|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$2,451.00
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$509.92 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Aetna Commercial |
$1,027.67
|
| Rate for Payer: Aetna Medicare |
$766.92
|
| Rate for Payer: BCBS Complete |
$535.42
|
| Rate for Payer: BCBS MAPPO |
$766.92
|
| Rate for Payer: BCN Commercial |
$1,264.37
|
| Rate for Payer: BCN Medicare Advantage |
$766.92
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cofinity Commercial |
$1,104.36
|
| Rate for Payer: Cofinity Commercial |
$1,027.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.92
|
| Rate for Payer: Healthscope Commercial |
$920.30
|
| Rate for Payer: Healthscope Whirlpool |
$920.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$805.27
|
| Rate for Payer: Meridian Medicaid |
$535.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$843.61
|
| Rate for Payer: Nomi Health Commercial |
$920.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,838.25
|
| Rate for Payer: PACE SWMI |
$766.92
|
| Rate for Payer: PHP Medicare Advantage |
$766.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,351.58
|
| Rate for Payer: Priority Health Medicare |
$766.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,351.58
|
| Rate for Payer: Railroad Medicare Medicare |
$766.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,397.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$766.92
|
| Rate for Payer: UHC Exchange |
$1,397.74
|
| Rate for Payer: UHC Medicaid |
$509.92
|
| Rate for Payer: UHCCP DNSP |
$766.92
|
| Rate for Payer: UHCCP Medicaid |
$509.92
|
|
|
PR RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 21181
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$879.99
|
| Rate for Payer: Aetna Medicare |
$656.71
|
| Rate for Payer: BCBS Complete |
$450.43
|
| Rate for Payer: BCBS MAPPO |
$656.71
|
| Rate for Payer: BCN Commercial |
$1,121.95
|
| Rate for Payer: BCN Medicare Advantage |
$656.71
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cofinity Commercial |
$945.66
|
| Rate for Payer: Cofinity Commercial |
$879.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.71
|
| Rate for Payer: Healthscope Commercial |
$788.05
|
| Rate for Payer: Healthscope Whirlpool |
$788.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.55
|
| Rate for Payer: Meridian Medicaid |
$450.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$722.38
|
| Rate for Payer: Nomi Health Commercial |
$788.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.00
|
| Rate for Payer: PACE SWMI |
$656.71
|
| Rate for Payer: PHP Medicare Advantage |
$656.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,199.34
|
| Rate for Payer: Priority Health Medicare |
$656.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.34
|
| Rate for Payer: Railroad Medicare Medicare |
$656.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,296.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$656.71
|
| Rate for Payer: UHC Exchange |
$1,296.84
|
| Rate for Payer: UHC Medicaid |
$428.98
|
| Rate for Payer: UHCCP DNSP |
$656.71
|
| Rate for Payer: UHCCP Medicaid |
$428.98
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$1,305.84 |
| Rate for Payer: Aetna Commercial |
$920.85
|
| Rate for Payer: Aetna Medicare |
$687.20
|
| Rate for Payer: BCBS Complete |
$471.45
|
| Rate for Payer: BCBS MAPPO |
$687.20
|
| Rate for Payer: BCN Commercial |
$1,145.36
|
| Rate for Payer: BCN Medicare Advantage |
$687.20
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cofinity Commercial |
$989.57
|
| Rate for Payer: Cofinity Commercial |
$920.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.20
|
| Rate for Payer: Healthscope Commercial |
$824.64
|
| Rate for Payer: Healthscope Whirlpool |
$824.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$721.56
|
| Rate for Payer: Meridian Medicaid |
$471.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$755.92
|
| Rate for Payer: Nomi Health Commercial |
$824.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.75
|
| Rate for Payer: PACE SWMI |
$687.20
|
| Rate for Payer: PHP Medicare Advantage |
$687.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,224.35
|
| Rate for Payer: Priority Health Medicare |
$687.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$687.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,305.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$687.20
|
| Rate for Payer: UHC Exchange |
$1,305.84
|
| Rate for Payer: UHC Medicaid |
$449.00
|
| Rate for Payer: UHCCP DNSP |
$687.20
|
| Rate for Payer: UHCCP Medicaid |
$449.00
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$913.72
|
| Rate for Payer: Aetna Medicare |
$681.88
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS MAPPO |
$681.88
|
| Rate for Payer: BCN Commercial |
$1,135.89
|
| Rate for Payer: BCN Medicare Advantage |
$681.88
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$981.91
|
| Rate for Payer: Cofinity Commercial |
$913.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.88
|
| Rate for Payer: Healthscope Commercial |
$818.26
|
| Rate for Payer: Healthscope Whirlpool |
$818.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.97
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$750.07
|
| Rate for Payer: Nomi Health Commercial |
$818.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: PACE SWMI |
$681.88
|
| Rate for Payer: PHP Medicare Advantage |
$681.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,214.23
|
| Rate for Payer: Priority Health Medicare |
$681.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.23
|
| Rate for Payer: Railroad Medicare Medicare |
$681.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$681.88
|
| Rate for Payer: UHC Exchange |
$1,299.21
|
| Rate for Payer: UHC Medicaid |
$445.60
|
| Rate for Payer: UHCCP DNSP |
$681.88
|
| Rate for Payer: UHCCP Medicaid |
$445.60
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
IP
|
$2,382.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,786.50 |
| Max. Negotiated Rate |
$2,382.00 |
| Rate for Payer: Aetna Commercial |
$2,143.80
|
| Rate for Payer: ASR ASR |
$2,310.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.10
|
| Rate for Payer: BCN Commercial |
$1,956.10
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,905.60
|
| Rate for Payer: Healthscope Commercial |
$2,310.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,382.00
|
| Rate for Payer: Mclaren Commercial |
$2,143.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,024.70
|
| Rate for Payer: Nomi Health Commercial |
$1,953.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
OP
|
$2,382.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,669.78 |
| Max. Negotiated Rate |
$9,037.65 |
| Rate for Payer: Aetna Commercial |
$2,143.80
|
| Rate for Payer: Aetna Medicare |
$7,230.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: ASR ASR |
$2,310.54
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,963.96
|
| Rate for Payer: BCN Commercial |
$1,963.96
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,905.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Healthscope Commercial |
$2,310.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,382.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,230.12
|
| Rate for Payer: Mclaren Commercial |
$2,143.80
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$3,970.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,024.70
|
| Rate for Payer: Nomi Health Commercial |
$1,953.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Commercial |
$7,953.13
|
| Rate for Payer: PHP Medicaid |
$3,875.34
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,087.11
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,669.78
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP DNSP |
$7,230.12
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
27422
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$913.72
|
| Rate for Payer: Aetna Medicare |
$681.88
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS MAPPO |
$681.88
|
| Rate for Payer: BCN Commercial |
$1,135.89
|
| Rate for Payer: BCN Medicare Advantage |
$681.88
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$981.91
|
| Rate for Payer: Cofinity Commercial |
$913.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.88
|
| Rate for Payer: Healthscope Commercial |
$818.26
|
| Rate for Payer: Healthscope Whirlpool |
$818.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.97
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$750.07
|
| Rate for Payer: Nomi Health Commercial |
$818.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: PACE SWMI |
$681.88
|
| Rate for Payer: PHP Medicare Advantage |
$681.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,214.23
|
| Rate for Payer: Priority Health Medicare |
$681.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.23
|
| Rate for Payer: Railroad Medicare Medicare |
$681.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$681.88
|
| Rate for Payer: UHC Exchange |
$1,299.21
|
| Rate for Payer: UHC Medicaid |
$445.60
|
| Rate for Payer: UHCCP DNSP |
$681.88
|
| Rate for Payer: UHCCP Medicaid |
$445.60
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,405.00
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$449.64 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$922.16
|
| Rate for Payer: Aetna Medicare |
$688.18
|
| Rate for Payer: BCBS Complete |
$472.12
|
| Rate for Payer: BCBS MAPPO |
$688.18
|
| Rate for Payer: BCN Commercial |
$1,140.37
|
| Rate for Payer: BCN Medicare Advantage |
$688.18
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cash Price |
$1,924.00
|
| Rate for Payer: Cofinity Commercial |
$990.98
|
| Rate for Payer: Cofinity Commercial |
$922.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.18
|
| Rate for Payer: Healthscope Commercial |
$825.82
|
| Rate for Payer: Healthscope Whirlpool |
$825.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$722.59
|
| Rate for Payer: Meridian Medicaid |
$472.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$757.00
|
| Rate for Payer: Nomi Health Commercial |
$825.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,803.75
|
| Rate for Payer: PACE SWMI |
$688.18
|
| Rate for Payer: PHP Medicare Advantage |
$688.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,219.02
|
| Rate for Payer: Priority Health Medicare |
$688.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,219.02
|
| Rate for Payer: Railroad Medicare Medicare |
$688.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$688.18
|
| Rate for Payer: UHC Exchange |
$1,298.84
|
| Rate for Payer: UHC Medicaid |
$449.64
|
| Rate for Payer: UHCCP DNSP |
$688.18
|
| Rate for Payer: UHCCP Medicaid |
$449.64
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$3,111.00
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$657.11 |
| Max. Negotiated Rate |
$2,333.25 |
| Rate for Payer: Aetna Commercial |
$1,348.92
|
| Rate for Payer: Aetna Medicare |
$1,006.66
|
| Rate for Payer: BCBS Complete |
$689.97
|
| Rate for Payer: BCBS MAPPO |
$1,006.66
|
| Rate for Payer: BCN Commercial |
$1,682.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,006.66
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cofinity Commercial |
$1,449.59
|
| Rate for Payer: Cofinity Commercial |
$1,348.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,006.66
|
| Rate for Payer: Healthscope Commercial |
$1,207.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,056.99
|
| Rate for Payer: Meridian Medicaid |
$689.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,107.33
|
| Rate for Payer: Nomi Health Commercial |
$1,207.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,333.25
|
| Rate for Payer: PACE SWMI |
$1,006.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,006.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$657.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,798.20
|
| Rate for Payer: Priority Health Medicare |
$1,006.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,798.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,006.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,910.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,006.66
|
| Rate for Payer: UHC Exchange |
$1,910.07
|
| Rate for Payer: UHC Medicaid |
$657.11
|
| Rate for Payer: UHCCP DNSP |
$1,006.66
|
| Rate for Payer: UHCCP Medicaid |
$657.11
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$657.11 |
| Max. Negotiated Rate |
$2,576.25 |
| Rate for Payer: Aetna Commercial |
$1,348.92
|
| Rate for Payer: Aetna Medicare |
$1,006.66
|
| Rate for Payer: BCBS Complete |
$689.97
|
| Rate for Payer: BCBS MAPPO |
$1,006.66
|
| Rate for Payer: BCN Commercial |
$1,682.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,006.66
|
| Rate for Payer: Cash Price |
$2,748.00
|
| Rate for Payer: Cash Price |
$2,748.00
|
| Rate for Payer: Cofinity Commercial |
$1,449.59
|
| Rate for Payer: Cofinity Commercial |
$1,348.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,006.66
|
| Rate for Payer: Healthscope Commercial |
$1,207.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,056.99
|
| Rate for Payer: Meridian Medicaid |
$689.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,107.33
|
| Rate for Payer: Nomi Health Commercial |
$1,207.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,576.25
|
| Rate for Payer: PACE SWMI |
$1,006.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,006.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$657.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,798.20
|
| Rate for Payer: Priority Health Medicare |
$1,006.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,798.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,006.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,922.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,006.66
|
| Rate for Payer: UHC Exchange |
$1,922.56
|
| Rate for Payer: UHC Medicaid |
$657.11
|
| Rate for Payer: UHCCP DNSP |
$1,006.66
|
| Rate for Payer: UHCCP Medicaid |
$657.11
|
|
|
PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT
|
Professional
|
Both
|
$6,655.00
|
|
|
Service Code
|
HCPCS 21194
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$4,991.25 |
| Rate for Payer: Aetna Commercial |
$1,677.97
|
| Rate for Payer: Aetna Medicare |
$1,252.22
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$1,252.22
|
| Rate for Payer: BCN Commercial |
$2,130.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,252.22
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cash Price |
$5,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,803.20
|
| Rate for Payer: Cofinity Commercial |
$1,677.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,252.22
|
| Rate for Payer: Healthscope Commercial |
$1,502.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,502.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,314.83
|
| Rate for Payer: Meridian Medicaid |
$856.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,377.44
|
| Rate for Payer: Nomi Health Commercial |
$1,502.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,991.25
|
| Rate for Payer: PACE SWMI |
$1,252.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,252.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,277.29
|
| Rate for Payer: Priority Health Medicare |
$1,252.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,277.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,252.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,496.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,252.22
|
| Rate for Payer: UHC Exchange |
$2,496.60
|
| Rate for Payer: UHC Medicaid |
$816.00
|
| Rate for Payer: UHCCP DNSP |
$1,252.22
|
| Rate for Payer: UHCCP Medicaid |
$816.00
|
|
|
PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE
|
Professional
|
Both
|
$3,614.00
|
|
|
Service Code
|
HCPCS 21244
|
| Min. Negotiated Rate |
$572.33 |
| Max. Negotiated Rate |
$2,710.50 |
| Rate for Payer: Aetna Commercial |
$1,168.47
|
| Rate for Payer: Aetna Medicare |
$871.99
|
| Rate for Payer: BCBS Complete |
$600.95
|
| Rate for Payer: BCBS MAPPO |
$871.99
|
| Rate for Payer: BCN Commercial |
$1,506.40
|
| Rate for Payer: BCN Medicare Advantage |
$871.99
|
| Rate for Payer: Cash Price |
$2,891.20
|
| Rate for Payer: Cash Price |
$2,891.20
|
| Rate for Payer: Cofinity Commercial |
$1,255.67
|
| Rate for Payer: Cofinity Commercial |
$1,168.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$871.99
|
| Rate for Payer: Healthscope Commercial |
$1,046.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,046.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.59
|
| Rate for Payer: Meridian Medicaid |
$600.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$959.19
|
| Rate for Payer: Nomi Health Commercial |
$1,046.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,710.50
|
| Rate for Payer: PACE SWMI |
$871.99
|
| Rate for Payer: PHP Medicare Advantage |
$871.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$572.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,610.29
|
| Rate for Payer: Priority Health Medicare |
$871.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,610.29
|
| Rate for Payer: Railroad Medicare Medicare |
$871.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,766.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$871.99
|
| Rate for Payer: UHC Exchange |
$1,766.24
|
| Rate for Payer: UHC Medicaid |
$572.33
|
| Rate for Payer: UHCCP DNSP |
$871.99
|
| Rate for Payer: UHCCP Medicaid |
$572.33
|
|
|
PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 26587
|
| Min. Negotiated Rate |
$619.40 |
| Max. Negotiated Rate |
$1,819.20 |
| Rate for Payer: Aetna Commercial |
$1,272.46
|
| Rate for Payer: Aetna Medicare |
$949.60
|
| Rate for Payer: BCBS Complete |
$650.37
|
| Rate for Payer: BCBS MAPPO |
$949.60
|
| Rate for Payer: BCN Commercial |
$1,590.05
|
| Rate for Payer: BCN Medicare Advantage |
$949.60
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cofinity Commercial |
$1,367.42
|
| Rate for Payer: Cofinity Commercial |
$1,272.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$949.60
|
| Rate for Payer: Healthscope Commercial |
$1,139.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,139.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.08
|
| Rate for Payer: Meridian Medicaid |
$650.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,044.56
|
| Rate for Payer: Nomi Health Commercial |
$1,139.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.25
|
| Rate for Payer: PACE SWMI |
$949.60
|
| Rate for Payer: PHP Medicare Advantage |
$949.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,699.72
|
| Rate for Payer: Priority Health Medicare |
$949.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,699.72
|
| Rate for Payer: Railroad Medicare Medicare |
$949.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,819.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$949.60
|
| Rate for Payer: UHC Exchange |
$1,819.20
|
| Rate for Payer: UHC Medicaid |
$619.40
|
| Rate for Payer: UHCCP DNSP |
$949.60
|
| Rate for Payer: UHCCP Medicaid |
$619.40
|
|
|
PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 28238
|
| Min. Negotiated Rate |
$292.88 |
| Max. Negotiated Rate |
$1,144.50 |
| Rate for Payer: Aetna Commercial |
$601.27
|
| Rate for Payer: Aetna Medicare |
$448.71
|
| Rate for Payer: BCBS Complete |
$307.52
|
| Rate for Payer: BCBS MAPPO |
$448.71
|
| Rate for Payer: BCN Commercial |
$734.53
|
| Rate for Payer: BCN Medicare Advantage |
$448.71
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Cash Price |
$1,220.80
|
| Rate for Payer: Cofinity Commercial |
$646.14
|
| Rate for Payer: Cofinity Commercial |
$601.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.71
|
| Rate for Payer: Healthscope Commercial |
$538.45
|
| Rate for Payer: Healthscope Whirlpool |
$538.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.15
|
| Rate for Payer: Meridian Medicaid |
$307.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$493.58
|
| Rate for Payer: Nomi Health Commercial |
$538.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,144.50
|
| Rate for Payer: PACE SWMI |
$448.71
|
| Rate for Payer: PHP Medicare Advantage |
$448.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$292.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$785.18
|
| Rate for Payer: Priority Health Medicare |
$448.71
|
| Rate for Payer: Priority Health Narrow Network |
$785.18
|
| Rate for Payer: Railroad Medicare Medicare |
$448.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$448.71
|
| Rate for Payer: UHC Exchange |
$849.61
|
| Rate for Payer: UHC Medicaid |
$292.88
|
| Rate for Payer: UHCCP DNSP |
$448.71
|
| Rate for Payer: UHCCP Medicaid |
$292.88
|
|
|
PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ
|
Professional
|
Both
|
$3,547.00
|
|
|
Service Code
|
HCPCS 25337
|
| Min. Negotiated Rate |
$528.24 |
| Max. Negotiated Rate |
$2,660.25 |
| Rate for Payer: Aetna Commercial |
$1,079.13
|
| Rate for Payer: Aetna Medicare |
$805.32
|
| Rate for Payer: BCBS Complete |
$554.65
|
| Rate for Payer: BCBS MAPPO |
$805.32
|
| Rate for Payer: BCN Commercial |
$1,360.99
|
| Rate for Payer: BCN Medicare Advantage |
$805.32
|
| Rate for Payer: Cash Price |
$2,837.60
|
| Rate for Payer: Cash Price |
$2,837.60
|
| Rate for Payer: Cofinity Commercial |
$1,159.66
|
| Rate for Payer: Cofinity Commercial |
$1,079.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.32
|
| Rate for Payer: Healthscope Commercial |
$966.38
|
| Rate for Payer: Healthscope Whirlpool |
$966.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.59
|
| Rate for Payer: Meridian Medicaid |
$554.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$885.85
|
| Rate for Payer: Nomi Health Commercial |
$966.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,660.25
|
| Rate for Payer: PACE SWMI |
$805.32
|
| Rate for Payer: PHP Medicare Advantage |
$805.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$528.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,454.85
|
| Rate for Payer: Priority Health Medicare |
$805.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,454.85
|
| Rate for Payer: Railroad Medicare Medicare |
$805.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,539.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$805.32
|
| Rate for Payer: UHC Exchange |
$1,539.92
|
| Rate for Payer: UHC Medicaid |
$528.24
|
| Rate for Payer: UHCCP DNSP |
$805.32
|
| Rate for Payer: UHCCP Medicaid |
$528.24
|
|
|
PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD
|
Professional
|
Both
|
$4,612.00
|
|
|
Service Code
|
HCPCS 21172
|
| Min. Negotiated Rate |
$1,332.32 |
| Max. Negotiated Rate |
$3,667.92 |
| Rate for Payer: Aetna Commercial |
$2,775.52
|
| Rate for Payer: Aetna Medicare |
$2,071.28
|
| Rate for Payer: BCBS Complete |
$1,398.94
|
| Rate for Payer: BCBS MAPPO |
$2,071.28
|
| Rate for Payer: BCN Commercial |
$3,204.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.28
|
| Rate for Payer: Cash Price |
$3,689.60
|
| Rate for Payer: Cash Price |
$3,689.60
|
| Rate for Payer: Cofinity Commercial |
$2,982.64
|
| Rate for Payer: Cofinity Commercial |
$2,775.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.28
|
| Rate for Payer: Healthscope Commercial |
$2,485.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,485.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,174.84
|
| Rate for Payer: Meridian Medicaid |
$1,398.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,278.41
|
| Rate for Payer: Nomi Health Commercial |
$2,485.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,459.00
|
| Rate for Payer: PACE SWMI |
$2,071.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,332.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,425.53
|
| Rate for Payer: Priority Health Medicare |
$2,071.28
|
| Rate for Payer: Priority Health Narrow Network |
$3,425.53
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,667.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,071.28
|
| Rate for Payer: UHC Exchange |
$3,667.92
|
| Rate for Payer: UHC Medicaid |
$1,332.32
|
| Rate for Payer: UHCCP DNSP |
$2,071.28
|
| Rate for Payer: UHCCP Medicaid |
$1,332.32
|
|
|
PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX
|
Professional
|
Both
|
$1,477.00
|
|
|
Service Code
|
HCPCS 26502
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$1,245.20 |
| Rate for Payer: Aetna Commercial |
$953.92
|
| Rate for Payer: Aetna Medicare |
$711.88
|
| Rate for Payer: BCBS Complete |
$498.96
|
| Rate for Payer: BCBS MAPPO |
$711.88
|
| Rate for Payer: BCN Commercial |
$1,139.88
|
| Rate for Payer: BCN Medicare Advantage |
$711.88
|
| Rate for Payer: Cash Price |
$1,181.60
|
| Rate for Payer: Cash Price |
$1,181.60
|
| Rate for Payer: Cofinity Commercial |
$953.92
|
| Rate for Payer: Cofinity Commercial |
$1,025.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.88
|
| Rate for Payer: Healthscope Commercial |
$854.26
|
| Rate for Payer: Healthscope Whirlpool |
$854.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.47
|
| Rate for Payer: Meridian Medicaid |
$498.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$783.07
|
| Rate for Payer: Nomi Health Commercial |
$854.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,107.75
|
| Rate for Payer: PACE SWMI |
$711.88
|
| Rate for Payer: PHP Medicare Advantage |
$711.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,218.50
|
| Rate for Payer: Priority Health Medicare |
$711.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,218.50
|
| Rate for Payer: Railroad Medicare Medicare |
$711.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,245.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$711.88
|
| Rate for Payer: UHC Exchange |
$1,245.20
|
| Rate for Payer: UHC Medicaid |
$475.20
|
| Rate for Payer: UHCCP DNSP |
$711.88
|
| Rate for Payer: UHCCP Medicaid |
$475.20
|
|
|
PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 26500
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,109.90 |
| Rate for Payer: Aetna Commercial |
$876.21
|
| Rate for Payer: Aetna Medicare |
$653.89
|
| Rate for Payer: BCBS Complete |
$460.05
|
| Rate for Payer: BCBS MAPPO |
$653.89
|
| Rate for Payer: BCN Commercial |
$1,038.29
|
| Rate for Payer: BCN Medicare Advantage |
$653.89
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$941.60
|
| Rate for Payer: Cofinity Commercial |
$876.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.89
|
| Rate for Payer: Healthscope Commercial |
$784.67
|
| Rate for Payer: Healthscope Whirlpool |
$784.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.58
|
| Rate for Payer: Meridian Medicaid |
$460.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$719.28
|
| Rate for Payer: Nomi Health Commercial |
$784.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$653.89
|
| Rate for Payer: PHP Medicare Advantage |
$653.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,109.90
|
| Rate for Payer: Priority Health Medicare |
$653.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.90
|
| Rate for Payer: Railroad Medicare Medicare |
$653.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,087.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.89
|
| Rate for Payer: UHC Exchange |
$1,087.60
|
| Rate for Payer: UHC Medicaid |
$438.14
|
| Rate for Payer: UHCCP DNSP |
$653.89
|
| Rate for Payer: UHCCP Medicaid |
$438.14
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$134.83 |
| Max. Negotiated Rate |
$392.57 |
| Rate for Payer: Aetna Commercial |
$277.67
|
| Rate for Payer: Aetna Medicare |
$207.22
|
| Rate for Payer: BCBS Complete |
$141.57
|
| Rate for Payer: BCBS MAPPO |
$207.22
|
| Rate for Payer: BCN Commercial |
$322.19
|
| Rate for Payer: BCN Medicare Advantage |
$207.22
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$298.40
|
| Rate for Payer: Cofinity Commercial |
$277.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.22
|
| Rate for Payer: Healthscope Commercial |
$248.66
|
| Rate for Payer: Healthscope Whirlpool |
$248.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.58
|
| Rate for Payer: Meridian Medicaid |
$141.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.94
|
| Rate for Payer: Nomi Health Commercial |
$248.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PACE SWMI |
$207.22
|
| Rate for Payer: PHP Medicare Advantage |
$207.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$392.57
|
| Rate for Payer: Priority Health Medicare |
$207.22
|
| Rate for Payer: Priority Health Narrow Network |
$392.57
|
| Rate for Payer: Railroad Medicare Medicare |
$207.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$207.22
|
| Rate for Payer: UHC Exchange |
$372.60
|
| Rate for Payer: UHC Medicaid |
$134.83
|
| Rate for Payer: UHCCP DNSP |
$207.22
|
| Rate for Payer: UHCCP Medicaid |
$134.83
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$796.35 |
| Rate for Payer: Aetna Commercial |
$548.68
|
| Rate for Payer: Aetna Medicare |
$409.46
|
| Rate for Payer: BCBS Complete |
$279.34
|
| Rate for Payer: BCBS MAPPO |
$409.46
|
| Rate for Payer: BCN Commercial |
$682.23
|
| Rate for Payer: BCN Medicare Advantage |
$409.46
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$589.62
|
| Rate for Payer: Cofinity Commercial |
$548.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.46
|
| Rate for Payer: Healthscope Commercial |
$491.35
|
| Rate for Payer: Healthscope Whirlpool |
$491.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$429.93
|
| Rate for Payer: Meridian Medicaid |
$279.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$450.41
|
| Rate for Payer: Nomi Health Commercial |
$491.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.50
|
| Rate for Payer: PACE SWMI |
$409.46
|
| Rate for Payer: PHP Medicare Advantage |
$409.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$743.18
|
| Rate for Payer: Priority Health Medicare |
$409.46
|
| Rate for Payer: Priority Health Narrow Network |
$743.18
|
| Rate for Payer: Railroad Medicare Medicare |
$409.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$796.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$409.46
|
| Rate for Payer: UHC Exchange |
$796.35
|
| Rate for Payer: UHC Medicaid |
$266.04
|
| Rate for Payer: UHCCP DNSP |
$409.46
|
| Rate for Payer: UHCCP Medicaid |
$266.04
|
|
|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$2,447.00
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$562.11 |
| Max. Negotiated Rate |
$1,835.25 |
| Rate for Payer: Aetna Commercial |
$1,174.71
|
| Rate for Payer: Aetna Medicare |
$876.65
|
| Rate for Payer: BCBS Complete |
$590.22
|
| Rate for Payer: BCBS MAPPO |
$876.65
|
| Rate for Payer: BCN Commercial |
$1,408.29
|
| Rate for Payer: BCN Medicare Advantage |
$876.65
|
| Rate for Payer: Cash Price |
$1,957.60
|
| Rate for Payer: Cash Price |
$1,957.60
|
| Rate for Payer: Cofinity Commercial |
$1,262.38
|
| Rate for Payer: Cofinity Commercial |
$1,174.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$876.65
|
| Rate for Payer: Healthscope Commercial |
$1,051.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,051.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$920.48
|
| Rate for Payer: Meridian Medicaid |
$590.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$964.32
|
| Rate for Payer: Nomi Health Commercial |
$1,051.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,835.25
|
| Rate for Payer: PACE SWMI |
$876.65
|
| Rate for Payer: PHP Medicare Advantage |
$876.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$562.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,715.91
|
| Rate for Payer: Priority Health Medicare |
$876.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.91
|
| Rate for Payer: Railroad Medicare Medicare |
$876.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,667.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$876.65
|
| Rate for Payer: UHC Exchange |
$1,667.62
|
| Rate for Payer: UHC Medicaid |
$562.11
|
| Rate for Payer: UHCCP DNSP |
$876.65
|
| Rate for Payer: UHCCP Medicaid |
$562.11
|
|
|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$414.29 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Medicare |
$618.18
|
| Rate for Payer: BCBS Complete |
$435.00
|
| Rate for Payer: BCBS MAPPO |
$618.18
|
| Rate for Payer: BCN Commercial |
$1,007.42
|
| Rate for Payer: BCN Medicare Advantage |
$618.18
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cofinity Commercial |
$828.36
|
| Rate for Payer: Cofinity Commercial |
$890.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$618.18
|
| Rate for Payer: Healthscope Commercial |
$741.82
|
| Rate for Payer: Healthscope Whirlpool |
$741.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$649.09
|
| Rate for Payer: Meridian Medicaid |
$435.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$680.00
|
| Rate for Payer: Nomi Health Commercial |
$741.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,225.50
|
| Rate for Payer: PACE SWMI |
$618.18
|
| Rate for Payer: PHP Medicare Advantage |
$618.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,076.90
|
| Rate for Payer: Priority Health Medicare |
$618.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,076.90
|
| Rate for Payer: Railroad Medicare Medicare |
$618.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$618.18
|
| Rate for Payer: UHC Exchange |
$1,089.10
|
| Rate for Payer: UHC Medicaid |
$414.29
|
| Rate for Payer: UHCCP DNSP |
$618.18
|
| Rate for Payer: UHCCP Medicaid |
$414.29
|
|
|
PR REAORT VALV W CP BYPASS
|
Professional
|
Both
|
$8,285.00
|
|
|
Service Code
|
HCPCS 33400
|
| Min. Negotiated Rate |
$3,314.00 |
| Max. Negotiated Rate |
$6,213.75 |
| Rate for Payer: BCBS Complete |
$3,314.00
|
| Rate for Payer: Cash Price |
$6,628.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,213.75
|
|
|
PR RECMPL WND LID,NOS,EAR <1 CM
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 13150
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$465.75 |
| Rate for Payer: BCBS Complete |
$248.40
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$465.75
|
|
|
PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX
|
Professional
|
Both
|
$3,569.00
|
|
|
Service Code
|
HCPCS 69310
|
| Min. Negotiated Rate |
$661.37 |
| Max. Negotiated Rate |
$2,676.75 |
| Rate for Payer: Aetna Commercial |
$1,326.22
|
| Rate for Payer: Aetna Medicare |
$989.72
|
| Rate for Payer: BCBS Complete |
$694.44
|
| Rate for Payer: BCBS MAPPO |
$989.72
|
| Rate for Payer: BCN Commercial |
$1,669.73
|
| Rate for Payer: BCN Medicare Advantage |
$989.72
|
| Rate for Payer: Cash Price |
$2,855.20
|
| Rate for Payer: Cash Price |
$2,855.20
|
| Rate for Payer: Cofinity Commercial |
$1,326.22
|
| Rate for Payer: Cofinity Commercial |
$1,425.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$989.72
|
| Rate for Payer: Healthscope Commercial |
$1,187.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,187.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.21
|
| Rate for Payer: Meridian Medicaid |
$694.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,088.69
|
| Rate for Payer: Nomi Health Commercial |
$1,187.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,676.75
|
| Rate for Payer: PACE SWMI |
$989.72
|
| Rate for Payer: PHP Medicare Advantage |
$989.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$661.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,649.86
|
| Rate for Payer: Priority Health Medicare |
$989.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,649.86
|
| Rate for Payer: Railroad Medicare Medicare |
$989.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,847.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$989.72
|
| Rate for Payer: UHC Exchange |
$1,847.25
|
| Rate for Payer: UHC Medicaid |
$661.37
|
| Rate for Payer: UHCCP DNSP |
$989.72
|
| Rate for Payer: UHCCP Medicaid |
$661.37
|
|
