|
PR OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC
|
Professional
|
Both
|
$3,087.00
|
|
|
Service Code
|
HCPCS 22212
|
| Min. Negotiated Rate |
$1,234.80 |
| Max. Negotiated Rate |
$2,128.98 |
| Rate for Payer: Aetna Commercial |
$1,981.14
|
| Rate for Payer: Aetna Medicare |
$1,478.46
|
| Rate for Payer: BCBS Complete |
$1,234.80
|
| Rate for Payer: BCBS MAPPO |
$1,478.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,478.46
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cofinity Commercial |
$2,128.98
|
| Rate for Payer: Cofinity Commercial |
$1,981.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,478.46
|
| Rate for Payer: Healthscope Commercial |
$1,774.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,774.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,552.38
|
| Rate for Payer: Nomi Health Commercial |
$1,774.15
|
| Rate for Payer: PACE SWMI |
$1,478.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,478.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,006.55
|
| Rate for Payer: Priority Health Medicare |
$1,478.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,478.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,478.46
|
| Rate for Payer: UHCCP DNSP |
$1,478.46
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM CRV
|
Professional
|
Both
|
$3,290.00
|
|
|
Service Code
|
HCPCS 22220
|
| Min. Negotiated Rate |
$1,316.00 |
| Max. Negotiated Rate |
$2,289.04 |
| Rate for Payer: Aetna Commercial |
$2,130.08
|
| Rate for Payer: Aetna Medicare |
$1,589.61
|
| Rate for Payer: BCBS Complete |
$1,316.00
|
| Rate for Payer: BCBS MAPPO |
$1,589.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,589.61
|
| Rate for Payer: Cash Price |
$2,632.00
|
| Rate for Payer: Cash Price |
$2,632.00
|
| Rate for Payer: Cofinity Commercial |
$2,289.04
|
| Rate for Payer: Cofinity Commercial |
$2,130.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,589.61
|
| Rate for Payer: Healthscope Commercial |
$1,907.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,907.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,669.09
|
| Rate for Payer: Nomi Health Commercial |
$1,907.53
|
| Rate for Payer: PACE SWMI |
$1,589.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,589.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,138.50
|
| Rate for Payer: Priority Health Medicare |
$1,589.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,589.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,589.61
|
| Rate for Payer: UHCCP DNSP |
$1,589.61
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM EA ADDL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 22226
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$504.69 |
| Rate for Payer: Aetna Commercial |
$469.64
|
| Rate for Payer: Aetna Medicare |
$350.48
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$350.48
|
| Rate for Payer: BCN Medicare Advantage |
$350.48
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$504.69
|
| Rate for Payer: Cofinity Commercial |
$469.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.48
|
| Rate for Payer: Healthscope Commercial |
$420.58
|
| Rate for Payer: Healthscope Whirlpool |
$420.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.00
|
| Rate for Payer: Nomi Health Commercial |
$420.58
|
| Rate for Payer: PACE SWMI |
$350.48
|
| Rate for Payer: PHP Medicare Advantage |
$350.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$350.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.48
|
| Rate for Payer: UHC Medicare Advantage |
$350.48
|
| Rate for Payer: UHCCP DNSP |
$350.48
|
|
|
PR OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM LUMBAR
|
Professional
|
Both
|
$3,280.00
|
|
|
Service Code
|
HCPCS 22224
|
| Min. Negotiated Rate |
$1,312.00 |
| Max. Negotiated Rate |
$2,216.35 |
| Rate for Payer: Aetna Commercial |
$2,062.43
|
| Rate for Payer: Aetna Medicare |
$1,539.13
|
| Rate for Payer: BCBS Complete |
$1,312.00
|
| Rate for Payer: BCBS MAPPO |
$1,539.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,539.13
|
| Rate for Payer: Cash Price |
$2,624.00
|
| Rate for Payer: Cash Price |
$2,624.00
|
| Rate for Payer: Cofinity Commercial |
$2,216.35
|
| Rate for Payer: Cofinity Commercial |
$2,062.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,539.13
|
| Rate for Payer: Healthscope Commercial |
$1,846.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,846.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,616.09
|
| Rate for Payer: Nomi Health Commercial |
$1,846.96
|
| Rate for Payer: PACE SWMI |
$1,539.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,539.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,132.00
|
| Rate for Payer: Priority Health Medicare |
$1,539.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,539.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,539.13
|
| Rate for Payer: UHCCP DNSP |
$1,539.13
|
|
|
PR OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 28304
|
| Min. Negotiated Rate |
$591.72 |
| Max. Negotiated Rate |
$985.40 |
| Rate for Payer: Aetna Commercial |
$792.90
|
| Rate for Payer: Aetna Medicare |
$591.72
|
| Rate for Payer: BCBS Complete |
$606.40
|
| Rate for Payer: BCBS MAPPO |
$591.72
|
| Rate for Payer: BCN Medicare Advantage |
$591.72
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cofinity Commercial |
$852.08
|
| Rate for Payer: Cofinity Commercial |
$792.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.72
|
| Rate for Payer: Healthscope Commercial |
$710.06
|
| Rate for Payer: Healthscope Whirlpool |
$710.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.31
|
| Rate for Payer: Nomi Health Commercial |
$710.06
|
| Rate for Payer: PACE SWMI |
$591.72
|
| Rate for Payer: PHP Medicare Advantage |
$591.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.40
|
| Rate for Payer: Priority Health Medicare |
$591.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.72
|
| Rate for Payer: UHC Medicare Advantage |
$591.72
|
| Rate for Payer: UHCCP DNSP |
$591.72
|
|
|
PR OSTEOTOMY TIBIA
|
Professional
|
Both
|
$3,036.00
|
|
|
Service Code
|
HCPCS 27705
|
| Min. Negotiated Rate |
$716.16 |
| Max. Negotiated Rate |
$1,973.40 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna Medicare |
$716.16
|
| Rate for Payer: BCBS Complete |
$1,214.40
|
| Rate for Payer: BCBS MAPPO |
$716.16
|
| Rate for Payer: BCN Medicare Advantage |
$716.16
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cofinity Commercial |
$959.65
|
| Rate for Payer: Cofinity Commercial |
$1,031.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.16
|
| Rate for Payer: Healthscope Commercial |
$859.39
|
| Rate for Payer: Healthscope Whirlpool |
$859.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.97
|
| Rate for Payer: Nomi Health Commercial |
$859.39
|
| Rate for Payer: PACE SWMI |
$716.16
|
| Rate for Payer: PHP Medicare Advantage |
$716.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,973.40
|
| Rate for Payer: Priority Health Medicare |
$716.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.16
|
| Rate for Payer: UHC Medicare Advantage |
$716.16
|
| Rate for Payer: UHCCP DNSP |
$716.16
|
|
|
PR OSTEOTOMY TIBIA & FIBULA
|
Professional
|
Both
|
$3,469.00
|
|
|
Service Code
|
HCPCS 27709
|
| Min. Negotiated Rate |
$1,098.03 |
| Max. Negotiated Rate |
$2,254.85 |
| Rate for Payer: Aetna Commercial |
$1,471.36
|
| Rate for Payer: Aetna Medicare |
$1,098.03
|
| Rate for Payer: BCBS Complete |
$1,387.60
|
| Rate for Payer: BCBS MAPPO |
$1,098.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.03
|
| Rate for Payer: Cash Price |
$2,775.20
|
| Rate for Payer: Cash Price |
$2,775.20
|
| Rate for Payer: Cofinity Commercial |
$1,581.16
|
| Rate for Payer: Cofinity Commercial |
$1,471.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.03
|
| Rate for Payer: Healthscope Commercial |
$1,317.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,317.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,152.93
|
| Rate for Payer: Nomi Health Commercial |
$1,317.64
|
| Rate for Payer: PACE SWMI |
$1,098.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,254.85
|
| Rate for Payer: Priority Health Medicare |
$1,098.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,098.03
|
| Rate for Payer: UHCCP DNSP |
$1,098.03
|
|
|
PR OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX
|
Professional
|
Both
|
$3,164.00
|
|
|
Service Code
|
HCPCS 27140
|
| Min. Negotiated Rate |
$866.41 |
| Max. Negotiated Rate |
$2,056.60 |
| Rate for Payer: Aetna Commercial |
$1,160.99
|
| Rate for Payer: Aetna Medicare |
$866.41
|
| Rate for Payer: BCBS Complete |
$1,265.60
|
| Rate for Payer: BCBS MAPPO |
$866.41
|
| Rate for Payer: BCN Medicare Advantage |
$866.41
|
| Rate for Payer: Cash Price |
$2,531.20
|
| Rate for Payer: Cash Price |
$2,531.20
|
| Rate for Payer: Cofinity Commercial |
$1,247.63
|
| Rate for Payer: Cofinity Commercial |
$1,160.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.41
|
| Rate for Payer: Healthscope Commercial |
$1,039.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,039.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.73
|
| Rate for Payer: Nomi Health Commercial |
$1,039.69
|
| Rate for Payer: PACE SWMI |
$866.41
|
| Rate for Payer: PHP Medicare Advantage |
$866.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health Medicare |
$866.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.41
|
| Rate for Payer: UHC Medicare Advantage |
$866.41
|
| Rate for Payer: UHCCP DNSP |
$866.41
|
|
|
PR OSTEOTOMY ULNA
|
Professional
|
Both
|
$2,228.00
|
|
|
Service Code
|
HCPCS 25360
|
| Min. Negotiated Rate |
$635.11 |
| Max. Negotiated Rate |
$1,448.20 |
| Rate for Payer: Aetna Commercial |
$851.05
|
| Rate for Payer: Aetna Medicare |
$635.11
|
| Rate for Payer: BCBS Complete |
$891.20
|
| Rate for Payer: BCBS MAPPO |
$635.11
|
| Rate for Payer: BCN Medicare Advantage |
$635.11
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cofinity Commercial |
$914.56
|
| Rate for Payer: Cofinity Commercial |
$851.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.11
|
| Rate for Payer: Healthscope Commercial |
$762.13
|
| Rate for Payer: Healthscope Whirlpool |
$762.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$666.87
|
| Rate for Payer: Nomi Health Commercial |
$762.13
|
| Rate for Payer: PACE SWMI |
$635.11
|
| Rate for Payer: PHP Medicare Advantage |
$635.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health Medicare |
$635.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$635.11
|
| Rate for Payer: UHC Medicare Advantage |
$635.11
|
| Rate for Payer: UHCCP DNSP |
$635.11
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL
|
Professional
|
Both
|
$2,723.00
|
|
|
Service Code
|
HCPCS 27457
|
| Min. Negotiated Rate |
$921.97 |
| Max. Negotiated Rate |
$1,769.95 |
| Rate for Payer: Aetna Commercial |
$1,235.44
|
| Rate for Payer: Aetna Medicare |
$921.97
|
| Rate for Payer: BCBS Complete |
$1,089.20
|
| Rate for Payer: BCBS MAPPO |
$921.97
|
| Rate for Payer: BCN Medicare Advantage |
$921.97
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cofinity Commercial |
$1,327.64
|
| Rate for Payer: Cofinity Commercial |
$1,235.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.97
|
| Rate for Payer: Healthscope Commercial |
$1,106.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,106.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$968.07
|
| Rate for Payer: Nomi Health Commercial |
$1,106.36
|
| Rate for Payer: PACE SWMI |
$921.97
|
| Rate for Payer: PHP Medicare Advantage |
$921.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,769.95
|
| Rate for Payer: Priority Health Medicare |
$921.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.97
|
| Rate for Payer: UHC Medicare Advantage |
$921.97
|
| Rate for Payer: UHCCP DNSP |
$921.97
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 27455
|
| Min. Negotiated Rate |
$813.20 |
| Max. Negotiated Rate |
$1,331.28 |
| Rate for Payer: Aetna Commercial |
$1,238.83
|
| Rate for Payer: Aetna Medicare |
$924.50
|
| Rate for Payer: BCBS Complete |
$813.20
|
| Rate for Payer: BCBS MAPPO |
$924.50
|
| Rate for Payer: BCN Medicare Advantage |
$924.50
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Cofinity Commercial |
$1,238.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.50
|
| Rate for Payer: Healthscope Commercial |
$1,109.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,109.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.73
|
| Rate for Payer: Nomi Health Commercial |
$1,109.40
|
| Rate for Payer: PACE SWMI |
$924.50
|
| Rate for Payer: PHP Medicare Advantage |
$924.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health Medicare |
$924.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.50
|
| Rate for Payer: UHC Medicare Advantage |
$924.50
|
| Rate for Payer: UHCCP DNSP |
$924.50
|
|
|
PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 28312
|
| Min. Negotiated Rate |
$324.40 |
| Max. Negotiated Rate |
$527.15 |
| Rate for Payer: Aetna Commercial |
$455.32
|
| Rate for Payer: Aetna Medicare |
$339.79
|
| Rate for Payer: BCBS Complete |
$324.40
|
| Rate for Payer: BCBS MAPPO |
$339.79
|
| Rate for Payer: BCN Medicare Advantage |
$339.79
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$489.30
|
| Rate for Payer: Cofinity Commercial |
$455.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.79
|
| Rate for Payer: Healthscope Commercial |
$407.75
|
| Rate for Payer: Healthscope Whirlpool |
$407.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.78
|
| Rate for Payer: Nomi Health Commercial |
$407.75
|
| Rate for Payer: PACE SWMI |
$339.79
|
| Rate for Payer: PHP Medicare Advantage |
$339.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.15
|
| Rate for Payer: Priority Health Medicare |
$339.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.79
|
| Rate for Payer: UHC Medicare Advantage |
$339.79
|
| Rate for Payer: UHCCP DNSP |
$339.79
|
|
|
PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28310
|
| Min. Negotiated Rate |
$351.79 |
| Max. Negotiated Rate |
$621.40 |
| Rate for Payer: Aetna Commercial |
$471.40
|
| Rate for Payer: Aetna Medicare |
$351.79
|
| Rate for Payer: BCBS Complete |
$382.40
|
| Rate for Payer: BCBS MAPPO |
$351.79
|
| Rate for Payer: BCN Medicare Advantage |
$351.79
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$506.58
|
| Rate for Payer: Cofinity Commercial |
$471.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.79
|
| Rate for Payer: Healthscope Commercial |
$422.15
|
| Rate for Payer: Healthscope Whirlpool |
$422.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.38
|
| Rate for Payer: Nomi Health Commercial |
$422.15
|
| Rate for Payer: PACE SWMI |
$351.79
|
| Rate for Payer: PHP Medicare Advantage |
$351.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health Medicare |
$351.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.79
|
| Rate for Payer: UHC Medicare Advantage |
$351.79
|
| Rate for Payer: UHCCP DNSP |
$351.79
|
|
|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$353.64 |
| Max. Negotiated Rate |
$1,714.05 |
| Rate for Payer: Aetna Commercial |
$473.88
|
| Rate for Payer: Aetna Medicare |
$353.64
|
| Rate for Payer: BCBS Complete |
$1,054.80
|
| Rate for Payer: BCBS MAPPO |
$353.64
|
| Rate for Payer: BCN Medicare Advantage |
$353.64
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cofinity Commercial |
$509.24
|
| Rate for Payer: Cofinity Commercial |
$473.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.64
|
| Rate for Payer: Healthscope Commercial |
$424.37
|
| Rate for Payer: Healthscope Whirlpool |
$424.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.32
|
| Rate for Payer: Nomi Health Commercial |
$424.37
|
| Rate for Payer: PACE SWMI |
$353.64
|
| Rate for Payer: PHP Medicare Advantage |
$353.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,714.05
|
| Rate for Payer: Priority Health Medicare |
$353.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.64
|
| Rate for Payer: UHC Medicare Advantage |
$353.64
|
| Rate for Payer: UHCCP DNSP |
$353.64
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$646.96 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: Aetna Commercial |
$866.93
|
| Rate for Payer: Aetna Medicare |
$646.96
|
| Rate for Payer: BCBS Complete |
$688.80
|
| Rate for Payer: BCBS MAPPO |
$646.96
|
| Rate for Payer: BCN Medicare Advantage |
$646.96
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$931.62
|
| Rate for Payer: Cofinity Commercial |
$866.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.96
|
| Rate for Payer: Healthscope Commercial |
$776.35
|
| Rate for Payer: Healthscope Whirlpool |
$776.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.31
|
| Rate for Payer: Nomi Health Commercial |
$776.35
|
| Rate for Payer: PACE SWMI |
$646.96
|
| Rate for Payer: PHP Medicare Advantage |
$646.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.30
|
| Rate for Payer: Priority Health Medicare |
$646.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$646.96
|
| Rate for Payer: UHC Medicare Advantage |
$646.96
|
| Rate for Payer: UHCCP DNSP |
$646.96
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$3,962.00
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$870.69 |
| Max. Negotiated Rate |
$2,575.30 |
| Rate for Payer: Aetna Commercial |
$1,166.72
|
| Rate for Payer: Aetna Medicare |
$870.69
|
| Rate for Payer: BCBS Complete |
$1,584.80
|
| Rate for Payer: BCBS MAPPO |
$870.69
|
| Rate for Payer: BCN Medicare Advantage |
$870.69
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cofinity Commercial |
$1,253.79
|
| Rate for Payer: Cofinity Commercial |
$1,166.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.69
|
| Rate for Payer: Healthscope Commercial |
$1,044.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.22
|
| Rate for Payer: Nomi Health Commercial |
$1,044.83
|
| Rate for Payer: PACE SWMI |
$870.69
|
| Rate for Payer: PHP Medicare Advantage |
$870.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.30
|
| Rate for Payer: Priority Health Medicare |
$870.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.69
|
| Rate for Payer: UHC Medicare Advantage |
$870.69
|
| Rate for Payer: UHCCP DNSP |
$870.69
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$390.34 |
| Max. Negotiated Rate |
$921.05 |
| Rate for Payer: Aetna Commercial |
$523.06
|
| Rate for Payer: Aetna Medicare |
$390.34
|
| Rate for Payer: BCBS Complete |
$566.80
|
| Rate for Payer: BCBS MAPPO |
$390.34
|
| Rate for Payer: BCN Medicare Advantage |
$390.34
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$562.09
|
| Rate for Payer: Cofinity Commercial |
$523.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.34
|
| Rate for Payer: Healthscope Commercial |
$468.41
|
| Rate for Payer: Healthscope Whirlpool |
$468.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.86
|
| Rate for Payer: Nomi Health Commercial |
$468.41
|
| Rate for Payer: PACE SWMI |
$390.34
|
| Rate for Payer: PHP Medicare Advantage |
$390.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health Medicare |
$390.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.34
|
| Rate for Payer: UHC Medicare Advantage |
$390.34
|
| Rate for Payer: UHCCP DNSP |
$390.34
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$371.07 |
| Max. Negotiated Rate |
$706.55 |
| Rate for Payer: Aetna Commercial |
$497.23
|
| Rate for Payer: Aetna Medicare |
$371.07
|
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: BCBS MAPPO |
$371.07
|
| Rate for Payer: BCN Medicare Advantage |
$371.07
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$534.34
|
| Rate for Payer: Cofinity Commercial |
$497.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.07
|
| Rate for Payer: Healthscope Commercial |
$445.28
|
| Rate for Payer: Healthscope Whirlpool |
$445.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.62
|
| Rate for Payer: Nomi Health Commercial |
$445.28
|
| Rate for Payer: PACE SWMI |
$371.07
|
| Rate for Payer: PHP Medicare Advantage |
$371.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
| Rate for Payer: Priority Health Medicare |
$371.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.07
|
| Rate for Payer: UHC Medicare Advantage |
$371.07
|
| Rate for Payer: UHCCP DNSP |
$371.07
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$327.42 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$438.74
|
| Rate for Payer: Aetna Medicare |
$327.42
|
| Rate for Payer: BCBS Complete |
$508.00
|
| Rate for Payer: BCBS MAPPO |
$327.42
|
| Rate for Payer: BCN Medicare Advantage |
$327.42
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Cofinity Commercial |
$438.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.42
|
| Rate for Payer: Healthscope Commercial |
$392.90
|
| Rate for Payer: Healthscope Whirlpool |
$392.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.79
|
| Rate for Payer: Nomi Health Commercial |
$392.90
|
| Rate for Payer: PACE SWMI |
$327.42
|
| Rate for Payer: PHP Medicare Advantage |
$327.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health Medicare |
$327.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.42
|
| Rate for Payer: UHC Medicare Advantage |
$327.42
|
| Rate for Payer: UHCCP DNSP |
$327.42
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$45.10 |
| Rate for Payer: Aetna Commercial |
$40.59
|
| Rate for Payer: Aetna Commercial |
$121.95
|
| Rate for Payer: ASR ASR |
$131.44
|
| Rate for Payer: ASR ASR |
$43.75
|
| Rate for Payer: ASR Commercial |
$131.44
|
| Rate for Payer: ASR Commercial |
$43.75
|
| Rate for Payer: BCBS Trust/PPO |
$110.42
|
| Rate for Payer: BCBS Trust/PPO |
$36.75
|
| Rate for Payer: BCN Commercial |
$34.97
|
| Rate for Payer: BCN Commercial |
$105.05
|
| 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 |
$108.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Healthscope Commercial |
$135.50
|
| Rate for Payer: Healthscope Commercial |
$45.10
|
| Rate for Payer: Healthscope Whirlpool |
$43.75
|
| Rate for Payer: Healthscope Whirlpool |
$131.44
|
| Rate for Payer: Mclaren Commercial |
$121.95
|
| Rate for Payer: Mclaren Commercial |
$40.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.17
|
| Rate for Payer: Nomi Health Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$111.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.32
|
| 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
|
$135.50
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: Aetna Commercial |
$121.95
|
| Rate for Payer: Aetna Commercial |
$40.59
|
| Rate for Payer: Aetna Medicare |
$67.75
|
| Rate for Payer: Aetna Medicare |
$22.55
|
| Rate for Payer: ASR ASR |
$131.44
|
| Rate for Payer: ASR ASR |
$43.75
|
| Rate for Payer: ASR Commercial |
$43.75
|
| Rate for Payer: ASR Commercial |
$131.44
|
| Rate for Payer: BCBS Complete |
$54.20
|
| Rate for Payer: BCBS Complete |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$110.96
|
| Rate for Payer: BCBS Trust/PPO |
$36.93
|
| Rate for Payer: BCN Commercial |
$34.97
|
| Rate for Payer: BCN Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$108.40
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$127.37
|
| Rate for Payer: Cofinity Commercial |
$42.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Healthscope Commercial |
$135.50
|
| Rate for Payer: Healthscope Commercial |
$45.10
|
| Rate for Payer: Healthscope Whirlpool |
$131.44
|
| Rate for Payer: Healthscope Whirlpool |
$43.75
|
| Rate for Payer: Mclaren Commercial |
$121.95
|
| Rate for Payer: Mclaren Commercial |
$40.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.17
|
| Rate for Payer: Nomi Health Commercial |
$111.11
|
| Rate for Payer: Nomi Health Commercial |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.52
|
| Rate for Payer: Priority Health Narrow Network |
$31.62
|
| Rate for Payer: Priority Health Narrow Network |
$94.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.24
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$4,482.00
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$1,792.80 |
| Max. Negotiated Rate |
$2,920.08 |
| Rate for Payer: Aetna Commercial |
$2,717.29
|
| Rate for Payer: Aetna Medicare |
$2,027.83
|
| Rate for Payer: BCBS Complete |
$1,792.80
|
| Rate for Payer: BCBS MAPPO |
$2,027.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,027.83
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cofinity Commercial |
$2,920.08
|
| Rate for Payer: Cofinity Commercial |
$2,717.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,027.83
|
| Rate for Payer: Healthscope Commercial |
$2,433.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,433.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,129.22
|
| Rate for Payer: Nomi Health Commercial |
$2,433.40
|
| Rate for Payer: PACE SWMI |
$2,027.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,027.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,913.30
|
| Rate for Payer: Priority Health Medicare |
$2,027.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,027.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,027.83
|
| Rate for Payer: UHCCP DNSP |
$2,027.83
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Aetna Commercial |
$119.89
|
| Rate for Payer: Aetna Medicare |
$89.47
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$89.47
|
| Rate for Payer: BCN Medicare Advantage |
$89.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$128.84
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.47
|
| Rate for Payer: Healthscope Commercial |
$107.36
|
| Rate for Payer: Healthscope Whirlpool |
$107.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$107.36
|
| Rate for Payer: PACE SWMI |
$89.47
|
| Rate for Payer: PHP Medicare Advantage |
$89.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health Medicare |
$89.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.47
|
| Rate for Payer: UHC Medicare Advantage |
$89.47
|
| Rate for Payer: UHCCP DNSP |
$89.47
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$447.13 |
| Max. Negotiated Rate |
$1,027.65 |
| Rate for Payer: Aetna Commercial |
$599.15
|
| Rate for Payer: Aetna Medicare |
$447.13
|
| Rate for Payer: BCBS Complete |
$632.40
|
| Rate for Payer: BCBS MAPPO |
$447.13
|
| Rate for Payer: BCN Medicare Advantage |
$447.13
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$643.87
|
| Rate for Payer: Cofinity Commercial |
$599.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.13
|
| Rate for Payer: Healthscope Commercial |
$536.56
|
| Rate for Payer: Healthscope Whirlpool |
$536.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.49
|
| Rate for Payer: Nomi Health Commercial |
$536.56
|
| Rate for Payer: PACE SWMI |
$447.13
|
| Rate for Payer: PHP Medicare Advantage |
$447.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health Medicare |
$447.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.13
|
| Rate for Payer: UHC Medicare Advantage |
$447.13
|
| Rate for Payer: UHCCP DNSP |
$447.13
|
|
|
PR OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$2,385.00
|
|
|
Service Code
|
HCPCS 58925
|
| Min. Negotiated Rate |
$739.77 |
| Max. Negotiated Rate |
$1,550.25 |
| Rate for Payer: Aetna Commercial |
$991.29
|
| Rate for Payer: Aetna Medicare |
$739.77
|
| Rate for Payer: BCBS Complete |
$954.00
|
| Rate for Payer: BCBS MAPPO |
$739.77
|
| Rate for Payer: BCN Medicare Advantage |
$739.77
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cofinity Commercial |
$991.29
|
| Rate for Payer: Cofinity Commercial |
$1,065.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.77
|
| Rate for Payer: Healthscope Commercial |
$887.72
|
| Rate for Payer: Healthscope Whirlpool |
$887.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.76
|
| Rate for Payer: Nomi Health Commercial |
$887.72
|
| Rate for Payer: PACE SWMI |
$739.77
|
| Rate for Payer: PHP Medicare Advantage |
$739.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.25
|
| Rate for Payer: Priority Health Medicare |
$739.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.77
|
| Rate for Payer: UHC Medicare Advantage |
$739.77
|
| Rate for Payer: UHCCP DNSP |
$739.77
|
|
