicaid |
$203.84
|
| Rate for Payer: UHCCP DNSP |
$321.62
|
| Rate for Payer: UHCCP Medicaid |
$203.84
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM LUMBAR
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 22224
|
| Min. Negotiated Rate |
$944.02 |
| Max. Negotiated Rate |
$2,801.77 |
| Rate for Payer: Aetna Commercial |
$1,954.20
|
| Rate for Payer: Aetna Medicare |
$1,458.36
|
| Rate for Payer: BCBS Complete |
$991.22
|
| Rate for Payer: BCBS MAPPO |
$1,458.36
|
| Rate for Payer: BCN Commercial |
$2,404.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,458.36
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cofinity Commercial |
$2,100.04
|
| Rate for Payer: Cofinity Commercial |
$1,954.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,458.36
|
| Rate for Payer: Healthscope Commercial |
$1,750.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,750.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,531.28
|
| Rate for Payer: Meridian Medicaid |
$991.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,604.20
|
| Rate for Payer: Nomi Health Commercial |
$1,750.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,533.50
|
| Rate for Payer: PACE SWMI |
$1,458.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,458.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$944.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,570.61
|
| Rate for Payer: Priority Health Medicare |
$1,458.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,570.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,458.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,801.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,458.36
|
| Rate for Payer: UHC Exchange |
$2,801.77
|
| Rate for Payer: UHC Medicaid |
$944.02
|
| Rate for Payer: UHCCP DNSP |
$1,458.36
|
| Rate for Payer: UHCCP Medicaid |
$944.02
|
|
|
PR OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 28304
|
| Min. Negotiated Rate |
$370.83 |
| Max. Negotiated Rate |
$1,170.75 |
| Rate for Payer: Aetna Commercial |
$761.25
|
| Rate for Payer: Aetna Medicare |
$568.10
|
| Rate for Payer: BCBS Complete |
$389.37
|
| Rate for Payer: BCBS MAPPO |
$568.10
|
| Rate for Payer: BCN Commercial |
$934.71
|
| Rate for Payer: BCN Medicare Advantage |
$568.10
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cofinity Commercial |
$818.06
|
| Rate for Payer: Cofinity Commercial |
$761.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$568.10
|
| Rate for Payer: Healthscope Commercial |
$681.72
|
| Rate for Payer: Healthscope Whirlpool |
$681.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.50
|
| Rate for Payer: Meridian Medicaid |
$389.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$624.91
|
| Rate for Payer: Nomi Health Commercial |
$681.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,170.75
|
| Rate for Payer: PACE SWMI |
$568.10
|
| Rate for Payer: PHP Medicare Advantage |
$568.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$999.17
|
| Rate for Payer: Priority Health Medicare |
$568.10
|
| Rate for Payer: Priority Health Narrow Network |
$999.17
|
| Rate for Payer: Railroad Medicare Medicare |
$568.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,056.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$568.10
|
| Rate for Payer: UHC Exchange |
$1,056.60
|
| Rate for Payer: UHC Medicaid |
$370.83
|
| Rate for Payer: UHCCP DNSP |
$568.10
|
| Rate for Payer: UHCCP Medicaid |
$370.83
|
|
|
PR OSTEOTOMY TIBIA
|
Professional
|
Both
|
$3,127.00
|
|
|
Service Code
|
HCPCS 27705
|
| Min. Negotiated Rate |
$441.76 |
| Max. Negotiated Rate |
$2,345.25 |
| Rate for Payer: Aetna Commercial |
$907.69
|
| Rate for Payer: Aetna Medicare |
$677.38
|
| Rate for Payer: BCBS Complete |
$463.85
|
| Rate for Payer: BCBS MAPPO |
$677.38
|
| Rate for Payer: BCN Commercial |
$1,129.92
|
| Rate for Payer: BCN Medicare Advantage |
$677.38
|
| Rate for Payer: Cash Price |
$2,501.60
|
| Rate for Payer: Cash Price |
$2,501.60
|
| Rate for Payer: Cofinity Commercial |
$975.43
|
| Rate for Payer: Cofinity Commercial |
$907.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.38
|
| Rate for Payer: Healthscope Commercial |
$812.86
|
| Rate for Payer: Healthscope Whirlpool |
$812.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$711.25
|
| Rate for Payer: Meridian Medicaid |
$463.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$745.12
|
| Rate for Payer: Nomi Health Commercial |
$812.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,345.25
|
| Rate for Payer: PACE SWMI |
$677.38
|
| Rate for Payer: PHP Medicare Advantage |
$677.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,207.85
|
| Rate for Payer: Priority Health Medicare |
$677.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,207.85
|
| Rate for Payer: Railroad Medicare Medicare |
$677.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,324.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$677.38
|
| Rate for Payer: UHC Exchange |
$1,324.98
|
| Rate for Payer: UHC Medicaid |
$441.76
|
| Rate for Payer: UHCCP DNSP |
$677.38
|
| Rate for Payer: UHCCP Medicaid |
$441.76
|
|
|
PR OSTEOTOMY TIBIA & FIBULA
|
Professional
|
Both
|
$3,573.00
|
|
|
Service Code
|
HCPCS 27709
|
| Min. Negotiated Rate |
$670.31 |
| Max. Negotiated Rate |
$2,679.75 |
| Rate for Payer: Aetna Commercial |
$1,384.90
|
| Rate for Payer: Aetna Medicare |
$1,033.51
|
| Rate for Payer: BCBS Complete |
$703.83
|
| Rate for Payer: BCBS MAPPO |
$1,033.51
|
| Rate for Payer: BCN Commercial |
$1,725.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,033.51
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cash Price |
$2,858.40
|
| Rate for Payer: Cofinity Commercial |
$1,488.25
|
| Rate for Payer: Cofinity Commercial |
$1,384.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,033.51
|
| Rate for Payer: Healthscope Commercial |
$1,240.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,240.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,085.19
|
| Rate for Payer: Meridian Medicaid |
$703.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,136.86
|
| Rate for Payer: Nomi Health Commercial |
$1,240.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,679.75
|
| Rate for Payer: PACE SWMI |
$1,033.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,033.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,843.98
|
| Rate for Payer: Priority Health Medicare |
$1,033.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,843.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,033.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,047.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,033.51
|
| Rate for Payer: UHC Exchange |
$2,047.74
|
| Rate for Payer: UHC Medicaid |
$670.31
|
| Rate for Payer: UHCCP DNSP |
$1,033.51
|
| Rate for Payer: UHCCP Medicaid |
$670.31
|
|
|
PR OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX
|
Professional
|
Both
|
$3,259.00
|
|
|
Service Code
|
HCPCS 27140
|
| Min. Negotiated Rate |
$529.52 |
| Max. Negotiated Rate |
$2,444.25 |
| Rate for Payer: Aetna Commercial |
$1,090.00
|
| Rate for Payer: Aetna Medicare |
$813.43
|
| Rate for Payer: BCBS Complete |
$556.00
|
| Rate for Payer: BCBS MAPPO |
$813.43
|
| Rate for Payer: BCN Commercial |
$1,364.46
|
| Rate for Payer: BCN Medicare Advantage |
$813.43
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cofinity Commercial |
$1,171.34
|
| Rate for Payer: Cofinity Commercial |
$1,090.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.43
|
| Rate for Payer: Healthscope Commercial |
$976.12
|
| Rate for Payer: Healthscope Whirlpool |
$976.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$854.10
|
| Rate for Payer: Meridian Medicaid |
$556.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$894.77
|
| Rate for Payer: Nomi Health Commercial |
$976.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,444.25
|
| Rate for Payer: PACE SWMI |
$813.43
|
| Rate for Payer: PHP Medicare Advantage |
$813.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,458.57
|
| Rate for Payer: Priority Health Medicare |
$813.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,458.57
|
| Rate for Payer: Railroad Medicare Medicare |
$813.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$813.43
|
| Rate for Payer: UHC Exchange |
$1,566.80
|
| Rate for Payer: UHC Medicaid |
$529.52
|
| Rate for Payer: UHCCP DNSP |
$813.43
|
| Rate for Payer: UHCCP Medicaid |
$529.52
|
|
|
PR OSTEOTOMY ULNA
|
Professional
|
Both
|
$2,295.00
|
|
|
Service Code
|
HCPCS 25360
|
| Min. Negotiated Rate |
$388.94 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Aetna Commercial |
$795.49
|
| Rate for Payer: Aetna Medicare |
$593.65
|
| Rate for Payer: BCBS Complete |
$408.39
|
| Rate for Payer: BCBS MAPPO |
$593.65
|
| Rate for Payer: BCN Commercial |
$1,006.42
|
| Rate for Payer: BCN Medicare Advantage |
$593.65
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cash Price |
$1,836.00
|
| Rate for Payer: Cofinity Commercial |
$854.86
|
| Rate for Payer: Cofinity Commercial |
$795.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.65
|
| Rate for Payer: Healthscope Commercial |
$712.38
|
| Rate for Payer: Healthscope Whirlpool |
$712.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.33
|
| Rate for Payer: Meridian Medicaid |
$408.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$653.01
|
| Rate for Payer: Nomi Health Commercial |
$712.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,721.25
|
| Rate for Payer: PACE SWMI |
$593.65
|
| Rate for Payer: PHP Medicare Advantage |
$593.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,075.83
|
| Rate for Payer: Priority Health Medicare |
$593.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,075.83
|
| Rate for Payer: Railroad Medicare Medicare |
$593.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,138.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$593.65
|
| Rate for Payer: UHC Exchange |
$1,138.81
|
| Rate for Payer: UHC Medicaid |
$388.94
|
| Rate for Payer: UHCCP DNSP |
$593.65
|
| Rate for Payer: UHCCP Medicaid |
$388.94
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 27457
|
| Min. Negotiated Rate |
$561.26 |
| Max. Negotiated Rate |
$2,103.75 |
| Rate for Payer: Aetna Commercial |
$1,158.15
|
| Rate for Payer: Aetna Medicare |
$864.29
|
| Rate for Payer: BCBS Complete |
$589.32
|
| Rate for Payer: BCBS MAPPO |
$864.29
|
| Rate for Payer: BCN Commercial |
$1,449.13
|
| Rate for Payer: BCN Medicare Advantage |
$864.29
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,244.00
|
| Rate for Payer: Cofinity Commercial |
$1,244.58
|
| Rate for Payer: Cofinity Commercial |
$1,158.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.29
|
| Rate for Payer: Healthscope Commercial |
$1,037.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.50
|
| Rate for Payer: Meridian Medicaid |
$589.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$950.72
|
| Rate for Payer: Nomi Health Commercial |
$1,037.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,103.75
|
| Rate for Payer: PACE SWMI |
$864.29
|
| Rate for Payer: PHP Medicare Advantage |
$864.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,549.07
|
| Rate for Payer: Priority Health Medicare |
$864.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,549.07
|
| Rate for Payer: Railroad Medicare Medicare |
$864.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,686.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$864.29
|
| Rate for Payer: UHC Exchange |
$1,686.90
|
| Rate for Payer: UHC Medicaid |
$561.26
|
| Rate for Payer: UHCCP DNSP |
$864.29
|
| Rate for Payer: UHCCP Medicaid |
$561.26
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$2,094.00
|
|
|
Service Code
|
HCPCS 27455
|
| Min. Negotiated Rate |
$569.35 |
| Max. Negotiated Rate |
$1,665.39 |
| Rate for Payer: Aetna Commercial |
$1,169.79
|
| Rate for Payer: Aetna Medicare |
$872.98
|
| Rate for Payer: BCBS Complete |
$597.82
|
| Rate for Payer: BCBS MAPPO |
$872.98
|
| Rate for Payer: BCN Commercial |
$1,458.09
|
| Rate for Payer: BCN Medicare Advantage |
$872.98
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cofinity Commercial |
$1,257.09
|
| Rate for Payer: Cofinity Commercial |
$1,169.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.98
|
| Rate for Payer: Healthscope Commercial |
$1,047.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,047.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$916.63
|
| Rate for Payer: Meridian Medicaid |
$597.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$960.28
|
| Rate for Payer: Nomi Health Commercial |
$1,047.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,570.50
|
| Rate for Payer: PACE SWMI |
$872.98
|
| Rate for Payer: PHP Medicare Advantage |
$872.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$569.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,558.66
|
| Rate for Payer: Priority Health Medicare |
$872.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,558.66
|
| Rate for Payer: Railroad Medicare Medicare |
$872.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,665.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$872.98
|
| Rate for Payer: UHC Exchange |
$1,665.39
|
| Rate for Payer: UHC Medicaid |
$569.35
|
| Rate for Payer: UHCCP DNSP |
$872.98
|
| Rate for Payer: UHCCP Medicaid |
$569.35
|
|
|
PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 28312
|
| Min. Negotiated Rate |
$221.09 |
| Max. Negotiated Rate |
$626.25 |
| Rate for Payer: Aetna Commercial |
$448.91
|
| Rate for Payer: Aetna Medicare |
$335.01
|
| Rate for Payer: BCBS Complete |
$232.14
|
| Rate for Payer: BCBS MAPPO |
$335.01
|
| Rate for Payer: BCN Commercial |
$541.80
|
| Rate for Payer: BCN Medicare Advantage |
$335.01
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$482.41
|
| Rate for Payer: Cofinity Commercial |
$448.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.01
|
| Rate for Payer: Healthscope Commercial |
$402.01
|
| Rate for Payer: Healthscope Whirlpool |
$402.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$351.76
|
| Rate for Payer: Meridian Medicaid |
$232.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$368.51
|
| Rate for Payer: Nomi Health Commercial |
$402.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$626.25
|
| Rate for Payer: PACE SWMI |
$335.01
|
| Rate for Payer: PHP Medicare Advantage |
$335.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$579.17
|
| Rate for Payer: Priority Health Medicare |
$335.01
|
| Rate for Payer: Priority Health Narrow Network |
$579.17
|
| Rate for Payer: Railroad Medicare Medicare |
$335.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$335.01
|
| Rate for Payer: UHC Exchange |
$551.63
|
| Rate for Payer: UHC Medicaid |
$221.09
|
| Rate for Payer: UHCCP DNSP |
$335.01
|
| Rate for Payer: UHCCP Medicaid |
$221.09
|
|
|
PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 28310
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$738.75 |
| Rate for Payer: Aetna Commercial |
$455.47
|
| Rate for Payer: Aetna Medicare |
$339.90
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCBS MAPPO |
$339.90
|
| Rate for Payer: BCN Commercial |
$558.23
|
| Rate for Payer: BCN Medicare Advantage |
$339.90
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cofinity Commercial |
$489.46
|
| Rate for Payer: Cofinity Commercial |
$455.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.90
|
| Rate for Payer: Healthscope Commercial |
$407.88
|
| Rate for Payer: Healthscope Whirlpool |
$407.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.89
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$373.89
|
| Rate for Payer: Nomi Health Commercial |
$407.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.75
|
| Rate for Payer: PACE SWMI |
$339.90
|
| Rate for Payer: PHP Medicare Advantage |
$339.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$596.73
|
| Rate for Payer: Priority Health Medicare |
$339.90
|
| Rate for Payer: Priority Health Narrow Network |
$596.73
|
| Rate for Payer: Railroad Medicare Medicare |
$339.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$339.90
|
| Rate for Payer: UHC Exchange |
$627.48
|
| Rate for Payer: UHC Medicaid |
$223.01
|
| Rate for Payer: UHCCP DNSP |
$339.90
|
| Rate for Payer: UHCCP Medicaid |
$223.01
|
|
|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$2,037.00 |
| Rate for Payer: Aetna Commercial |
$432.30
|
| Rate for Payer: Aetna Medicare |
$322.61
|
| Rate for Payer: BCBS Complete |
$214.70
|
| Rate for Payer: BCBS MAPPO |
$322.61
|
| Rate for Payer: BCN Commercial |
$596.31
|
| Rate for Payer: BCN Medicare Advantage |
$322.61
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cofinity Commercial |
$464.56
|
| Rate for Payer: Cofinity Commercial |
$432.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.61
|
| Rate for Payer: Healthscope Commercial |
$387.13
|
| Rate for Payer: Healthscope Whirlpool |
$387.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.74
|
| Rate for Payer: Meridian Medicaid |
$214.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$354.87
|
| Rate for Payer: Nomi Health Commercial |
$387.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,037.00
|
| Rate for Payer: PACE SWMI |
$322.61
|
| Rate for Payer: PHP Medicare Advantage |
$322.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$580.24
|
| Rate for Payer: Priority Health Medicare |
$322.61
|
| Rate for Payer: Priority Health Narrow Network |
$580.24
|
| Rate for Payer: Railroad Medicare Medicare |
$322.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$647.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$322.61
|
| Rate for Payer: UHC Exchange |
$647.44
|
| Rate for Payer: UHC Medicaid |
$204.48
|
| Rate for Payer: UHCCP DNSP |
$322.61
|
| Rate for Payer: UHCCP Medicaid |
$204.48
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$398.74 |
| Max. Negotiated Rate |
$1,330.50 |
| Rate for Payer: Aetna Commercial |
$820.54
|
| Rate for Payer: Aetna Medicare |
$612.34
|
| Rate for Payer: BCBS Complete |
$418.68
|
| Rate for Payer: BCBS MAPPO |
$612.34
|
| Rate for Payer: BCN Commercial |
$1,019.86
|
| Rate for Payer: BCN Medicare Advantage |
$612.34
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$881.77
|
| Rate for Payer: Cofinity Commercial |
$820.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$612.34
|
| Rate for Payer: Healthscope Commercial |
$734.81
|
| Rate for Payer: Healthscope Whirlpool |
$734.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$642.96
|
| Rate for Payer: Meridian Medicaid |
$418.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$673.57
|
| Rate for Payer: Nomi Health Commercial |
$734.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,330.50
|
| Rate for Payer: PACE SWMI |
$612.34
|
| Rate for Payer: PHP Medicare Advantage |
$612.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,090.21
|
| Rate for Payer: Priority Health Medicare |
$612.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,090.21
|
| Rate for Payer: Railroad Medicare Medicare |
$612.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,173.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$612.34
|
| Rate for Payer: UHC Exchange |
$1,173.39
|
| Rate for Payer: UHC Medicaid |
$398.74
|
| Rate for Payer: UHCCP DNSP |
$612.34
|
| Rate for Payer: UHCCP Medicaid |
$398.74
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$4,081.00
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$532.93 |
| Max. Negotiated Rate |
$3,060.75 |
| Rate for Payer: Aetna Commercial |
$1,097.93
|
| Rate for Payer: Aetna Medicare |
$819.35
|
| Rate for Payer: BCBS Complete |
$559.58
|
| Rate for Payer: BCBS MAPPO |
$819.35
|
| Rate for Payer: BCN Commercial |
$1,371.44
|
| Rate for Payer: BCN Medicare Advantage |
$819.35
|
| Rate for Payer: Cash Price |
$3,264.80
|
| Rate for Payer: Cash Price |
$3,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.86
|
| Rate for Payer: Cofinity Commercial |
$1,097.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.35
|
| Rate for Payer: Healthscope Commercial |
$983.22
|
| Rate for Payer: Healthscope Whirlpool |
$983.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$860.32
|
| Rate for Payer: Meridian Medicaid |
$559.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$901.28
|
| Rate for Payer: Nomi Health Commercial |
$983.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,060.75
|
| Rate for Payer: PACE SWMI |
$819.35
|
| Rate for Payer: PHP Medicare Advantage |
$819.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,466.03
|
| Rate for Payer: Priority Health Medicare |
$819.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,466.03
|
| Rate for Payer: Railroad Medicare Medicare |
$819.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,550.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$819.35
|
| Rate for Payer: UHC Exchange |
$1,550.06
|
| Rate for Payer: UHC Medicaid |
$532.93
|
| Rate for Payer: UHCCP DNSP |
$819.35
|
| Rate for Payer: UHCCP Medicaid |
$532.93
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$502.67
|
| Rate for Payer: Aetna Medicare |
$375.13
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS MAPPO |
$375.13
|
| Rate for Payer: BCN Commercial |
$618.99
|
| Rate for Payer: BCN Medicare Advantage |
$375.13
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$540.19
|
| Rate for Payer: Cofinity Commercial |
$502.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.13
|
| Rate for Payer: Healthscope Commercial |
$450.16
|
| Rate for Payer: Healthscope Whirlpool |
$450.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.89
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$412.64
|
| Rate for Payer: Nomi Health Commercial |
$450.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.00
|
| Rate for Payer: PACE SWMI |
$375.13
|
| Rate for Payer: PHP Medicare Advantage |
$375.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$661.69
|
| Rate for Payer: Priority Health Medicare |
$375.13
|
| Rate for Payer: Priority Health Narrow Network |
$661.69
|
| Rate for Payer: Railroad Medicare Medicare |
$375.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$699.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$375.13
|
| Rate for Payer: UHC Exchange |
$699.67
|
| Rate for Payer: UHC Medicaid |
$246.02
|
| Rate for Payer: UHCCP DNSP |
$375.13
|
| Rate for Payer: UHCCP Medicaid |
$246.02
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$237.07 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$482.17
|
| Rate for Payer: Aetna Medicare |
$359.83
|
| Rate for Payer: BCBS Complete |
$248.92
|
| Rate for Payer: BCBS MAPPO |
$359.83
|
| Rate for Payer: BCN Commercial |
$591.11
|
| Rate for Payer: BCN Medicare Advantage |
$359.83
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$518.16
|
| Rate for Payer: Cofinity Commercial |
$482.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.83
|
| Rate for Payer: Healthscope Commercial |
$431.80
|
| Rate for Payer: Healthscope Whirlpool |
$431.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.82
|
| Rate for Payer: Meridian Medicaid |
$248.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$395.81
|
| Rate for Payer: Nomi Health Commercial |
$431.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.00
|
| Rate for Payer: PACE SWMI |
$359.83
|
| Rate for Payer: PHP Medicare Advantage |
$359.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$631.87
|
| Rate for Payer: Priority Health Medicare |
$359.83
|
| Rate for Payer: Priority Health Narrow Network |
$631.87
|
| Rate for Payer: Railroad Medicare Medicare |
$359.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$662.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$359.83
|
| Rate for Payer: UHC Exchange |
$662.84
|
| Rate for Payer: UHC Medicaid |
$237.07
|
| Rate for Payer: UHCCP DNSP |
$359.83
|
| Rate for Payer: UHCCP Medicaid |
$237.07
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$410.94
|
| Rate for Payer: Aetna Medicare |
$306.67
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$306.67
|
| Rate for Payer: BCN Commercial |
$496.98
|
| Rate for Payer: BCN Medicare Advantage |
$306.67
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$410.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.67
|
| Rate for Payer: Healthscope Commercial |
$368.00
|
| Rate for Payer: Healthscope Whirlpool |
$368.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.00
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$337.34
|
| Rate for Payer: Nomi Health Commercial |
$368.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: PACE SWMI |
$306.67
|
| Rate for Payer: PHP Medicare Advantage |
$306.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$577.24
|
| Rate for Payer: Priority Health Medicare |
$306.67
|
| Rate for Payer: Priority Health Narrow Network |
$577.24
|
| Rate for Payer: Railroad Medicare Medicare |
$306.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$306.67
|
| Rate for Payer: UHC Exchange |
$586.55
|
| Rate for Payer: UHC Medicaid |
$192.98
|
| Rate for Payer: UHCCP DNSP |
$306.67
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.50
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.63 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: Aetna Commercial |
$121.95
|
| Rate for Payer: Aetna Commercial |
$40.59
|
| Rate for Payer: ASR ASR |
$43.75
|
| Rate for Payer: ASR ASR |
$131.44
|
| Rate for Payer: BCBS Trust/PPO |
$37.04
|
| Rate for Payer: BCBS Trust/PPO |
$111.28
|
| Rate for Payer: BCN Commercial |
$37.04
|
| Rate for Payer: BCN Commercial |
$111.28
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cash Price |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$127.37
|
| Rate for Payer: Cofinity Commercial |
$42.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.40
|
| Rate for Payer: Healthscope Commercial |
$131.44
|
| Rate for Payer: Healthscope Commercial |
$43.75
|
| Rate for Payer: Healthscope Whirlpool |
$45.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.50
|
| Rate for Payer: Mclaren Commercial |
$40.59
|
| Rate for Payer: Mclaren Commercial |
$121.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Nomi Health Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$111.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.69
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$45.10 |
| Rate for Payer: Aetna Commercial |
$40.59
|
| Rate for Payer: Aetna Commercial |
$121.95
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Aetna Medicare |
$16.69
|
| Rate for Payer: ASR ASR |
$43.75
|
| Rate for Payer: ASR ASR |
$131.44
|
| Rate for Payer: BCBS Complete |
$54.20
|
| Rate for Payer: BCBS Complete |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$111.72
|
| Rate for Payer: BCN Commercial |
$111.72
|
| Rate for Payer: BCN Commercial |
$37.19
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cash Price |
$108.40
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cash Price |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$127.37
|
| Rate for Payer: Cofinity Commercial |
$42.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.40
|
| Rate for Payer: Healthscope Commercial |
$43.75
|
| Rate for Payer: Healthscope Commercial |
$131.44
|
| Rate for Payer: Healthscope Whirlpool |
$45.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.50
|
| Rate for Payer: Mclaren Commercial |
$40.59
|
| Rate for Payer: Mclaren Commercial |
$121.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.34
|
| Rate for Payer: Nomi Health Commercial |
$111.11
|
| Rate for Payer: Nomi Health Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.69
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$4,616.00
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$1,268.84 |
| Max. Negotiated Rate |
$4,299.83 |
| Rate for Payer: Aetna Commercial |
$2,661.60
|
| Rate for Payer: Aetna Medicare |
$1,986.27
|
| Rate for Payer: BCBS Complete |
$1,332.28
|
| Rate for Payer: BCBS MAPPO |
$1,986.27
|
| Rate for Payer: BCN Commercial |
$4,299.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,986.27
|
| Rate for Payer: Cash Price |
$3,692.80
|
| Rate for Payer: Cash Price |
$3,692.80
|
| Rate for Payer: Cofinity Commercial |
$2,860.23
|
| Rate for Payer: Cofinity Commercial |
$2,661.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,986.27
|
| Rate for Payer: Healthscope Commercial |
$2,383.52
|
| Rate for Payer: Healthscope Whirlpool |
$2,383.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.58
|
| Rate for Payer: Meridian Medicaid |
$1,332.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,184.90
|
| Rate for Payer: Nomi Health Commercial |
$2,383.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,462.00
|
| Rate for Payer: PACE SWMI |
$1,986.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,986.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,268.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,614.98
|
| Rate for Payer: Priority Health Medicare |
$1,986.27
|
| Rate for Payer: Priority Health Narrow Network |
$3,614.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,986.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,600.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,986.27
|
| Rate for Payer: UHC Exchange |
$3,600.20
|
| Rate for Payer: UHC Medicaid |
$1,268.84
|
| Rate for Payer: UHCCP DNSP |
$1,986.27
|
| Rate for Payer: UHCCP Medicaid |
$1,268.84
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$257.25 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Medicare |
$84.05
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCBS MAPPO |
$84.05
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$84.05
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cofinity Commercial |
$121.03
|
| Rate for Payer: Cofinity Commercial |
$112.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.05
|
| Rate for Payer: Healthscope Commercial |
$100.86
|
| Rate for Payer: Healthscope Whirlpool |
$100.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.25
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.45
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.25
|
| Rate for Payer: PACE SWMI |
$84.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.34
|
| Rate for Payer: Priority Health Medicare |
$84.05
|
| Rate for Payer: Priority Health Narrow Network |
$131.34
|
| Rate for Payer: Railroad Medicare Medicare |
$84.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.05
|
| Rate for Payer: UHC Exchange |
$150.91
|
| Rate for Payer: UHC Medicaid |
$55.17
|
| Rate for Payer: UHCCP DNSP |
$84.05
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$1,628.00
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$272.43 |
| Max. Negotiated Rate |
$1,221.00 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Medicare |
$415.45
|
| Rate for Payer: BCBS Complete |
$286.05
|
| Rate for Payer: BCBS MAPPO |
$415.45
|
| Rate for Payer: BCN Commercial |
$711.11
|
| Rate for Payer: BCN Medicare Advantage |
$415.45
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cofinity Commercial |
$598.25
|
| Rate for Payer: Cofinity Commercial |
$556.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.45
|
| Rate for Payer: Healthscope Commercial |
$498.54
|
| Rate for Payer: Healthscope Whirlpool |
$498.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.22
|
| Rate for Payer: Meridian Medicaid |
$286.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.00
|
| Rate for Payer: Nomi Health Commercial |
$498.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,221.00
|
| Rate for Payer: PACE SWMI |
$415.45
|
| Rate for Payer: PHP Medicare Advantage |
$415.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$702.66
|
| Rate for Payer: Priority Health Medicare |
$415.45
|
| Rate for Payer: Priority Health Narrow Network |
$702.66
|
| Rate for Payer: Railroad Medicare Medicare |
$415.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.45
|
| Rate for Payer: UHC Exchange |
$793.44
|
| Rate for Payer: UHC Medicaid |
$272.43
|
| Rate for Payer: UHCCP DNSP |
$415.45
|
| Rate for Payer: UHCCP Medicaid |
$272.43
|
|
|
PR OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 58925
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$1,842.75 |
| Rate for Payer: Aetna Commercial |
$924.53
|
| Rate for Payer: Aetna Medicare |
$689.95
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$689.95
|
| Rate for Payer: BCN Commercial |
$1,156.31
|
| Rate for Payer: BCN Medicare Advantage |
$689.95
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cofinity Commercial |
$993.53
|
| Rate for Payer: Cofinity Commercial |
$924.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.95
|
| Rate for Payer: Healthscope Commercial |
$827.94
|
| Rate for Payer: Healthscope Whirlpool |
$827.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.45
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$758.95
|
| Rate for Payer: Nomi Health Commercial |
$827.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,842.75
|
| Rate for Payer: PACE SWMI |
$689.95
|
| Rate for Payer: PHP Medicare Advantage |
$689.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,171.10
|
| Rate for Payer: Priority Health Medicare |
$689.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,171.10
|
| Rate for Payer: Railroad Medicare Medicare |
$689.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,340.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$689.95
|
| Rate for Payer: UHC Exchange |
$1,340.72
|
| Rate for Payer: UHC Medicaid |
$445.17
|
| Rate for Payer: UHCCP DNSP |
$689.95
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR OVINE, UP TO 999 USP UNITS
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J3471
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.50
|
| Rate for Payer: UHC Exchange |
$0.50
|
|
|
PR PACKING STRIPS, NON-IMPREG
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS A6407
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$2.66
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Healthscope Whirlpool |
$3.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.93
|
| Rate for Payer: Nomi Health Commercial |
$3.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.66
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHCCP DNSP |
$2.66
|
|
