|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$992.84
|
| Rate for Payer: Aetna Medicare |
$1,156.50
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.91
|
| Rate for Payer: UHC Exchange |
$849.91
|
| Rate for Payer: UHCCP Medicaid |
$485.85
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,503.45 |
| Max. Negotiated Rate |
$2,313.00 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: ASR ASR |
$2,243.61
|
| Rate for Payer: ASR Commercial |
$2,243.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,884.86
|
| Rate for Payer: BCN Commercial |
$1,793.27
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$2,174.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,850.40
|
| Rate for Payer: Healthscope Commercial |
$2,313.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,243.61
|
| Rate for Payer: Mclaren Commercial |
$2,081.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,966.05
|
| Rate for Payer: Nomi Health Commercial |
$1,896.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,035.44
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
27422
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$992.84
|
| Rate for Payer: Aetna Medicare |
$1,156.50
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$849.91
|
| Rate for Payer: UHC Exchange |
$849.91
|
| Rate for Payer: UHCCP Medicaid |
$485.85
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,503.45 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$2,243.61
|
| Rate for Payer: ASR Commercial |
$2,243.61
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.12
|
| Rate for Payer: BCN Commercial |
$1,793.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$2,174.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,850.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$2,313.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,243.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$2,081.70
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,966.05
|
| Rate for Payer: Nomi Health Commercial |
$1,896.66
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,026.65
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,621.41
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,035.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$487.77 |
| Max. Negotiated Rate |
$1,517.75 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Medicare |
$1,167.50
|
| Rate for Payer: BCBS Complete |
$512.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$1,099.53
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Meridian Medicaid |
$512.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$853.03
|
| Rate for Payer: UHC Exchange |
$853.03
|
| Rate for Payer: UHCCP Medicaid |
$487.77
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$200.75 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: Aetna Commercial |
$1,457.34
|
| Rate for Payer: Aetna Medicare |
$1,510.00
|
| Rate for Payer: BCBS Complete |
$755.49
|
| Rate for Payer: BCBS Trust/PPO |
$200.75
|
| Rate for Payer: BCN Commercial |
$1,602.86
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Meridian Medicaid |
$755.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$719.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,704.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,704.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,251.40
|
| Rate for Payer: UHC Exchange |
$1,251.40
|
| Rate for Payer: UHCCP Medicaid |
$719.51
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$3,335.00
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$272.60 |
| Max. Negotiated Rate |
$2,167.75 |
| Rate for Payer: Aetna Commercial |
$1,470.76
|
| Rate for Payer: Aetna Medicare |
$1,667.50
|
| Rate for Payer: BCBS Complete |
$755.49
|
| Rate for Payer: BCBS Trust/PPO |
$272.60
|
| Rate for Payer: BCN Commercial |
$1,621.92
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Meridian Medicaid |
$755.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$719.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,167.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,704.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,704.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,253.94
|
| Rate for Payer: UHC Exchange |
$1,253.94
|
| Rate for Payer: UHCCP Medicaid |
$719.51
|
|
|
PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT
|
Professional
|
Both
|
$6,461.00
|
|
|
Service Code
|
HCPCS 21194
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$4,199.65 |
| Rate for Payer: Aetna Commercial |
$1,893.04
|
| Rate for Payer: Aetna Medicare |
$3,230.50
|
| Rate for Payer: BCBS Complete |
$956.77
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$2,076.39
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Meridian Medicaid |
$956.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$911.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,199.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,158.59
|
| Rate for Payer: Priority Health Narrow Network |
$2,158.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,631.17
|
| Rate for Payer: UHC Exchange |
$1,631.17
|
| Rate for Payer: UHCCP Medicaid |
$911.21
|
|
|
PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE
|
Professional
|
Both
|
$3,509.00
|
|
|
Service Code
|
HCPCS 21244
|
| Min. Negotiated Rate |
$110.96 |
| Max. Negotiated Rate |
$2,280.85 |
| Rate for Payer: Aetna Commercial |
$1,342.79
|
| Rate for Payer: Aetna Medicare |
$1,754.50
|
| Rate for Payer: BCBS Complete |
$676.55
|
| Rate for Payer: BCBS Trust/PPO |
$110.96
|
| Rate for Payer: BCN Commercial |
$1,474.83
|
| Rate for Payer: Cash Price |
$2,807.20
|
| Rate for Payer: Cash Price |
$2,807.20
|
| Rate for Payer: Meridian Medicaid |
$676.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$644.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,280.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,537.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,537.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,204.48
|
| Rate for Payer: UHC Exchange |
$1,204.48
|
| Rate for Payer: UHCCP Medicaid |
$644.33
|
|
|
PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
HCPCS 26587
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$1,610.04 |
| Rate for Payer: Aetna Commercial |
$1,391.35
|
| Rate for Payer: Aetna Medicare |
$869.50
|
| Rate for Payer: BCBS Complete |
$714.12
|
| Rate for Payer: BCBS Trust/PPO |
$57.06
|
| Rate for Payer: BCN Commercial |
$1,533.47
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Meridian Medicaid |
$714.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,130.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,610.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,610.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,116.49
|
| Rate for Payer: UHC Exchange |
$1,116.49
|
| Rate for Payer: UHCCP Medicaid |
$680.11
|
|
|
PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
HCPCS 28238
|
| Min. Negotiated Rate |
$314.18 |
| Max. Negotiated Rate |
$2,785.20 |
| Rate for Payer: Aetna Commercial |
$642.89
|
| Rate for Payer: Aetna Medicare |
$741.00
|
| Rate for Payer: BCBS Complete |
$329.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.20
|
| Rate for Payer: BCN Commercial |
$981.75
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Meridian Medicaid |
$329.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$314.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.60
|
| Rate for Payer: Priority Health Narrow Network |
$752.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.33
|
| Rate for Payer: UHC Exchange |
$580.33
|
| Rate for Payer: UHCCP Medicaid |
$314.18
|
|
|
PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 25337
|
| Min. Negotiated Rate |
$336.53 |
| Max. Negotiated Rate |
$2,238.60 |
| Rate for Payer: Aetna Commercial |
$1,179.01
|
| Rate for Payer: Aetna Medicare |
$1,722.00
|
| Rate for Payer: BCBS Complete |
$611.24
|
| Rate for Payer: BCBS Trust/PPO |
$336.53
|
| Rate for Payer: BCN Commercial |
$1,307.70
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Meridian Medicaid |
$611.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$582.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,238.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,374.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,374.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,009.64
|
| Rate for Payer: UHC Exchange |
$1,009.64
|
| Rate for Payer: UHCCP Medicaid |
$582.13
|
|
|
PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD
|
Professional
|
Both
|
$4,478.00
|
|
|
Service Code
|
HCPCS 21172
|
| Min. Negotiated Rate |
$580.95 |
| Max. Negotiated Rate |
$3,274.52 |
| Rate for Payer: Aetna Commercial |
$2,826.55
|
| Rate for Payer: Aetna Medicare |
$2,239.00
|
| Rate for Payer: BCBS Complete |
$1,439.19
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$3,123.14
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Meridian Medicaid |
$1,439.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,370.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,910.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,274.52
|
| Rate for Payer: Priority Health Narrow Network |
$3,274.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,057.16
|
| Rate for Payer: UHC Exchange |
$2,057.16
|
| Rate for Payer: UHCCP Medicaid |
$1,370.66
|
|
|
PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 26502
|
| Min. Negotiated Rate |
$487.56 |
| Max. Negotiated Rate |
$2,792.59 |
| Rate for Payer: Aetna Commercial |
$1,000.01
|
| Rate for Payer: Aetna Medicare |
$717.00
|
| Rate for Payer: BCBS Complete |
$511.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,792.59
|
| Rate for Payer: BCN Commercial |
$1,124.45
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Meridian Medicaid |
$511.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,170.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,170.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$782.51
|
| Rate for Payer: UHC Exchange |
$782.51
|
| Rate for Payer: UHCCP Medicaid |
$487.56
|
|
|
PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26500
|
| Min. Negotiated Rate |
$444.11 |
| Max. Negotiated Rate |
$5,862.74 |
| Rate for Payer: Aetna Commercial |
$873.76
|
| Rate for Payer: Aetna Medicare |
$694.00
|
| Rate for Payer: BCBS Complete |
$466.32
|
| Rate for Payer: BCBS Trust/PPO |
$5,862.74
|
| Rate for Payer: BCN Commercial |
$987.13
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Meridian Medicaid |
$466.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,066.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,066.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$690.32
|
| Rate for Payer: UHC Exchange |
$690.32
|
| Rate for Payer: UHCCP Medicaid |
$444.11
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$137.81 |
| Max. Negotiated Rate |
$771.85 |
| Rate for Payer: Aetna Commercial |
$285.26
|
| Rate for Payer: Aetna Medicare |
$193.50
|
| Rate for Payer: BCBS Complete |
$144.70
|
| Rate for Payer: BCBS Trust/PPO |
$771.85
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Meridian Medicaid |
$144.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.02
|
| Rate for Payer: Priority Health Narrow Network |
$383.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.76
|
| Rate for Payer: UHC Exchange |
$236.76
|
| Rate for Payer: UHCCP Medicaid |
$137.81
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$291.81 |
| Max. Negotiated Rate |
$2,890.86 |
| Rate for Payer: Aetna Commercial |
$579.83
|
| Rate for Payer: Aetna Medicare |
$408.50
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,890.86
|
| Rate for Payer: BCN Commercial |
$655.32
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Meridian Medicaid |
$306.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$725.41
|
| Rate for Payer: Priority Health Narrow Network |
$725.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.94
|
| Rate for Payer: UHC Exchange |
$542.94
|
| Rate for Payer: UHCCP Medicaid |
$291.81
|
|
|
PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT
|
Professional
|
Both
|
$2,376.00
|
|
|
Service Code
|
HCPCS 44050
|
| Min. Negotiated Rate |
$602.36 |
| Max. Negotiated Rate |
$2,793.65 |
| Rate for Payer: Aetna Commercial |
$1,263.25
|
| Rate for Payer: Aetna Medicare |
$1,188.00
|
| Rate for Payer: BCBS Complete |
$632.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,793.65
|
| Rate for Payer: BCN Commercial |
$1,366.35
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Meridian Medicaid |
$632.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$602.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,677.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,677.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,125.89
|
| Rate for Payer: UHC Exchange |
$1,125.89
|
| Rate for Payer: UHCCP Medicaid |
$602.36
|
|
|
PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26437
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,032.99 |
| Rate for Payer: Aetna Commercial |
$878.32
|
| Rate for Payer: Aetna Medicare |
$793.00
|
| Rate for Payer: BCBS Complete |
$452.44
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$993.97
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Meridian Medicaid |
$452.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,032.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.85
|
| Rate for Payer: UHC Exchange |
$682.85
|
| Rate for Payer: UHCCP Medicaid |
$430.90
|
|
|
PR REAORT VALV W CP BYPASS
|
Professional
|
Both
|
$8,044.00
|
|
|
Service Code
|
HCPCS 33400
|
| Min. Negotiated Rate |
$3,217.60 |
| Max. Negotiated Rate |
$5,228.60 |
| Rate for Payer: Aetna Medicare |
$4,022.00
|
| Rate for Payer: BCBS Complete |
$3,217.60
|
| Rate for Payer: Cash Price |
$6,435.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,228.60
|
|
|
PR RECMPL WND LID,NOS,EAR <1 CM
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 13150
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$391.95 |
| Rate for Payer: Aetna Medicare |
$301.50
|
| Rate for Payer: BCBS Complete |
$241.20
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.95
|
|
|
PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX
|
Professional
|
Both
|
$3,465.00
|
|
|
Service Code
|
HCPCS 69310
|
| Min. Negotiated Rate |
$714.19 |
| Max. Negotiated Rate |
$2,252.25 |
| Rate for Payer: Aetna Commercial |
$1,261.16
|
| Rate for Payer: Aetna Medicare |
$1,732.50
|
| Rate for Payer: BCBS Complete |
$749.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,074.63
|
| Rate for Payer: BCN Commercial |
$1,653.20
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Cash Price |
$2,772.00
|
| Rate for Payer: Meridian Medicaid |
$749.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$714.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,636.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,636.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,177.14
|
| Rate for Payer: UHC Exchange |
$1,177.14
|
| Rate for Payer: UHCCP Medicaid |
$714.19
|
|
|
PR RECONSTRUCTION NAIL BED W/GRAFT
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 11762
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$421.24 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: Aetna Medicare |
$223.50
|
| Rate for Payer: BCBS Complete |
$127.26
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$421.24
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Meridian Medicaid |
$127.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.30
|
| Rate for Payer: Priority Health Narrow Network |
$253.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.09
|
| Rate for Payer: UHC Exchange |
$203.09
|
| Rate for Payer: UHCCP Medicaid |
$121.20
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
CPT 23420
|
| Hospital Charge Code |
23420
|
| Min. Negotiated Rate |
$2,590.90 |
| Max. Negotiated Rate |
$3,986.00 |
| Rate for Payer: Aetna Commercial |
$3,587.40
|
| Rate for Payer: ASR ASR |
$3,866.42
|
| Rate for Payer: ASR Commercial |
$3,866.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,248.19
|
| Rate for Payer: BCN Commercial |
$3,090.35
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cofinity Commercial |
$3,746.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,188.80
|
| Rate for Payer: Healthscope Commercial |
$3,986.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,866.42
|
| Rate for Payer: Mclaren Commercial |
$3,587.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,388.10
|
| Rate for Payer: Nomi Health Commercial |
$3,268.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,507.68
|
|
|
PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC
|
Professional
|
Both
|
$3,986.00
|
|
|
Service Code
|
HCPCS 23420
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Aetna Commercial |
$1,298.68
|
| Rate for Payer: Aetna Medicare |
$1,993.00
|
| Rate for Payer: BCBS Complete |
$666.70
|
| Rate for Payer: BCBS Trust/PPO |
$120.13
|
| Rate for Payer: BCN Commercial |
$1,576.02
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Cash Price |
$3,188.80
|
| Rate for Payer: Meridian Medicaid |
$666.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,502.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,502.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,116.08
|
| Rate for Payer: UHC Exchange |
$1,116.08
|
| Rate for Payer: UHCCP Medicaid |
$634.95
|
|
