|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
12031
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$142.46
|
| Rate for Payer: BCBS Complete |
$157.60
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| Rate for Payer: BCN Medicare Advantage |
$142.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$190.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.46
|
| Rate for Payer: Healthscope Commercial |
$170.95
|
| Rate for Payer: Healthscope Whirlpool |
$170.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| Rate for Payer: Nomi Health Commercial |
$170.95
|
| Rate for Payer: PACE SWMI |
$142.46
|
| Rate for Payer: PHP Medicare Advantage |
$142.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health Medicare |
$142.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.46
|
| Rate for Payer: UHC Medicare Advantage |
$142.46
|
| Rate for Payer: UHCCP DNSP |
$142.46
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 12031
|
| Min. Negotiated Rate |
$142.46 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna Commercial |
$190.90
|
| Rate for Payer: Aetna Medicare |
$142.46
|
| Rate for Payer: BCBS Complete |
$157.60
|
| Rate for Payer: BCBS MAPPO |
$142.46
|
| Rate for Payer: BCN Medicare Advantage |
$142.46
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Cofinity Commercial |
$190.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.46
|
| Rate for Payer: Healthscope Commercial |
$170.95
|
| Rate for Payer: Healthscope Whirlpool |
$170.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.58
|
| Rate for Payer: Nomi Health Commercial |
$170.95
|
| Rate for Payer: PACE SWMI |
$142.46
|
| Rate for Payer: PHP Medicare Advantage |
$142.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: Priority Health Medicare |
$142.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.46
|
| Rate for Payer: UHC Medicare Advantage |
$142.46
|
| Rate for Payer: UHCCP DNSP |
$142.46
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
12031
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$256.10 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: ASR ASR |
$382.18
|
| Rate for Payer: ASR Commercial |
$382.18
|
| Rate for Payer: BCBS Trust/PPO |
$321.07
|
| Rate for Payer: BCN Commercial |
$305.47
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$370.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.20
|
| Rate for Payer: Healthscope Commercial |
$394.00
|
| Rate for Payer: Healthscope Whirlpool |
$382.18
|
| Rate for Payer: Mclaren Commercial |
$354.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.90
|
| Rate for Payer: Nomi Health Commercial |
$323.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.72
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Min. Negotiated Rate |
$179.15 |
| Max. Negotiated Rate |
$326.95 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$179.15
|
| Rate for Payer: BCBS Complete |
$201.20
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| Rate for Payer: BCN Medicare Advantage |
$179.15
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$257.98
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.15
|
| Rate for Payer: Healthscope Commercial |
$214.98
|
| Rate for Payer: Healthscope Whirlpool |
$214.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| Rate for Payer: Nomi Health Commercial |
$214.98
|
| Rate for Payer: PACE SWMI |
$179.15
|
| Rate for Payer: PHP Medicare Advantage |
$179.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health Medicare |
$179.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.15
|
| Rate for Payer: UHC Medicare Advantage |
$179.15
|
| Rate for Payer: UHCCP DNSP |
$179.15
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$487.91
|
| Rate for Payer: ASR Commercial |
$487.91
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$411.91
|
| Rate for Payer: BCN Commercial |
$389.98
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$472.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$503.00
|
| Rate for Payer: Healthscope Whirlpool |
$487.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$452.70
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.55
|
| Rate for Payer: Nomi Health Commercial |
$412.46
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$440.73
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$352.60
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$442.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
12032
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$326.95 |
| Max. Negotiated Rate |
$503.00 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: ASR ASR |
$487.91
|
| Rate for Payer: ASR Commercial |
$487.91
|
| Rate for Payer: BCBS Trust/PPO |
$409.89
|
| Rate for Payer: BCN Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$472.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.40
|
| Rate for Payer: Healthscope Commercial |
$503.00
|
| Rate for Payer: Healthscope Whirlpool |
$487.91
|
| Rate for Payer: Mclaren Commercial |
$452.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.55
|
| Rate for Payer: Nomi Health Commercial |
$412.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$442.64
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
12032
|
| Min. Negotiated Rate |
$179.15 |
| Max. Negotiated Rate |
$326.95 |
| Rate for Payer: Aetna Commercial |
$240.06
|
| Rate for Payer: Aetna Medicare |
$179.15
|
| Rate for Payer: BCBS Complete |
$201.20
|
| Rate for Payer: BCBS MAPPO |
$179.15
|
| Rate for Payer: BCN Medicare Advantage |
$179.15
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$257.98
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.15
|
| Rate for Payer: Healthscope Commercial |
$214.98
|
| Rate for Payer: Healthscope Whirlpool |
$214.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.11
|
| Rate for Payer: Nomi Health Commercial |
$214.98
|
| Rate for Payer: PACE SWMI |
$179.15
|
| Rate for Payer: PHP Medicare Advantage |
$179.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.95
|
| Rate for Payer: Priority Health Medicare |
$179.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.15
|
| Rate for Payer: UHC Medicare Advantage |
$179.15
|
| Rate for Payer: UHCCP DNSP |
$179.15
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E >30.0 CM
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 12037
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$492.70 |
| Rate for Payer: Aetna Commercial |
$421.62
|
| Rate for Payer: Aetna Medicare |
$314.64
|
| Rate for Payer: BCBS Complete |
$303.20
|
| Rate for Payer: BCBS MAPPO |
$314.64
|
| Rate for Payer: BCN Medicare Advantage |
$314.64
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$453.08
|
| Rate for Payer: Cofinity Commercial |
$421.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.64
|
| Rate for Payer: Healthscope Commercial |
$377.57
|
| Rate for Payer: Healthscope Whirlpool |
$377.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.37
|
| Rate for Payer: Nomi Health Commercial |
$377.57
|
| Rate for Payer: PACE SWMI |
$314.64
|
| Rate for Payer: PHP Medicare Advantage |
$314.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health Medicare |
$314.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.64
|
| Rate for Payer: UHC Medicare Advantage |
$314.64
|
| Rate for Payer: UHCCP DNSP |
$314.64
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$641.00 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$621.77
|
| Rate for Payer: ASR Commercial |
$621.77
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$524.91
|
| Rate for Payer: BCN Commercial |
$496.97
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$602.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$641.00
|
| Rate for Payer: Healthscope Whirlpool |
$621.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$576.90
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: Nomi Health Commercial |
$525.62
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.64
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$449.34
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$416.65 |
| Max. Negotiated Rate |
$641.00 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: ASR ASR |
$621.77
|
| Rate for Payer: ASR Commercial |
$621.77
|
| Rate for Payer: BCBS Trust/PPO |
$522.35
|
| Rate for Payer: BCN Commercial |
$496.97
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$602.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.80
|
| Rate for Payer: Healthscope Commercial |
$641.00
|
| Rate for Payer: Healthscope Whirlpool |
$621.77
|
| Rate for Payer: Mclaren Commercial |
$576.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: Nomi Health Commercial |
$525.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.08
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
12034
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$194.26
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$279.73
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Healthscope Commercial |
$233.11
|
| Rate for Payer: Healthscope Whirlpool |
$233.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: Nomi Health Commercial |
$233.11
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health Medicare |
$194.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
| Rate for Payer: UHCCP DNSP |
$194.26
|
|
|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$194.26
|
| Rate for Payer: BCBS Complete |
$256.40
|
| Rate for Payer: BCBS MAPPO |
$194.26
|
| Rate for Payer: BCN Medicare Advantage |
$194.26
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$279.73
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.26
|
| Rate for Payer: Healthscope Commercial |
$233.11
|
| Rate for Payer: Healthscope Whirlpool |
$233.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.97
|
| Rate for Payer: Nomi Health Commercial |
$233.11
|
| Rate for Payer: PACE SWMI |
$194.26
|
| Rate for Payer: PHP Medicare Advantage |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health Medicare |
$194.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.26
|
| Rate for Payer: UHCCP DNSP |
$194.26
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$650.56 |
| Rate for Payer: Aetna Commercial |
$605.39
|
| Rate for Payer: Aetna Medicare |
$451.78
|
| Rate for Payer: BCBS Complete |
$304.80
|
| Rate for Payer: BCBS MAPPO |
$451.78
|
| Rate for Payer: BCN Medicare Advantage |
$451.78
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$650.56
|
| Rate for Payer: Cofinity Commercial |
$605.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.78
|
| Rate for Payer: Healthscope Commercial |
$542.14
|
| Rate for Payer: Healthscope Whirlpool |
$542.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.37
|
| Rate for Payer: Nomi Health Commercial |
$542.14
|
| Rate for Payer: PACE SWMI |
$451.78
|
| Rate for Payer: PHP Medicare Advantage |
$451.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health Medicare |
$451.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$451.78
|
| Rate for Payer: UHC Medicare Advantage |
$451.78
|
| Rate for Payer: UHCCP DNSP |
$451.78
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$823.09 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,102.94
|
| Rate for Payer: Aetna Medicare |
$823.09
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$823.09
|
| Rate for Payer: BCN Medicare Advantage |
$823.09
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,185.25
|
| Rate for Payer: Cofinity Commercial |
$1,102.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.09
|
| Rate for Payer: Healthscope Commercial |
$987.71
|
| Rate for Payer: Healthscope Whirlpool |
$987.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.24
|
| Rate for Payer: Nomi Health Commercial |
$987.71
|
| Rate for Payer: PACE SWMI |
$823.09
|
| Rate for Payer: PHP Medicare Advantage |
$823.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$823.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.09
|
| Rate for Payer: UHC Medicare Advantage |
$823.09
|
| Rate for Payer: UHCCP DNSP |
$823.09
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$257.08 |
| Rate for Payer: Aetna Commercial |
$239.23
|
| Rate for Payer: Aetna Medicare |
$178.53
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS MAPPO |
$178.53
|
| Rate for Payer: BCN Medicare Advantage |
$178.53
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$257.08
|
| Rate for Payer: Cofinity Commercial |
$239.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.53
|
| Rate for Payer: Healthscope Commercial |
$214.24
|
| Rate for Payer: Healthscope Whirlpool |
$214.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.46
|
| Rate for Payer: Nomi Health Commercial |
$214.24
|
| Rate for Payer: PACE SWMI |
$178.53
|
| Rate for Payer: PHP Medicare Advantage |
$178.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health Medicare |
$178.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.53
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
| Rate for Payer: UHCCP DNSP |
$178.53
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$479.05 |
| Rate for Payer: Aetna Commercial |
$330.07
|
| Rate for Payer: Aetna Medicare |
$246.32
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS MAPPO |
$246.32
|
| Rate for Payer: BCN Medicare Advantage |
$246.32
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$354.70
|
| Rate for Payer: Cofinity Commercial |
$330.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.32
|
| Rate for Payer: Healthscope Commercial |
$295.58
|
| Rate for Payer: Healthscope Whirlpool |
$295.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.64
|
| Rate for Payer: Nomi Health Commercial |
$295.58
|
| Rate for Payer: PACE SWMI |
$246.32
|
| Rate for Payer: PHP Medicare Advantage |
$246.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health Medicare |
$246.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.32
|
| Rate for Payer: UHC Medicare Advantage |
$246.32
|
| Rate for Payer: UHCCP DNSP |
$246.32
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$692.27 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$927.64
|
| Rate for Payer: Aetna Medicare |
$692.27
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS MAPPO |
$692.27
|
| Rate for Payer: BCN Medicare Advantage |
$692.27
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$996.87
|
| Rate for Payer: Cofinity Commercial |
$927.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.27
|
| Rate for Payer: Healthscope Commercial |
$830.72
|
| Rate for Payer: Healthscope Whirlpool |
$830.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.88
|
| Rate for Payer: Nomi Health Commercial |
$830.72
|
| Rate for Payer: PACE SWMI |
$692.27
|
| Rate for Payer: PHP Medicare Advantage |
$692.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health Medicare |
$692.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$692.27
|
| Rate for Payer: UHC Medicare Advantage |
$692.27
|
| Rate for Payer: UHCCP DNSP |
$692.27
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$346.08 |
| Max. Negotiated Rate |
$638.95 |
| Rate for Payer: Aetna Commercial |
$463.75
|
| Rate for Payer: Aetna Medicare |
$346.08
|
| Rate for Payer: BCBS Complete |
$393.20
|
| Rate for Payer: BCBS MAPPO |
$346.08
|
| Rate for Payer: BCN Medicare Advantage |
$346.08
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cofinity Commercial |
$498.36
|
| Rate for Payer: Cofinity Commercial |
$463.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.08
|
| Rate for Payer: Healthscope Commercial |
$415.30
|
| Rate for Payer: Healthscope Whirlpool |
$415.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.38
|
| Rate for Payer: Nomi Health Commercial |
$415.30
|
| Rate for Payer: PACE SWMI |
$346.08
|
| Rate for Payer: PHP Medicare Advantage |
$346.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.95
|
| Rate for Payer: Priority Health Medicare |
$346.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.08
|
| Rate for Payer: UHC Medicare Advantage |
$346.08
|
| Rate for Payer: UHCCP DNSP |
$346.08
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Commercial |
$407.19
|
| Rate for Payer: Aetna Medicare |
$303.87
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS MAPPO |
$303.87
|
| Rate for Payer: BCN Medicare Advantage |
$303.87
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Cofinity Commercial |
$407.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.87
|
| Rate for Payer: Healthscope Commercial |
$364.64
|
| Rate for Payer: Healthscope Whirlpool |
$364.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$364.64
|
| Rate for Payer: PACE SWMI |
$303.87
|
| Rate for Payer: PHP Medicare Advantage |
$303.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health Medicare |
$303.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.87
|
| Rate for Payer: UHC Medicare Advantage |
$303.87
|
| Rate for Payer: UHCCP DNSP |
$303.87
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$481.20 |
| Max. Negotiated Rate |
$945.36 |
| Rate for Payer: Aetna Commercial |
$879.71
|
| Rate for Payer: Aetna Medicare |
$656.50
|
| Rate for Payer: BCBS Complete |
$481.20
|
| Rate for Payer: BCBS MAPPO |
$656.50
|
| Rate for Payer: BCN Medicare Advantage |
$656.50
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$945.36
|
| Rate for Payer: Cofinity Commercial |
$879.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$656.50
|
| Rate for Payer: Healthscope Commercial |
$787.80
|
| Rate for Payer: Healthscope Whirlpool |
$787.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$689.33
|
| Rate for Payer: Nomi Health Commercial |
$787.80
|
| Rate for Payer: PACE SWMI |
$656.50
|
| Rate for Payer: PHP Medicare Advantage |
$656.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.95
|
| Rate for Payer: Priority Health Medicare |
$656.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$656.50
|
| Rate for Payer: UHC Medicare Advantage |
$656.50
|
| Rate for Payer: UHCCP DNSP |
$656.50
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$911.28 |
| Max. Negotiated Rate |
$1,531.40 |
| Rate for Payer: Aetna Commercial |
$1,221.12
|
| Rate for Payer: Aetna Medicare |
$911.28
|
| Rate for Payer: BCBS Complete |
$942.40
|
| Rate for Payer: BCBS MAPPO |
$911.28
|
| Rate for Payer: BCN Medicare Advantage |
$911.28
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cofinity Commercial |
$1,312.24
|
| Rate for Payer: Cofinity Commercial |
$1,221.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$911.28
|
| Rate for Payer: Healthscope Commercial |
$1,093.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,093.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.84
|
| Rate for Payer: Nomi Health Commercial |
$1,093.54
|
| Rate for Payer: PACE SWMI |
$911.28
|
| Rate for Payer: PHP Medicare Advantage |
$911.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.40
|
| Rate for Payer: Priority Health Medicare |
$911.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$911.28
|
| Rate for Payer: UHC Medicare Advantage |
$911.28
|
| Rate for Payer: UHCCP DNSP |
$911.28
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$686.08 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$919.35
|
| Rate for Payer: Aetna Medicare |
$686.08
|
| Rate for Payer: BCBS Complete |
$919.20
|
| Rate for Payer: BCBS MAPPO |
$686.08
|
| Rate for Payer: BCN Medicare Advantage |
$686.08
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cofinity Commercial |
$987.96
|
| Rate for Payer: Cofinity Commercial |
$919.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.08
|
| Rate for Payer: Healthscope Commercial |
$823.30
|
| Rate for Payer: Healthscope Whirlpool |
$823.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.38
|
| Rate for Payer: Nomi Health Commercial |
$823.30
|
| Rate for Payer: PACE SWMI |
$686.08
|
| Rate for Payer: PHP Medicare Advantage |
$686.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health Medicare |
$686.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.08
|
| Rate for Payer: UHC Medicare Advantage |
$686.08
|
| Rate for Payer: UHCCP DNSP |
$686.08
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,458.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$1,301.93 |
| Max. Negotiated Rate |
$2,897.70 |
| Rate for Payer: Aetna Commercial |
$1,744.59
|
| Rate for Payer: Aetna Medicare |
$1,301.93
|
| Rate for Payer: BCBS Complete |
$1,783.20
|
| Rate for Payer: BCBS MAPPO |
$1,301.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,301.93
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cofinity Commercial |
$1,874.78
|
| Rate for Payer: Cofinity Commercial |
$1,744.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,301.93
|
| Rate for Payer: Healthscope Commercial |
$1,562.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,562.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,367.03
|
| Rate for Payer: Nomi Health Commercial |
$1,562.32
|
| Rate for Payer: PACE SWMI |
$1,301.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,301.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,897.70
|
| Rate for Payer: Priority Health Medicare |
$1,301.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,301.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.93
|
| Rate for Payer: UHCCP DNSP |
$1,301.93
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,654.57 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$2,217.12
|
| Rate for Payer: Aetna Medicare |
$1,654.57
|
| Rate for Payer: BCBS Complete |
$2,036.80
|
| Rate for Payer: BCBS MAPPO |
$1,654.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,654.57
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cofinity Commercial |
$2,382.58
|
| Rate for Payer: Cofinity Commercial |
$2,217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,654.57
|
| Rate for Payer: Healthscope Commercial |
$1,985.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,985.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,737.30
|
| Rate for Payer: Nomi Health Commercial |
$1,985.48
|
| Rate for Payer: PACE SWMI |
$1,654.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,654.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health Medicare |
$1,654.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,654.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,654.57
|
| Rate for Payer: UHCCP DNSP |
$1,654.57
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,361.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,836.61 |
| Max. Negotiated Rate |
$3,484.65 |
| Rate for Payer: Aetna Commercial |
$2,461.06
|
| Rate for Payer: Aetna Medicare |
$1,836.61
|
| Rate for Payer: BCBS Complete |
$2,144.40
|
| Rate for Payer: BCBS MAPPO |
$1,836.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,836.61
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cofinity Commercial |
$2,644.72
|
| Rate for Payer: Cofinity Commercial |
$2,461.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,836.61
|
| Rate for Payer: Healthscope Commercial |
$2,203.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,203.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,928.44
|
| Rate for Payer: Nomi Health Commercial |
$2,203.93
|
| Rate for Payer: PACE SWMI |
$1,836.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,836.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,484.65
|
| Rate for Payer: Priority Health Medicare |
$1,836.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,836.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,836.61
|
| Rate for Payer: UHCCP DNSP |
$1,836.61
|
|
