|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$235.32
|
| Rate for Payer: Aetna Medicare |
$175.61
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$175.61
|
| Rate for Payer: BCN Commercial |
$243.08
|
| Rate for Payer: BCN Medicare Advantage |
$175.61
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$252.88
|
| Rate for Payer: Cofinity Commercial |
$235.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.61
|
| Rate for Payer: Healthscope Commercial |
$210.73
|
| Rate for Payer: Healthscope Whirlpool |
$210.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.39
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.17
|
| Rate for Payer: Nomi Health Commercial |
$210.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.00
|
| Rate for Payer: PACE SWMI |
$175.61
|
| Rate for Payer: PHP Medicare Advantage |
$175.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.12
|
| Rate for Payer: Priority Health Medicare |
$175.61
|
| Rate for Payer: Priority Health Narrow Network |
$282.12
|
| Rate for Payer: Railroad Medicare Medicare |
$175.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.61
|
| Rate for Payer: UHC Exchange |
$357.59
|
| Rate for Payer: UHC Medicaid |
$114.81
|
| Rate for Payer: UHCCP DNSP |
$175.61
|
| Rate for Payer: UHCCP Medicaid |
$114.81
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$313.96 |
| Max. Negotiated Rate |
$788.92 |
| Rate for Payer: Aetna Commercial |
$621.17
|
| Rate for Payer: Aetna Medicare |
$463.56
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCBS MAPPO |
$463.56
|
| Rate for Payer: BCN Commercial |
$738.00
|
| Rate for Payer: BCN Medicare Advantage |
$463.56
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$667.53
|
| Rate for Payer: Cofinity Commercial |
$621.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.56
|
| Rate for Payer: Healthscope Commercial |
$556.27
|
| Rate for Payer: Healthscope Whirlpool |
$556.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$486.74
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$509.92
|
| Rate for Payer: Nomi Health Commercial |
$556.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.75
|
| Rate for Payer: PACE SWMI |
$463.56
|
| Rate for Payer: PHP Medicare Advantage |
$463.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$788.92
|
| Rate for Payer: Priority Health Medicare |
$463.56
|
| Rate for Payer: Priority Health Narrow Network |
$788.92
|
| Rate for Payer: Railroad Medicare Medicare |
$463.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$463.56
|
| Rate for Payer: UHC Exchange |
$770.45
|
| Rate for Payer: UHC Medicaid |
$313.96
|
| Rate for Payer: UHCCP DNSP |
$463.56
|
| Rate for Payer: UHCCP Medicaid |
$313.96
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,874.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$3,655.50 |
| Rate for Payer: Aetna Commercial |
$1,076.01
|
| Rate for Payer: Aetna Medicare |
$802.99
|
| Rate for Payer: BCBS Complete |
$542.36
|
| Rate for Payer: BCBS MAPPO |
$802.99
|
| Rate for Payer: BCN Commercial |
$1,275.83
|
| Rate for Payer: BCN Medicare Advantage |
$802.99
|
| Rate for Payer: Cash Price |
$3,899.20
|
| Rate for Payer: Cash Price |
$3,899.20
|
| Rate for Payer: Cofinity Commercial |
$1,156.31
|
| Rate for Payer: Cofinity Commercial |
$1,076.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.99
|
| Rate for Payer: Healthscope Commercial |
$963.59
|
| Rate for Payer: Healthscope Whirlpool |
$963.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$843.14
|
| Rate for Payer: Meridian Medicaid |
$542.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$883.29
|
| Rate for Payer: Nomi Health Commercial |
$963.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,655.50
|
| Rate for Payer: PACE SWMI |
$802.99
|
| Rate for Payer: PHP Medicare Advantage |
$802.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,372.00
|
| Rate for Payer: Priority Health Medicare |
$802.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,372.00
|
| Rate for Payer: Railroad Medicare Medicare |
$802.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,515.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$802.99
|
| Rate for Payer: UHC Exchange |
$1,515.05
|
| Rate for Payer: UHC Medicaid |
$516.53
|
| Rate for Payer: UHCCP DNSP |
$802.99
|
| Rate for Payer: UHCCP Medicaid |
$516.53
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$345.86 |
| Rate for Payer: Aetna Commercial |
$219.53
|
| Rate for Payer: Aetna Medicare |
$163.83
|
| Rate for Payer: BCBS Complete |
$112.95
|
| Rate for Payer: BCBS MAPPO |
$163.83
|
| Rate for Payer: BCN Commercial |
$283.85
|
| Rate for Payer: BCN Medicare Advantage |
$163.83
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$235.92
|
| Rate for Payer: Cofinity Commercial |
$219.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.83
|
| Rate for Payer: Healthscope Commercial |
$196.60
|
| Rate for Payer: Healthscope Whirlpool |
$196.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.02
|
| Rate for Payer: Meridian Medicaid |
$112.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.21
|
| Rate for Payer: Nomi Health Commercial |
$196.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.50
|
| Rate for Payer: PACE SWMI |
$163.83
|
| Rate for Payer: PHP Medicare Advantage |
$163.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.86
|
| Rate for Payer: Priority Health Medicare |
$163.83
|
| Rate for Payer: Priority Health Narrow Network |
$345.86
|
| Rate for Payer: Railroad Medicare Medicare |
$163.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.83
|
| Rate for Payer: UHC Exchange |
$318.84
|
| Rate for Payer: UHC Medicaid |
$107.57
|
| Rate for Payer: UHCCP DNSP |
$163.83
|
| Rate for Payer: UHCCP Medicaid |
$107.57
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$569.25 |
| Rate for Payer: Aetna Commercial |
$298.59
|
| Rate for Payer: Aetna Medicare |
$222.83
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCBS MAPPO |
$222.83
|
| Rate for Payer: BCN Commercial |
$389.42
|
| Rate for Payer: BCN Medicare Advantage |
$222.83
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cofinity Commercial |
$320.88
|
| Rate for Payer: Cofinity Commercial |
$298.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.83
|
| Rate for Payer: Healthscope Commercial |
$267.40
|
| Rate for Payer: Healthscope Whirlpool |
$267.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.97
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$245.11
|
| Rate for Payer: Nomi Health Commercial |
$267.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.25
|
| Rate for Payer: PACE SWMI |
$222.83
|
| Rate for Payer: PHP Medicare Advantage |
$222.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$474.49
|
| Rate for Payer: Priority Health Medicare |
$222.83
|
| Rate for Payer: Priority Health Narrow Network |
$474.49
|
| Rate for Payer: Railroad Medicare Medicare |
$222.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$445.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.83
|
| Rate for Payer: UHC Exchange |
$445.20
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP DNSP |
$222.83
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$1,775.25 |
| Rate for Payer: Aetna Commercial |
$879.87
|
| Rate for Payer: Aetna Medicare |
$656.62
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS MAPPO |
$656.62
|
| Rate for Payer: BCN Commercial |
$1,099.54
|
| Rate for Payer: BCN Medicare Advantage |
$656.62
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cofinity Commercial |
$945.53
|
| Rate for Payer: Cofinity Commercial |
$879.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.62
|
| Rate for Payer: Healthscope Commercial |
$787.94
|
| Rate for Payer: Healthscope Whirlpool |
$787.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.45
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$722.28
|
| Rate for Payer: Nomi Health Commercial |
$787.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,775.25
|
| Rate for Payer: PACE SWMI |
$656.62
|
| Rate for Payer: PHP Medicare Advantage |
$656.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,175.38
|
| Rate for Payer: Priority Health Medicare |
$656.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,175.38
|
| Rate for Payer: Railroad Medicare Medicare |
$656.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,231.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$656.62
|
| Rate for Payer: UHC Exchange |
$1,231.10
|
| Rate for Payer: UHC Medicaid |
$431.54
|
| Rate for Payer: UHCCP DNSP |
$656.62
|
| Rate for Payer: UHCCP Medicaid |
$431.54
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$1,012.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Aetna Medicare |
$349.04
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS MAPPO |
$349.04
|
| Rate for Payer: BCN Commercial |
$552.26
|
| Rate for Payer: BCN Medicare Advantage |
$349.04
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cofinity Commercial |
$502.62
|
| Rate for Payer: Cofinity Commercial |
$467.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.04
|
| Rate for Payer: Healthscope Commercial |
$418.85
|
| Rate for Payer: Healthscope Whirlpool |
$418.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.49
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.94
|
| Rate for Payer: Nomi Health Commercial |
$418.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$759.00
|
| Rate for Payer: PACE SWMI |
$349.04
|
| Rate for Payer: PHP Medicare Advantage |
$349.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$672.89
|
| Rate for Payer: Priority Health Medicare |
$349.04
|
| Rate for Payer: Priority Health Narrow Network |
$672.89
|
| Rate for Payer: Railroad Medicare Medicare |
$349.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$614.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$349.04
|
| Rate for Payer: UHC Exchange |
$614.72
|
| Rate for Payer: UHC Medicaid |
$230.89
|
| Rate for Payer: UHCCP DNSP |
$349.04
|
| Rate for Payer: UHCCP Medicaid |
$230.89
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$590.37 |
| Rate for Payer: Aetna Commercial |
$450.13
|
| Rate for Payer: Aetna Medicare |
$335.92
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCBS MAPPO |
$335.92
|
| Rate for Payer: BCN Commercial |
$484.54
|
| Rate for Payer: BCN Medicare Advantage |
$335.92
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$483.72
|
| Rate for Payer: Cofinity Commercial |
$450.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.92
|
| Rate for Payer: Healthscope Commercial |
$403.10
|
| Rate for Payer: Healthscope Whirlpool |
$403.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.72
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$369.51
|
| Rate for Payer: Nomi Health Commercial |
$403.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.50
|
| Rate for Payer: PACE SWMI |
$335.92
|
| Rate for Payer: PHP Medicare Advantage |
$335.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$590.37
|
| Rate for Payer: Priority Health Medicare |
$335.92
|
| Rate for Payer: Priority Health Narrow Network |
$590.37
|
| Rate for Payer: Railroad Medicare Medicare |
$335.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$335.92
|
| Rate for Payer: UHC Exchange |
$528.82
|
| Rate for Payer: UHC Medicaid |
$223.01
|
| Rate for Payer: UHCCP DNSP |
$335.92
|
| Rate for Payer: UHCCP Medicaid |
$223.01
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$410.45 |
| Max. Negotiated Rate |
$1,242.03 |
| Rate for Payer: Aetna Commercial |
$854.30
|
| Rate for Payer: Aetna Medicare |
$637.54
|
| Rate for Payer: BCBS Complete |
$430.97
|
| Rate for Payer: BCBS MAPPO |
$637.54
|
| Rate for Payer: BCN Commercial |
$1,019.37
|
| Rate for Payer: BCN Medicare Advantage |
$637.54
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cofinity Commercial |
$918.06
|
| Rate for Payer: Cofinity Commercial |
$854.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.54
|
| Rate for Payer: Healthscope Commercial |
$765.05
|
| Rate for Payer: Healthscope Whirlpool |
$765.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.42
|
| Rate for Payer: Meridian Medicaid |
$430.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$701.29
|
| Rate for Payer: Nomi Health Commercial |
$765.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.25
|
| Rate for Payer: PACE SWMI |
$637.54
|
| Rate for Payer: PHP Medicare Advantage |
$637.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,242.03
|
| Rate for Payer: Priority Health Medicare |
$637.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.03
|
| Rate for Payer: Railroad Medicare Medicare |
$637.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,199.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$637.54
|
| Rate for Payer: UHC Exchange |
$1,199.10
|
| Rate for Payer: UHC Medicaid |
$410.45
|
| Rate for Payer: UHCCP DNSP |
$637.54
|
| Rate for Payer: UHCCP Medicaid |
$410.45
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,427.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$1,820.25 |
| Rate for Payer: Aetna Commercial |
$1,218.39
|
| Rate for Payer: Aetna Medicare |
$909.25
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS MAPPO |
$909.25
|
| Rate for Payer: BCN Commercial |
$1,410.28
|
| Rate for Payer: BCN Medicare Advantage |
$909.25
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cofinity Commercial |
$1,309.32
|
| Rate for Payer: Cofinity Commercial |
$1,218.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.25
|
| Rate for Payer: Healthscope Commercial |
$1,091.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$954.71
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,000.17
|
| Rate for Payer: Nomi Health Commercial |
$1,091.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,820.25
|
| Rate for Payer: PACE SWMI |
$909.25
|
| Rate for Payer: PHP Medicare Advantage |
$909.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,328.06
|
| Rate for Payer: Priority Health Medicare |
$909.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,328.06
|
| Rate for Payer: Railroad Medicare Medicare |
$909.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,669.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$909.25
|
| Rate for Payer: UHC Exchange |
$1,669.93
|
| Rate for Payer: UHC Medicaid |
$584.90
|
| Rate for Payer: UHCCP DNSP |
$909.25
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,367.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$430.26 |
| Max. Negotiated Rate |
$1,775.25 |
| Rate for Payer: Aetna Commercial |
$877.81
|
| Rate for Payer: Aetna Medicare |
$655.08
|
| Rate for Payer: BCBS Complete |
$451.77
|
| Rate for Payer: BCBS MAPPO |
$655.08
|
| Rate for Payer: BCN Commercial |
$1,089.09
|
| Rate for Payer: BCN Medicare Advantage |
$655.08
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cofinity Commercial |
$943.32
|
| Rate for Payer: Cofinity Commercial |
$877.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.08
|
| Rate for Payer: Healthscope Commercial |
$786.10
|
| Rate for Payer: Healthscope Whirlpool |
$786.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.83
|
| Rate for Payer: Meridian Medicaid |
$451.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$720.59
|
| Rate for Payer: Nomi Health Commercial |
$786.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,775.25
|
| Rate for Payer: PACE SWMI |
$655.08
|
| Rate for Payer: PHP Medicare Advantage |
$655.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,164.20
|
| Rate for Payer: Priority Health Medicare |
$655.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.20
|
| Rate for Payer: Railroad Medicare Medicare |
$655.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,220.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.08
|
| Rate for Payer: UHC Exchange |
$1,220.77
|
| Rate for Payer: UHC Medicaid |
$430.26
|
| Rate for Payer: UHCCP DNSP |
$655.08
|
| Rate for Payer: UHCCP Medicaid |
$430.26
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,592.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$843.91 |
| Max. Negotiated Rate |
$3,444.00 |
| Rate for Payer: Aetna Commercial |
$1,754.82
|
| Rate for Payer: Aetna Medicare |
$1,309.57
|
| Rate for Payer: BCBS Complete |
$886.11
|
| Rate for Payer: BCBS MAPPO |
$1,309.57
|
| Rate for Payer: BCN Commercial |
$2,210.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.57
|
| Rate for Payer: Cash Price |
$3,673.60
|
| Rate for Payer: Cash Price |
$3,673.60
|
| Rate for Payer: Cofinity Commercial |
$1,885.78
|
| Rate for Payer: Cofinity Commercial |
$1,754.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.57
|
| Rate for Payer: Healthscope Commercial |
$1,571.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,571.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,375.05
|
| Rate for Payer: Meridian Medicaid |
$886.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,440.53
|
| Rate for Payer: Nomi Health Commercial |
$1,571.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,444.00
|
| Rate for Payer: PACE SWMI |
$1,309.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,337.29
|
| Rate for Payer: Priority Health Medicare |
$1,309.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,337.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,309.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,288.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,309.57
|
| Rate for Payer: UHC Exchange |
$2,288.80
|
| Rate for Payer: UHC Medicaid |
$843.91
|
| Rate for Payer: UHCCP DNSP |
$1,309.57
|
| Rate for Payer: UHCCP Medicaid |
$843.91
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,245.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,065.21 |
| Max. Negotiated Rate |
$3,933.75 |
| Rate for Payer: Aetna Commercial |
$2,217.97
|
| Rate for Payer: Aetna Medicare |
$1,655.20
|
| Rate for Payer: BCBS Complete |
$1,118.47
|
| Rate for Payer: BCBS MAPPO |
$1,655.20
|
| Rate for Payer: BCN Commercial |
$2,806.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,655.20
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Cofinity Commercial |
$2,383.49
|
| Rate for Payer: Cofinity Commercial |
$2,217.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,655.20
|
| Rate for Payer: Healthscope Commercial |
$1,986.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,986.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,737.96
|
| Rate for Payer: Meridian Medicaid |
$1,118.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,820.72
|
| Rate for Payer: Nomi Health Commercial |
$1,986.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,933.75
|
| Rate for Payer: PACE SWMI |
$1,655.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,655.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,065.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,967.18
|
| Rate for Payer: Priority Health Medicare |
$1,655.20
|
| Rate for Payer: Priority Health Narrow Network |
$2,967.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,655.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,908.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,655.20
|
| Rate for Payer: UHC Exchange |
$2,908.03
|
| Rate for Payer: UHC Medicaid |
$1,065.21
|
| Rate for Payer: UHCCP DNSP |
$1,655.20
|
| Rate for Payer: UHCCP Medicaid |
$1,065.21
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,522.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,172.99 |
| Max. Negotiated Rate |
$4,141.50 |
| Rate for Payer: Aetna Commercial |
$2,447.52
|
| Rate for Payer: Aetna Medicare |
$1,826.51
|
| Rate for Payer: BCBS Complete |
$1,231.64
|
| Rate for Payer: BCBS MAPPO |
$1,826.51
|
| Rate for Payer: BCN Commercial |
$2,831.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,826.51
|
| Rate for Payer: Cash Price |
$4,417.60
|
| Rate for Payer: Cash Price |
$4,417.60
|
| Rate for Payer: Cofinity Commercial |
$2,630.17
|
| Rate for Payer: Cofinity Commercial |
$2,447.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,826.51
|
| Rate for Payer: Healthscope Commercial |
$2,191.81
|
| Rate for Payer: Healthscope Whirlpool |
$2,191.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,917.84
|
| Rate for Payer: Meridian Medicaid |
$1,231.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,009.16
|
| Rate for Payer: Nomi Health Commercial |
$2,191.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,141.50
|
| Rate for Payer: PACE SWMI |
$1,826.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,826.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,172.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,288.18
|
| Rate for Payer: Priority Health Medicare |
$1,826.51
|
| Rate for Payer: Priority Health Narrow Network |
$3,288.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,826.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,239.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,826.51
|
| Rate for Payer: UHC Exchange |
$3,239.17
|
| Rate for Payer: UHC Medicaid |
$1,172.99
|
| Rate for Payer: UHCCP DNSP |
$1,826.51
|
| Rate for Payer: UHCCP Medicaid |
$1,172.99
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$135.11
|
| Rate for Payer: Aetna Medicare |
$100.83
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS MAPPO |
$100.83
|
| Rate for Payer: BCN Commercial |
$164.34
|
| Rate for Payer: BCN Medicare Advantage |
$100.83
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Cofinity Commercial |
$135.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.83
|
| Rate for Payer: Healthscope Commercial |
$121.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.87
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.91
|
| Rate for Payer: Nomi Health Commercial |
$121.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.00
|
| Rate for Payer: PACE SWMI |
$100.83
|
| Rate for Payer: PHP Medicare Advantage |
$100.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.40
|
| Rate for Payer: Priority Health Medicare |
$100.83
|
| Rate for Payer: Priority Health Narrow Network |
$150.40
|
| Rate for Payer: Railroad Medicare Medicare |
$100.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.83
|
| Rate for Payer: UHC Exchange |
$198.85
|
| Rate for Payer: UHC Medicaid |
$66.24
|
| Rate for Payer: UHCCP DNSP |
$100.83
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,402.50 |
| Rate for Payer: Aetna Commercial |
$781.74
|
| Rate for Payer: Aetna Medicare |
$583.39
|
| Rate for Payer: BCBS Complete |
$407.04
|
| Rate for Payer: BCBS MAPPO |
$583.39
|
| Rate for Payer: BCN Commercial |
$998.95
|
| Rate for Payer: BCN Medicare Advantage |
$583.39
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$840.08
|
| Rate for Payer: Cofinity Commercial |
$781.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.39
|
| Rate for Payer: Healthscope Commercial |
$700.07
|
| Rate for Payer: Healthscope Whirlpool |
$700.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$612.56
|
| Rate for Payer: Meridian Medicaid |
$407.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$641.73
|
| Rate for Payer: Nomi Health Commercial |
$700.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,402.50
|
| Rate for Payer: PACE SWMI |
$583.39
|
| Rate for Payer: PHP Medicare Advantage |
$583.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$940.71
|
| Rate for Payer: Priority Health Medicare |
$583.39
|
| Rate for Payer: Priority Health Narrow Network |
$940.71
|
| Rate for Payer: Railroad Medicare Medicare |
$583.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$583.39
|
| Rate for Payer: UHC Exchange |
$1,104.34
|
| Rate for Payer: UHC Medicaid |
$387.66
|
| Rate for Payer: UHCCP DNSP |
$583.39
|
| Rate for Payer: UHCCP Medicaid |
$387.66
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$588.52 |
| Max. Negotiated Rate |
$1,714.80 |
| Rate for Payer: Aetna Commercial |
$1,193.28
|
| Rate for Payer: Aetna Medicare |
$890.51
|
| Rate for Payer: BCBS Complete |
$617.95
|
| Rate for Payer: BCBS MAPPO |
$890.51
|
| Rate for Payer: BCN Commercial |
$1,530.79
|
| Rate for Payer: BCN Medicare Advantage |
$890.51
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,282.33
|
| Rate for Payer: Cofinity Commercial |
$1,193.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.51
|
| Rate for Payer: Healthscope Commercial |
$1,068.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$935.04
|
| Rate for Payer: Meridian Medicaid |
$617.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$979.56
|
| Rate for Payer: Nomi Health Commercial |
$1,068.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,303.50
|
| Rate for Payer: PACE SWMI |
$890.51
|
| Rate for Payer: PHP Medicare Advantage |
$890.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$588.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,441.55
|
| Rate for Payer: Priority Health Medicare |
$890.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,441.55
|
| Rate for Payer: Railroad Medicare Medicare |
$890.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,714.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$890.51
|
| Rate for Payer: UHC Exchange |
$1,714.80
|
| Rate for Payer: UHC Medicaid |
$588.52
|
| Rate for Payer: UHCCP DNSP |
$890.51
|
| Rate for Payer: UHCCP Medicaid |
$588.52
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,740.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$640.28 |
| Max. Negotiated Rate |
$3,555.00 |
| Rate for Payer: Aetna Commercial |
$1,314.77
|
| Rate for Payer: Aetna Medicare |
$981.17
|
| Rate for Payer: BCBS Complete |
$672.29
|
| Rate for Payer: BCBS MAPPO |
$981.17
|
| Rate for Payer: BCN Commercial |
$1,642.84
|
| Rate for Payer: BCN Medicare Advantage |
$981.17
|
| Rate for Payer: Cash Price |
$3,792.00
|
| Rate for Payer: Cash Price |
$3,792.00
|
| Rate for Payer: Cofinity Commercial |
$1,412.88
|
| Rate for Payer: Cofinity Commercial |
$1,314.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.17
|
| Rate for Payer: Healthscope Commercial |
$1,177.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.23
|
| Rate for Payer: Meridian Medicaid |
$672.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,079.29
|
| Rate for Payer: Nomi Health Commercial |
$1,177.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,555.00
|
| Rate for Payer: PACE SWMI |
$981.17
|
| Rate for Payer: PHP Medicare Advantage |
$981.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,756.15
|
| Rate for Payer: Priority Health Medicare |
$981.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,756.15
|
| Rate for Payer: Railroad Medicare Medicare |
$981.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,878.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$981.17
|
| Rate for Payer: UHC Exchange |
$1,878.87
|
| Rate for Payer: UHC Medicaid |
$640.28
|
| Rate for Payer: UHCCP DNSP |
$981.17
|
| Rate for Payer: UHCCP Medicaid |
$640.28
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$618.34 |
| Max. Negotiated Rate |
$2,233.50 |
| Rate for Payer: Aetna Commercial |
$1,273.75
|
| Rate for Payer: Aetna Medicare |
$950.56
|
| Rate for Payer: BCBS Complete |
$649.26
|
| Rate for Payer: BCBS MAPPO |
$950.56
|
| Rate for Payer: BCN Commercial |
$1,603.50
|
| Rate for Payer: BCN Medicare Advantage |
$950.56
|
| Rate for Payer: Cash Price |
$2,382.40
|
| Rate for Payer: Cash Price |
$2,382.40
|
| Rate for Payer: Cofinity Commercial |
$1,368.81
|
| Rate for Payer: Cofinity Commercial |
$1,273.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$950.56
|
| Rate for Payer: Healthscope Commercial |
$1,140.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$998.09
|
| Rate for Payer: Meridian Medicaid |
$649.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,045.62
|
| Rate for Payer: Nomi Health Commercial |
$1,140.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,233.50
|
| Rate for Payer: PACE SWMI |
$950.56
|
| Rate for Payer: PHP Medicare Advantage |
$950.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$618.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,714.10
|
| Rate for Payer: Priority Health Medicare |
$950.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,714.10
|
| Rate for Payer: Railroad Medicare Medicare |
$950.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,849.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$950.56
|
| Rate for Payer: UHC Exchange |
$1,849.48
|
| Rate for Payer: UHC Medicaid |
$618.34
|
| Rate for Payer: UHCCP DNSP |
$950.56
|
| Rate for Payer: UHCCP Medicaid |
$618.34
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,443.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$471.16 |
| Max. Negotiated Rate |
$1,377.91 |
| Rate for Payer: Aetna Commercial |
$967.10
|
| Rate for Payer: Aetna Medicare |
$721.72
|
| Rate for Payer: BCBS Complete |
$494.72
|
| Rate for Payer: BCBS MAPPO |
$721.72
|
| Rate for Payer: BCN Commercial |
$1,204.12
|
| Rate for Payer: BCN Medicare Advantage |
$721.72
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cofinity Commercial |
$967.10
|
| Rate for Payer: Cofinity Commercial |
$1,039.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.72
|
| Rate for Payer: Healthscope Commercial |
$866.06
|
| Rate for Payer: Healthscope Whirlpool |
$866.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.81
|
| Rate for Payer: Meridian Medicaid |
$494.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$793.89
|
| Rate for Payer: Nomi Health Commercial |
$866.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.25
|
| Rate for Payer: PACE SWMI |
$721.72
|
| Rate for Payer: PHP Medicare Advantage |
$721.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,287.17
|
| Rate for Payer: Priority Health Medicare |
$721.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,287.17
|
| Rate for Payer: Railroad Medicare Medicare |
$721.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,377.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$721.72
|
| Rate for Payer: UHC Exchange |
$1,377.91
|
| Rate for Payer: UHC Medicaid |
$471.16
|
| Rate for Payer: UHCCP DNSP |
$721.72
|
| Rate for Payer: UHCCP Medicaid |
$471.16
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$368.49 |
| Max. Negotiated Rate |
$1,071.63 |
| Rate for Payer: Aetna Commercial |
$755.96
|
| Rate for Payer: Aetna Medicare |
$564.15
|
| Rate for Payer: BCBS Complete |
$386.91
|
| Rate for Payer: BCBS MAPPO |
$564.15
|
| Rate for Payer: BCN Commercial |
$935.21
|
| Rate for Payer: BCN Medicare Advantage |
$564.15
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cofinity Commercial |
$812.38
|
| Rate for Payer: Cofinity Commercial |
$755.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.15
|
| Rate for Payer: Healthscope Commercial |
$676.98
|
| Rate for Payer: Healthscope Whirlpool |
$676.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.36
|
| Rate for Payer: Meridian Medicaid |
$386.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$620.57
|
| Rate for Payer: Nomi Health Commercial |
$676.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.50
|
| Rate for Payer: PACE SWMI |
$564.15
|
| Rate for Payer: PHP Medicare Advantage |
$564.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$999.72
|
| Rate for Payer: Priority Health Medicare |
$564.15
|
| Rate for Payer: Priority Health Narrow Network |
$999.72
|
| Rate for Payer: Railroad Medicare Medicare |
$564.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$564.15
|
| Rate for Payer: UHC Exchange |
$1,071.63
|
| Rate for Payer: UHC Medicaid |
$368.49
|
| Rate for Payer: UHCCP DNSP |
$564.15
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$4,020.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$517.38 |
| Max. Negotiated Rate |
$3,015.00 |
| Rate for Payer: Aetna Commercial |
$1,062.79
|
| Rate for Payer: Aetna Medicare |
$793.13
|
| Rate for Payer: BCBS Complete |
$543.25
|
| Rate for Payer: BCBS MAPPO |
$793.13
|
| Rate for Payer: BCN Commercial |
$1,327.62
|
| Rate for Payer: BCN Medicare Advantage |
$793.13
|
| Rate for Payer: Cash Price |
$3,216.00
|
| Rate for Payer: Cash Price |
$3,216.00
|
| Rate for Payer: Cofinity Commercial |
$1,142.11
|
| Rate for Payer: Cofinity Commercial |
$1,062.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.13
|
| Rate for Payer: Healthscope Commercial |
$951.76
|
| Rate for Payer: Healthscope Whirlpool |
$951.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.79
|
| Rate for Payer: Meridian Medicaid |
$543.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$872.44
|
| Rate for Payer: Nomi Health Commercial |
$951.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,015.00
|
| Rate for Payer: PACE SWMI |
$793.13
|
| Rate for Payer: PHP Medicare Advantage |
$793.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,419.19
|
| Rate for Payer: Priority Health Medicare |
$793.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,419.19
|
| Rate for Payer: Railroad Medicare Medicare |
$793.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,530.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$793.13
|
| Rate for Payer: UHC Exchange |
$1,530.97
|
| Rate for Payer: UHC Medicaid |
$517.38
|
| Rate for Payer: UHCCP DNSP |
$793.13
|
| Rate for Payer: UHCCP Medicaid |
$517.38
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$2,956.50 |
| Rate for Payer: Aetna Commercial |
$1,091.85
|
| Rate for Payer: Aetna Medicare |
$814.81
|
| Rate for Payer: BCBS Complete |
$558.01
|
| Rate for Payer: BCBS MAPPO |
$814.81
|
| Rate for Payer: BCN Commercial |
$1,362.98
|
| Rate for Payer: BCN Medicare Advantage |
$814.81
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cofinity Commercial |
$1,173.33
|
| Rate for Payer: Cofinity Commercial |
$1,091.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$814.81
|
| Rate for Payer: Healthscope Commercial |
$977.77
|
| Rate for Payer: Healthscope Whirlpool |
$977.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$855.55
|
| Rate for Payer: Meridian Medicaid |
$558.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$896.29
|
| Rate for Payer: Nomi Health Commercial |
$977.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,956.50
|
| Rate for Payer: PACE SWMI |
$814.81
|
| Rate for Payer: PHP Medicare Advantage |
$814.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,456.97
|
| Rate for Payer: Priority Health Medicare |
$814.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,456.97
|
| Rate for Payer: Railroad Medicare Medicare |
$814.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,560.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$814.81
|
| Rate for Payer: UHC Exchange |
$1,560.76
|
| Rate for Payer: UHC Medicaid |
$531.44
|
| Rate for Payer: UHCCP DNSP |
$814.81
|
| Rate for Payer: UHCCP Medicaid |
$531.44
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$1,187.01 |
| Rate for Payer: Aetna Commercial |
$815.59
|
| Rate for Payer: Aetna Medicare |
$608.65
|
| Rate for Payer: BCBS Complete |
$414.88
|
| Rate for Payer: BCBS MAPPO |
$608.65
|
| Rate for Payer: BCN Commercial |
$1,021.36
|
| Rate for Payer: BCN Medicare Advantage |
$608.65
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cofinity Commercial |
$876.46
|
| Rate for Payer: Cofinity Commercial |
$815.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$608.65
|
| Rate for Payer: Healthscope Commercial |
$730.38
|
| Rate for Payer: Healthscope Whirlpool |
$730.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$639.08
|
| Rate for Payer: Meridian Medicaid |
$414.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$669.51
|
| Rate for Payer: Nomi Health Commercial |
$730.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,072.50
|
| Rate for Payer: PACE SWMI |
$608.65
|
| Rate for Payer: PHP Medicare Advantage |
$608.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,112.60
|
| Rate for Payer: Priority Health Medicare |
$608.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,112.60
|
| Rate for Payer: Railroad Medicare Medicare |
$608.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$608.65
|
| Rate for Payer: UHC Exchange |
$1,187.01
|
| Rate for Payer: UHC Medicaid |
$395.12
|
| Rate for Payer: UHCCP DNSP |
$608.65
|
| Rate for Payer: UHCCP Medicaid |
$395.12
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS BY LIGATION
|
Professional
|
Both
|
$4,534.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$590.01 |
| Max. Negotiated Rate |
$3,400.50 |
| Rate for Payer: Aetna Commercial |
$1,234.81
|
| Rate for Payer: Aetna Medicare |
$921.50
|
| Rate for Payer: BCBS Complete |
$619.51
|
| Rate for Payer: BCBS MAPPO |
$921.50
|
| Rate for Payer: BCN Commercial |
$1,433.69
|
| Rate for Payer: BCN Medicare Advantage |
$921.50
|
| Rate for Payer: Cash Price |
$3,627.20
|
| Rate for Payer: Cash Price |
$3,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,326.96
|
| Rate for Payer: Cofinity Commercial |
$1,234.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.50
|
| Rate for Payer: Healthscope Commercial |
$1,105.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.58
|
| Rate for Payer: Meridian Medicaid |
$619.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,013.65
|
| Rate for Payer: Nomi Health Commercial |
$1,105.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,400.50
|
| Rate for Payer: PACE SWMI |
$921.50
|
| Rate for Payer: PHP Medicare Advantage |
$921.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,541.76
|
| Rate for Payer: Priority Health Medicare |
$921.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,541.76
|
| Rate for Payer: Railroad Medicare Medicare |
$921.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,717.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$921.50
|
| Rate for Payer: UHC Exchange |
$1,717.38
|
| Rate for Payer: UHC Medicaid |
$590.01
|
| Rate for Payer: UHCCP DNSP |
$921.50
|
| Rate for Payer: UHCCP Medicaid |
$590.01
|
|
