|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$90.06
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.51
|
| Rate for Payer: UHC Exchange |
$92.51
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 13122
|
| Hospital Charge Code |
13122
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Commercial |
$90.06
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.51
|
| Rate for Payer: UHC Exchange |
$92.51
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR REPAIR COMPLEX TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 13100
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$501.39 |
| Rate for Payer: Aetna Commercial |
$215.74
|
| Rate for Payer: Aetna Medicare |
$276.00
|
| Rate for Payer: BCBS Complete |
$135.08
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$501.39
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Meridian Medicaid |
$135.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.01
|
| Rate for Payer: Priority Health Narrow Network |
$270.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.06
|
| Rate for Payer: UHC Exchange |
$247.06
|
| Rate for Payer: UHCCP Medicaid |
$128.65
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$432.90 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: ASR ASR |
$646.02
|
| Rate for Payer: ASR Commercial |
$646.02
|
| Rate for Payer: BCBS Trust/PPO |
$542.72
|
| Rate for Payer: BCN Commercial |
$516.35
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$626.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Healthscope Commercial |
$666.00
|
| Rate for Payer: Healthscope Whirlpool |
$646.02
|
| Rate for Payer: Mclaren Commercial |
$599.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.08
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: Aetna Medicare |
$333.00
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.32
|
| Rate for Payer: Priority Health Narrow Network |
$332.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.35
|
| Rate for Payer: UHC Exchange |
$301.35
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$583.97 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: Aetna Medicare |
$333.00
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.32
|
| Rate for Payer: Priority Health Narrow Network |
$332.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.35
|
| Rate for Payer: UHC Exchange |
$301.35
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR REPAIR COMPLEX TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
13101
|
| Min. Negotiated Rate |
$321.47 |
| Max. Negotiated Rate |
$929.61 |
| Rate for Payer: Aetna Commercial |
$599.40
|
| Rate for Payer: Aetna Medicare |
$599.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: ASR ASR |
$646.02
|
| Rate for Payer: ASR Commercial |
$646.02
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$545.39
|
| Rate for Payer: BCN Commercial |
$516.35
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$626.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$666.00
|
| Rate for Payer: Healthscope Whirlpool |
$646.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$599.75
|
| Rate for Payer: Mclaren Commercial |
$599.40
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.10
|
| Rate for Payer: Nomi Health Commercial |
$546.12
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$659.72
|
| Rate for Payer: PHP Medicaid |
$321.47
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$583.55
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$466.87
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$586.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$929.61
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP DNSP |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: VA VA |
$599.75
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: ASR ASR |
$202.73
|
| Rate for Payer: ASR Commercial |
$202.73
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.15
|
| Rate for Payer: BCN Commercial |
$162.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Healthscope Whirlpool |
$202.73
|
| Rate for Payer: Mclaren Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.13
|
| Rate for Payer: Priority Health Narrow Network |
$146.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.92
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.17
|
| Rate for Payer: Priority Health Narrow Network |
$96.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.17
|
| Rate for Payer: UHC Exchange |
$81.17
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 13102
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$483.39 |
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.17
|
| Rate for Payer: Priority Health Narrow Network |
$96.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.17
|
| Rate for Payer: UHC Exchange |
$81.17
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
13102
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: ASR ASR |
$202.73
|
| Rate for Payer: ASR Commercial |
$202.73
|
| Rate for Payer: BCBS Trust/PPO |
$170.31
|
| Rate for Payer: BCN Commercial |
$162.04
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Healthscope Whirlpool |
$202.73
|
| Rate for Payer: Mclaren Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.65
|
| Rate for Payer: Nomi Health Commercial |
$171.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.92
|
|
|
PR REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 13153
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$307.45 |
| Rate for Payer: Aetna Commercial |
$148.88
|
| Rate for Payer: Aetna Medicare |
$236.50
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$271.70
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.86
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.48
|
| Rate for Payer: UHC Exchange |
$154.48
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
|
|
PR REPAIR CONGENITAL AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$4,223.00
|
|
|
Service Code
|
HCPCS 35184
|
| Min. Negotiated Rate |
$604.49 |
| Max. Negotiated Rate |
$2,744.95 |
| Rate for Payer: Aetna Commercial |
$1,296.30
|
| Rate for Payer: Aetna Medicare |
$2,111.50
|
| Rate for Payer: BCBS Complete |
$634.71
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: BCN Commercial |
$1,376.60
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Cash Price |
$3,378.40
|
| Rate for Payer: Meridian Medicaid |
$634.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,744.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,505.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,505.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,363.64
|
| Rate for Payer: UHC Exchange |
$1,363.64
|
| Rate for Payer: UHCCP Medicaid |
$604.49
|
|
|
PR REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 25425
|
| Min. Negotiated Rate |
$517.47 |
| Max. Negotiated Rate |
$1,484.86 |
| Rate for Payer: Aetna Commercial |
$1,288.90
|
| Rate for Payer: Aetna Medicare |
$975.50
|
| Rate for Payer: BCBS Complete |
$657.75
|
| Rate for Payer: BCBS Trust/PPO |
$517.47
|
| Rate for Payer: BCN Commercial |
$1,415.70
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Meridian Medicaid |
$657.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,484.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,484.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,197.48
|
| Rate for Payer: UHC Exchange |
$1,197.48
|
| Rate for Payer: UHCCP Medicaid |
$626.43
|
|
|
PR REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 27676
|
| Min. Negotiated Rate |
$397.67 |
| Max. Negotiated Rate |
$3,872.44 |
| Rate for Payer: Aetna Commercial |
$797.98
|
| Rate for Payer: Aetna Medicare |
$1,084.50
|
| Rate for Payer: BCBS Complete |
$417.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,872.44
|
| Rate for Payer: BCN Commercial |
$889.88
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Meridian Medicaid |
$417.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.39
|
| Rate for Payer: Priority Health Narrow Network |
$941.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$716.05
|
| Rate for Payer: UHC Exchange |
$716.05
|
| Rate for Payer: UHCCP Medicaid |
$397.67
|
|
|
PR REPAIR ECTROPION EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 67917
|
| Min. Negotiated Rate |
$289.47 |
| Max. Negotiated Rate |
$908.94 |
| Rate for Payer: Aetna Commercial |
$590.68
|
| Rate for Payer: Aetna Medicare |
$625.00
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: BCBS Trust/PPO |
$744.37
|
| Rate for Payer: BCN Commercial |
$908.94
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Meridian Medicaid |
$303.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.13
|
| Rate for Payer: Priority Health Narrow Network |
$793.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.37
|
| Rate for Payer: UHC Exchange |
$510.37
|
| Rate for Payer: UHCCP Medicaid |
$289.47
|
|
|
PR REPAIR ENTEROCELE ABDOMINAL APPROACH SPX
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 57270
|
| Min. Negotiated Rate |
$520.57 |
| Max. Negotiated Rate |
$2,459.24 |
| Rate for Payer: Aetna Commercial |
$969.79
|
| Rate for Payer: Aetna Medicare |
$1,031.50
|
| Rate for Payer: BCBS Complete |
$546.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.24
|
| Rate for Payer: BCN Commercial |
$1,193.84
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Meridian Medicaid |
$546.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,216.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,216.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$914.47
|
| Rate for Payer: UHC Exchange |
$914.47
|
| Rate for Payer: UHCCP Medicaid |
$520.57
|
|
|
PR REPAIR ENTEROCELE VAGINAL APPROACH SPX
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 57268
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$599.11
|
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.44
|
| Rate for Payer: Priority Health Narrow Network |
$760.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.53
|
| Rate for Payer: UHC Exchange |
$547.53
|
| Rate for Payer: UHCCP Medicaid |
$325.89
|
|
|
PR REPAIR ENTROPION SUTURE
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 67921
|
| Min. Negotiated Rate |
$198.94 |
| Max. Negotiated Rate |
$697.83 |
| Rate for Payer: Aetna Commercial |
$400.74
|
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: BCBS Complete |
$208.89
|
| Rate for Payer: BCBS Trust/PPO |
$584.83
|
| Rate for Payer: BCN Commercial |
$697.83
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Meridian Medicaid |
$208.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.71
|
| Rate for Payer: Priority Health Narrow Network |
$545.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.85
|
| Rate for Payer: UHC Exchange |
$290.85
|
| Rate for Payer: UHCCP Medicaid |
$198.94
|
|
|
PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 26433
|
| Min. Negotiated Rate |
$330.19 |
| Max. Negotiated Rate |
$902.20 |
| Rate for Payer: Aetna Commercial |
$753.27
|
| Rate for Payer: Aetna Medicare |
$694.00
|
| Rate for Payer: BCBS Complete |
$386.46
|
| Rate for Payer: BCBS Trust/PPO |
$330.19
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Meridian Medicaid |
$386.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$885.93
|
| Rate for Payer: Priority Health Narrow Network |
$885.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.08
|
| Rate for Payer: UHC Exchange |
$582.08
|
| Rate for Payer: UHCCP Medicaid |
$368.06
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 26420
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$986.20
|
| Rate for Payer: Aetna Medicare |
$894.00
|
| Rate for Payer: BCBS Complete |
$500.76
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$1,105.38
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Meridian Medicaid |
$500.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,149.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$789.65
|
| Rate for Payer: UHC Exchange |
$789.65
|
| Rate for Payer: UHCCP Medicaid |
$476.91
|
|
|
PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS 26418
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$968.86 |
| Rate for Payer: Aetna Commercial |
$816.06
|
| Rate for Payer: Aetna Medicare |
$654.50
|
| Rate for Payer: BCBS Complete |
$422.48
|
| Rate for Payer: BCBS Trust/PPO |
$132.08
|
| Rate for Payer: BCN Commercial |
$930.93
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Cash Price |
$1,047.20
|
| Rate for Payer: Meridian Medicaid |
$422.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.86
|
| Rate for Payer: Priority Health Narrow Network |
$968.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.11
|
| Rate for Payer: UHC Exchange |
$624.11
|
| Rate for Payer: UHCCP Medicaid |
$402.36
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 26412
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,256.45 |
| Rate for Payer: Aetna Commercial |
$950.15
|
| Rate for Payer: Aetna Medicare |
$966.50
|
| Rate for Payer: BCBS Complete |
$483.30
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,067.76
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Cash Price |
$1,546.40
|
| Rate for Payer: Meridian Medicaid |
$483.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,256.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.39
|
| Rate for Payer: UHC Exchange |
$754.39
|
| Rate for Payer: UHCCP Medicaid |
$460.29
|
|
|
PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 26410
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$931.72 |
| Rate for Payer: Aetna Commercial |
$793.05
|
| Rate for Payer: Aetna Medicare |
$628.50
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS Trust/PPO |
$154.79
|
| Rate for Payer: BCN Commercial |
$897.21
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.72
|
| Rate for Payer: Priority Health Narrow Network |
$931.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$618.86
|
| Rate for Payer: UHC Exchange |
$618.86
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
|
|
PR REPAIR FASCIAL DEFECT LEG
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 27656
|
| Min. Negotiated Rate |
$220.88 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$468.22
|
| Rate for Payer: Aetna Medicare |
$462.50
|
| Rate for Payer: BCBS Complete |
$231.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$789.70
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Meridian Medicaid |
$231.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.19
|
| Rate for Payer: Priority Health Narrow Network |
$528.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.61
|
| Rate for Payer: UHC Exchange |
$414.61
|
| Rate for Payer: UHCCP Medicaid |
$220.88
|
|
