|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$467.98
|
| Rate for Payer: Aetna Medicare |
$349.24
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$349.24
|
| Rate for Payer: BCN Medicare Advantage |
$349.24
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$502.91
|
| Rate for Payer: Cofinity Commercial |
$467.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.24
|
| Rate for Payer: Healthscope Commercial |
$419.09
|
| Rate for Payer: Healthscope Whirlpool |
$419.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.70
|
| Rate for Payer: Nomi Health Commercial |
$419.09
|
| Rate for Payer: PACE SWMI |
$349.24
|
| Rate for Payer: PHP Medicare Advantage |
$349.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health Medicare |
$349.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.24
|
| Rate for Payer: UHC Medicare Advantage |
$349.24
|
| Rate for Payer: UHCCP DNSP |
$349.24
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$553.15 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$825.47
|
| Rate for Payer: ASR Commercial |
$825.47
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$696.88
|
| Rate for Payer: BCN Commercial |
$659.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$799.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Healthscope Whirlpool |
$825.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$765.90
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$697.82
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.65
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$596.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$553.15 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: ASR ASR |
$825.47
|
| Rate for Payer: ASR Commercial |
$825.47
|
| Rate for Payer: BCBS Trust/PPO |
$693.48
|
| Rate for Payer: BCN Commercial |
$659.78
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$799.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Healthscope Whirlpool |
$825.47
|
| Rate for Payer: Mclaren Commercial |
$765.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$697.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.88
|
|
|
PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 21175
|
| Min. Negotiated Rate |
$2,106.19 |
| Max. Negotiated Rate |
$4,677.40 |
| Rate for Payer: Aetna Commercial |
$2,822.29
|
| Rate for Payer: Aetna Medicare |
$2,106.19
|
| Rate for Payer: BCBS Complete |
$2,878.40
|
| Rate for Payer: BCBS MAPPO |
$2,106.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,106.19
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,032.91
|
| Rate for Payer: Cofinity Commercial |
$2,822.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,106.19
|
| Rate for Payer: Healthscope Commercial |
$2,527.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,527.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,211.50
|
| Rate for Payer: Nomi Health Commercial |
$2,527.43
|
| Rate for Payer: PACE SWMI |
$2,106.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,106.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,677.40
|
| Rate for Payer: Priority Health Medicare |
$2,106.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,106.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,106.19
|
| Rate for Payer: UHCCP DNSP |
$2,106.19
|
|
|
PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 26545
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$988.76 |
| Rate for Payer: Aetna Commercial |
$920.10
|
| Rate for Payer: Aetna Medicare |
$686.64
|
| Rate for Payer: BCBS Complete |
$486.40
|
| Rate for Payer: BCBS MAPPO |
$686.64
|
| Rate for Payer: BCN Medicare Advantage |
$686.64
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cofinity Commercial |
$988.76
|
| Rate for Payer: Cofinity Commercial |
$920.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.64
|
| Rate for Payer: Healthscope Commercial |
$823.97
|
| Rate for Payer: Healthscope Whirlpool |
$823.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.97
|
| Rate for Payer: Nomi Health Commercial |
$823.97
|
| Rate for Payer: PACE SWMI |
$686.64
|
| Rate for Payer: PHP Medicare Advantage |
$686.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health Medicare |
$686.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.64
|
| Rate for Payer: UHC Medicare Advantage |
$686.64
|
| Rate for Payer: UHCCP DNSP |
$686.64
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
|
Professional
|
Both
|
$3,566.00
|
|
|
Service Code
|
HCPCS 26542
|
| Min. Negotiated Rate |
$676.96 |
| Max. Negotiated Rate |
$2,317.90 |
| Rate for Payer: Aetna Commercial |
$907.13
|
| Rate for Payer: Aetna Medicare |
$676.96
|
| Rate for Payer: BCBS Complete |
$1,426.40
|
| Rate for Payer: BCBS MAPPO |
$676.96
|
| Rate for Payer: BCN Medicare Advantage |
$676.96
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cofinity Commercial |
$974.82
|
| Rate for Payer: Cofinity Commercial |
$907.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.96
|
| Rate for Payer: Healthscope Commercial |
$812.35
|
| Rate for Payer: Healthscope Whirlpool |
$812.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.81
|
| Rate for Payer: Nomi Health Commercial |
$812.35
|
| Rate for Payer: PACE SWMI |
$676.96
|
| Rate for Payer: PHP Medicare Advantage |
$676.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,317.90
|
| Rate for Payer: Priority Health Medicare |
$676.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.96
|
| Rate for Payer: UHC Medicare Advantage |
$676.96
|
| Rate for Payer: UHCCP DNSP |
$676.96
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$787.45 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,055.18
|
| Rate for Payer: Aetna Medicare |
$787.45
|
| Rate for Payer: BCBS Complete |
$952.00
|
| Rate for Payer: BCBS MAPPO |
$787.45
|
| Rate for Payer: BCN Medicare Advantage |
$787.45
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.93
|
| Rate for Payer: Cofinity Commercial |
$1,055.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.45
|
| Rate for Payer: Healthscope Commercial |
$944.94
|
| Rate for Payer: Healthscope Whirlpool |
$944.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.82
|
| Rate for Payer: Nomi Health Commercial |
$944.94
|
| Rate for Payer: PACE SWMI |
$787.45
|
| Rate for Payer: PHP Medicare Advantage |
$787.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health Medicare |
$787.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.45
|
| Rate for Payer: UHC Medicare Advantage |
$787.45
|
| Rate for Payer: UHCCP DNSP |
$787.45
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$1,044.17 |
| Rate for Payer: Aetna Commercial |
$971.66
|
| Rate for Payer: Aetna Medicare |
$725.12
|
| Rate for Payer: BCBS Complete |
$607.60
|
| Rate for Payer: BCBS MAPPO |
$725.12
|
| Rate for Payer: BCN Medicare Advantage |
$725.12
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cofinity Commercial |
$971.66
|
| Rate for Payer: Cofinity Commercial |
$1,044.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.12
|
| Rate for Payer: Healthscope Commercial |
$870.14
|
| Rate for Payer: Healthscope Whirlpool |
$870.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$761.38
|
| Rate for Payer: Nomi Health Commercial |
$870.14
|
| Rate for Payer: PACE SWMI |
$725.12
|
| Rate for Payer: PHP Medicare Advantage |
$725.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.35
|
| Rate for Payer: Priority Health Medicare |
$725.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$725.12
|
| Rate for Payer: UHC Medicare Advantage |
$725.12
|
| Rate for Payer: UHCCP DNSP |
$725.12
|
|
|
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 |
$719.01 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$719.01
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Healthscope Commercial |
$862.81
|
| Rate for Payer: Healthscope Whirlpool |
$862.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$719.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
| Rate for Payer: UHCCP DNSP |
$719.01
|
|
|
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
|
| Min. Negotiated Rate |
$719.01 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$719.01
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Healthscope Commercial |
$862.81
|
| Rate for Payer: Healthscope Whirlpool |
$862.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$719.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
| Rate for Payer: UHCCP DNSP |
$719.01
|
|
|
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 |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,081.70
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$2,243.61
|
| Rate for Payer: ASR Commercial |
$2,243.61
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.12
|
| Rate for Payer: BCN Commercial |
$1,793.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| 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 |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,313.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,243.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,081.70
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| 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 |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| 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 |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,621.41
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,035.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$721.72 |
| Max. Negotiated Rate |
$1,517.75 |
| Rate for Payer: Aetna Commercial |
$967.10
|
| Rate for Payer: Aetna Medicare |
$721.72
|
| Rate for Payer: BCBS Complete |
$934.00
|
| Rate for Payer: BCBS MAPPO |
$721.72
|
| Rate for Payer: BCN Medicare Advantage |
$721.72
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| 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: Nomi Health Commercial |
$866.06
|
| Rate for Payer: PACE SWMI |
$721.72
|
| Rate for Payer: PHP Medicare Advantage |
$721.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.75
|
| Rate for Payer: Priority Health Medicare |
$721.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.72
|
| Rate for Payer: UHC Medicare Advantage |
$721.72
|
| Rate for Payer: UHCCP DNSP |
$721.72
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$1,065.56 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: Aetna Commercial |
$1,427.85
|
| Rate for Payer: Aetna Medicare |
$1,065.56
|
| Rate for Payer: BCBS Complete |
$1,208.00
|
| Rate for Payer: BCBS MAPPO |
$1,065.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.56
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.41
|
| Rate for Payer: Cofinity Commercial |
$1,427.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.56
|
| Rate for Payer: Healthscope Commercial |
$1,278.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,278.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,118.84
|
| Rate for Payer: Nomi Health Commercial |
$1,278.67
|
| Rate for Payer: PACE SWMI |
$1,065.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.00
|
| Rate for Payer: Priority Health Medicare |
$1,065.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,065.56
|
| Rate for Payer: UHCCP DNSP |
$1,065.56
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$3,335.00
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$1,065.56 |
| Max. Negotiated Rate |
$2,167.75 |
| Rate for Payer: Aetna Commercial |
$1,427.85
|
| Rate for Payer: Aetna Medicare |
$1,065.56
|
| Rate for Payer: BCBS Complete |
$1,334.00
|
| Rate for Payer: BCBS MAPPO |
$1,065.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.56
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.41
|
| Rate for Payer: Cofinity Commercial |
$1,427.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.56
|
| Rate for Payer: Healthscope Commercial |
$1,278.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,278.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,118.84
|
| Rate for Payer: Nomi Health Commercial |
$1,278.67
|
| Rate for Payer: PACE SWMI |
$1,065.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,167.75
|
| Rate for Payer: Priority Health Medicare |
$1,065.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,065.56
|
| Rate for Payer: UHCCP DNSP |
$1,065.56
|
|
|
PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT
|
Professional
|
Both
|
$6,461.00
|
|
|
Service Code
|
HCPCS 21194
|
| Min. Negotiated Rate |
$1,342.34 |
| Max. Negotiated Rate |
$4,199.65 |
| Rate for Payer: Aetna Commercial |
$1,798.74
|
| Rate for Payer: Aetna Medicare |
$1,342.34
|
| Rate for Payer: BCBS Complete |
$2,584.40
|
| Rate for Payer: BCBS MAPPO |
$1,342.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.34
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cofinity Commercial |
$1,932.97
|
| Rate for Payer: Cofinity Commercial |
$1,798.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.34
|
| Rate for Payer: Healthscope Commercial |
$1,610.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,610.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,409.46
|
| Rate for Payer: Nomi Health Commercial |
$1,610.81
|
| Rate for Payer: PACE SWMI |
$1,342.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,199.65
|
| Rate for Payer: Priority Health Medicare |
$1,342.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.34
|
| Rate for Payer: UHCCP DNSP |
$1,342.34
|
|
|
PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE
|
Professional
|
Both
|
$3,509.00
|
|
|
Service Code
|
HCPCS 21244
|
| Min. Negotiated Rate |
$945.86 |
| Max. Negotiated Rate |
$2,280.85 |
| Rate for Payer: Aetna Commercial |
$1,267.45
|
| Rate for Payer: Aetna Medicare |
$945.86
|
| Rate for Payer: BCBS Complete |
$1,403.60
|
| Rate for Payer: BCBS MAPPO |
$945.86
|
| Rate for Payer: BCN Medicare Advantage |
$945.86
|
| Rate for Payer: Cash Price |
$2,807.20
|
| Rate for Payer: Cash Price |
$2,807.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.04
|
| Rate for Payer: Cofinity Commercial |
$1,267.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.86
|
| Rate for Payer: Healthscope Commercial |
$1,135.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.15
|
| Rate for Payer: Nomi Health Commercial |
$1,135.03
|
| Rate for Payer: PACE SWMI |
$945.86
|
| Rate for Payer: PHP Medicare Advantage |
$945.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,280.85
|
| Rate for Payer: Priority Health Medicare |
$945.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.86
|
| Rate for Payer: UHC Medicare Advantage |
$945.86
|
| Rate for Payer: UHCCP DNSP |
$945.86
|
|
|
PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
HCPCS 26587
|
| Min. Negotiated Rate |
$695.60 |
| Max. Negotiated Rate |
$1,451.38 |
| Rate for Payer: Aetna Commercial |
$1,350.59
|
| Rate for Payer: Aetna Medicare |
$1,007.90
|
| Rate for Payer: BCBS Complete |
$695.60
|
| Rate for Payer: BCBS MAPPO |
$1,007.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.90
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cofinity Commercial |
$1,451.38
|
| Rate for Payer: Cofinity Commercial |
$1,350.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.90
|
| Rate for Payer: Healthscope Commercial |
$1,209.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,209.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.30
|
| Rate for Payer: Nomi Health Commercial |
$1,209.48
|
| Rate for Payer: PACE SWMI |
$1,007.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,130.35
|
| Rate for Payer: Priority Health Medicare |
$1,007.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.90
|
| Rate for Payer: UHCCP DNSP |
$1,007.90
|
|
|
PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
HCPCS 28238
|
| Min. Negotiated Rate |
$464.68 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Aetna Commercial |
$622.67
|
| Rate for Payer: Aetna Medicare |
$464.68
|
| Rate for Payer: BCBS Complete |
$592.80
|
| Rate for Payer: BCBS MAPPO |
$464.68
|
| Rate for Payer: BCN Medicare Advantage |
$464.68
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cofinity Commercial |
$669.14
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.68
|
| Rate for Payer: Healthscope Commercial |
$557.62
|
| Rate for Payer: Healthscope Whirlpool |
$557.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.91
|
| Rate for Payer: Nomi Health Commercial |
$557.62
|
| Rate for Payer: PACE SWMI |
$464.68
|
| Rate for Payer: PHP Medicare Advantage |
$464.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.30
|
| Rate for Payer: Priority Health Medicare |
$464.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$464.68
|
| Rate for Payer: UHC Medicare Advantage |
$464.68
|
| Rate for Payer: UHCCP DNSP |
$464.68
|
|
|
PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ
|
Professional
|
Both
|
$3,444.00
|
|
|
Service Code
|
HCPCS 25337
|
| Min. Negotiated Rate |
$857.59 |
| Max. Negotiated Rate |
$2,238.60 |
| Rate for Payer: Aetna Commercial |
$1,149.17
|
| Rate for Payer: Aetna Medicare |
$857.59
|
| Rate for Payer: BCBS Complete |
$1,377.60
|
| Rate for Payer: BCBS MAPPO |
$857.59
|
| Rate for Payer: BCN Medicare Advantage |
$857.59
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cash Price |
$2,755.20
|
| Rate for Payer: Cofinity Commercial |
$1,234.93
|
| Rate for Payer: Cofinity Commercial |
$1,149.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$857.59
|
| Rate for Payer: Healthscope Commercial |
$1,029.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,029.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$900.47
|
| Rate for Payer: Nomi Health Commercial |
$1,029.11
|
| Rate for Payer: PACE SWMI |
$857.59
|
| Rate for Payer: PHP Medicare Advantage |
$857.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,238.60
|
| Rate for Payer: Priority Health Medicare |
$857.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$857.59
|
| Rate for Payer: UHC Medicare Advantage |
$857.59
|
| Rate for Payer: UHCCP DNSP |
$857.59
|
|
|
PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD
|
Professional
|
Both
|
$4,478.00
|
|
|
Service Code
|
HCPCS 21172
|
| Min. Negotiated Rate |
$1,791.20 |
| Max. Negotiated Rate |
$2,989.05 |
| Rate for Payer: Aetna Commercial |
$2,781.48
|
| Rate for Payer: Aetna Medicare |
$2,075.73
|
| Rate for Payer: BCBS Complete |
$1,791.20
|
| Rate for Payer: BCBS MAPPO |
$2,075.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,075.73
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cash Price |
$3,582.40
|
| Rate for Payer: Cofinity Commercial |
$2,989.05
|
| Rate for Payer: Cofinity Commercial |
$2,781.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,075.73
|
| Rate for Payer: Healthscope Commercial |
$2,490.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,490.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,179.52
|
| Rate for Payer: Nomi Health Commercial |
$2,490.88
|
| Rate for Payer: PACE SWMI |
$2,075.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,075.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,910.70
|
| Rate for Payer: Priority Health Medicare |
$2,075.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,075.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,075.73
|
| Rate for Payer: UHCCP DNSP |
$2,075.73
|
|
|
PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 26502
|
| Min. Negotiated Rate |
$573.60 |
| Max. Negotiated Rate |
$1,019.91 |
| Rate for Payer: Aetna Commercial |
$949.08
|
| Rate for Payer: Aetna Medicare |
$708.27
|
| Rate for Payer: BCBS Complete |
$573.60
|
| Rate for Payer: BCBS MAPPO |
$708.27
|
| Rate for Payer: BCN Medicare Advantage |
$708.27
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cofinity Commercial |
$949.08
|
| Rate for Payer: Cofinity Commercial |
$1,019.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.27
|
| Rate for Payer: Healthscope Commercial |
$849.92
|
| Rate for Payer: Healthscope Whirlpool |
$849.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.68
|
| Rate for Payer: Nomi Health Commercial |
$849.92
|
| Rate for Payer: PACE SWMI |
$708.27
|
| Rate for Payer: PHP Medicare Advantage |
$708.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.10
|
| Rate for Payer: Priority Health Medicare |
$708.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.27
|
| Rate for Payer: UHC Medicare Advantage |
$708.27
|
| Rate for Payer: UHCCP DNSP |
$708.27
|
|
|
PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26500
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$925.53 |
| Rate for Payer: Aetna Commercial |
$861.26
|
| Rate for Payer: Aetna Medicare |
$642.73
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$642.73
|
| Rate for Payer: BCN Medicare Advantage |
$642.73
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$925.53
|
| Rate for Payer: Cofinity Commercial |
$861.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.73
|
| Rate for Payer: Healthscope Commercial |
$771.28
|
| Rate for Payer: Healthscope Whirlpool |
$771.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.87
|
| Rate for Payer: Nomi Health Commercial |
$771.28
|
| Rate for Payer: PACE SWMI |
$642.73
|
| Rate for Payer: PHP Medicare Advantage |
$642.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$642.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.73
|
| Rate for Payer: UHC Medicare Advantage |
$642.73
|
| Rate for Payer: UHCCP DNSP |
$642.73
|
|
|
PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 45900
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$296.21 |
| Rate for Payer: Aetna Commercial |
$275.64
|
| Rate for Payer: Aetna Medicare |
$205.70
|
| Rate for Payer: BCBS Complete |
$154.80
|
| Rate for Payer: BCBS MAPPO |
$205.70
|
| Rate for Payer: BCN Medicare Advantage |
$205.70
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$296.21
|
| Rate for Payer: Cofinity Commercial |
$275.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.70
|
| Rate for Payer: Healthscope Commercial |
$246.84
|
| Rate for Payer: Healthscope Whirlpool |
$246.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.99
|
| Rate for Payer: Nomi Health Commercial |
$246.84
|
| Rate for Payer: PACE SWMI |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health Medicare |
$205.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.70
|
| Rate for Payer: UHC Medicare Advantage |
$205.70
|
| Rate for Payer: UHCCP DNSP |
$205.70
|
|
|
PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 54600
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$624.11 |
| Rate for Payer: Aetna Commercial |
$580.77
|
| Rate for Payer: Aetna Medicare |
$433.41
|
| Rate for Payer: BCBS Complete |
$326.80
|
| Rate for Payer: BCBS MAPPO |
$433.41
|
| Rate for Payer: BCN Medicare Advantage |
$433.41
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cofinity Commercial |
$624.11
|
| Rate for Payer: Cofinity Commercial |
$580.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.41
|
| Rate for Payer: Healthscope Commercial |
$520.09
|
| Rate for Payer: Healthscope Whirlpool |
$520.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.08
|
| Rate for Payer: Nomi Health Commercial |
$520.09
|
| Rate for Payer: PACE SWMI |
$433.41
|
| Rate for Payer: PHP Medicare Advantage |
$433.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.05
|
| Rate for Payer: Priority Health Medicare |
$433.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.41
|
| Rate for Payer: UHC Medicare Advantage |
$433.41
|
| Rate for Payer: UHCCP DNSP |
$433.41
|
|
