|
PR REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 12034
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$320.50
|
| Rate for Payer: BCBS Complete |
$138.44
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$394.62
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Meridian Medicaid |
$138.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.69
|
| Rate for Payer: Priority Health Narrow Network |
$277.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.15
|
| Rate for Payer: UHC Exchange |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$131.85
|
|
|
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 |
$85.82 |
| Max. Negotiated Rate |
$416.65 |
| Rate for Payer: Aetna Commercial |
$220.31
|
| Rate for Payer: Aetna Medicare |
$320.50
|
| Rate for Payer: BCBS Complete |
$138.44
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$394.62
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Meridian Medicaid |
$138.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.69
|
| Rate for Payer: Priority Health Narrow Network |
$277.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.15
|
| Rate for Payer: UHC Exchange |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$131.85
|
|
|
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
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
12034
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$641.00 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$621.77
|
| Rate for Payer: ASR Commercial |
$621.77
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$524.91
|
| Rate for Payer: BCN Commercial |
$496.97
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$641.00
|
| Rate for Payer: Healthscope Whirlpool |
$621.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$576.90
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.85
|
| Rate for Payer: Nomi Health Commercial |
$525.62
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 26591
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$758.72 |
| Rate for Payer: Aetna Commercial |
$635.36
|
| Rate for Payer: Aetna Medicare |
$381.00
|
| Rate for Payer: BCBS Complete |
$331.45
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: BCN Commercial |
$727.64
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Meridian Medicaid |
$331.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$758.72
|
| Rate for Payer: Priority Health Narrow Network |
$758.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$474.19
|
| Rate for Payer: UHC Exchange |
$474.19
|
| Rate for Payer: UHCCP Medicaid |
$315.67
|
|
|
PR REPAIR LACERATION DIAPHRAGM ANY APPROACH
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 39501
|
| Min. Negotiated Rate |
$545.71 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$877.19
|
| Rate for Payer: Aetna Medicare |
$2,366.00
|
| Rate for Payer: BCBS Complete |
$573.00
|
| Rate for Payer: BCBS Trust/PPO |
$575.32
|
| Rate for Payer: BCN Commercial |
$1,234.88
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Meridian Medicaid |
$573.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$545.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,358.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,358.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$959.24
|
| Rate for Payer: UHC Exchange |
$959.24
|
| Rate for Payer: UHCCP Medicaid |
$545.71
|
|
|
PR REPAIR LACERATION PALATE <2 CM
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 42180
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS Trust/PPO |
$363.47
|
| Rate for Payer: BCN Commercial |
$377.75
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.27
|
| Rate for Payer: Priority Health Narrow Network |
$338.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.19
|
| Rate for Payer: UHC Exchange |
$222.19
|
| Rate for Payer: UHCCP Medicaid |
$121.41
|
|
|
PR REPAIR LACERATION PALATE >2 CM/COMPLEX
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 42182
|
| Min. Negotiated Rate |
$166.57 |
| Max. Negotiated Rate |
$622.34 |
| Rate for Payer: Aetna Commercial |
$339.34
|
| Rate for Payer: Aetna Medicare |
$368.50
|
| Rate for Payer: BCBS Complete |
$174.90
|
| Rate for Payer: BCBS Trust/PPO |
$622.34
|
| Rate for Payer: BCN Commercial |
$487.70
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Meridian Medicaid |
$174.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.34
|
| Rate for Payer: Priority Health Narrow Network |
$465.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.73
|
| Rate for Payer: UHC Exchange |
$318.73
|
| Rate for Payer: UHCCP Medicaid |
$166.57
|
|
|
PR REPAIR LATERAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24343
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$948.56
|
| Rate for Payer: Aetna Medicare |
$1,149.00
|
| Rate for Payer: BCBS Complete |
$493.82
|
| Rate for Payer: BCBS Trust/PPO |
$147.92
|
| Rate for Payer: BCN Commercial |
$1,055.06
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Meridian Medicaid |
$493.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$796.69
|
| Rate for Payer: UHC Exchange |
$796.69
|
| Rate for Payer: UHCCP Medicaid |
$470.30
|
|
|
PR REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
HCPCS 40652
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$765.27 |
| Rate for Payer: Aetna Commercial |
$469.82
|
| Rate for Payer: Aetna Medicare |
$491.50
|
| Rate for Payer: BCBS Complete |
$248.03
|
| Rate for Payer: BCBS Trust/PPO |
$649.28
|
| Rate for Payer: BCN Commercial |
$765.27
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Cash Price |
$786.40
|
| Rate for Payer: Meridian Medicaid |
$248.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.87
|
| Rate for Payer: Priority Health Narrow Network |
$653.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.58
|
| Rate for Payer: UHC Exchange |
$420.58
|
| Rate for Payer: UHCCP Medicaid |
$236.22
|
|
|
PR REPAIR LIP FULL THICKNESS VERMILION ONLY
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 40650
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$709.07 |
| Rate for Payer: Aetna Commercial |
$408.20
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$217.61
|
| Rate for Payer: BCBS Trust/PPO |
$462.26
|
| Rate for Payer: BCN Commercial |
$709.07
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Meridian Medicaid |
$217.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$573.93
|
| Rate for Payer: Priority Health Narrow Network |
$573.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.16
|
| Rate for Payer: UHC Exchange |
$347.16
|
| Rate for Payer: UHCCP Medicaid |
$207.25
|
|
|
PR REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49540
|
| Min. Negotiated Rate |
$436.01 |
| Max. Negotiated Rate |
$3,768.36 |
| Rate for Payer: Aetna Commercial |
$918.82
|
| Rate for Payer: Aetna Medicare |
$601.50
|
| Rate for Payer: BCBS Complete |
$457.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,768.36
|
| Rate for Payer: BCN Commercial |
$996.41
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Meridian Medicaid |
$457.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,208.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.23
|
| Rate for Payer: UHC Exchange |
$806.23
|
| Rate for Payer: UHCCP Medicaid |
$436.01
|
|
|
PR REPAIR LUNG HERNIA THROUGH CHEST WALL
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 32800
|
| Min. Negotiated Rate |
$603.22 |
| Max. Negotiated Rate |
$1,531.40 |
| Rate for Payer: Aetna Commercial |
$1,220.47
|
| Rate for Payer: Aetna Medicare |
$1,178.00
|
| Rate for Payer: BCBS Complete |
$633.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,195.01
|
| Rate for Payer: BCN Commercial |
$1,367.81
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Meridian Medicaid |
$633.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$603.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,296.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,296.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.73
|
| Rate for Payer: UHC Exchange |
$1,084.73
|
| Rate for Payer: UHCCP Medicaid |
$603.22
|
|
|
PR REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 24345
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$1,493.70 |
| Rate for Payer: Aetna Commercial |
$942.95
|
| Rate for Payer: Aetna Medicare |
$1,149.00
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS Trust/PPO |
$241.43
|
| Rate for Payer: BCN Commercial |
$1,049.19
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Cash Price |
$1,838.40
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$791.58
|
| Rate for Payer: UHC Exchange |
$791.58
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
|
|
PR REPAIR MENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$4,458.00
|
|
|
Service Code
|
HCPCS 63700
|
| Min. Negotiated Rate |
$860.73 |
| Max. Negotiated Rate |
$2,897.70 |
| Rate for Payer: Aetna Commercial |
$1,689.72
|
| Rate for Payer: Aetna Medicare |
$2,229.00
|
| Rate for Payer: BCBS Complete |
$903.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.65
|
| Rate for Payer: BCN Commercial |
$2,141.53
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Cash Price |
$3,566.40
|
| Rate for Payer: Meridian Medicaid |
$903.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,897.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,286.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,286.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,462.94
|
| Rate for Payer: UHC Exchange |
$1,462.94
|
| Rate for Payer: UHCCP Medicaid |
$860.73
|
|
|
PR REPAIR MYELOMENINGOCELE < 5 CM DIAMETER
|
Professional
|
Both
|
$5,092.00
|
|
|
Service Code
|
HCPCS 63704
|
| Min. Negotiated Rate |
$1,092.69 |
| Max. Negotiated Rate |
$3,309.80 |
| Rate for Payer: Aetna Commercial |
$2,146.84
|
| Rate for Payer: Aetna Medicare |
$2,546.00
|
| Rate for Payer: BCBS Complete |
$1,147.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.73
|
| Rate for Payer: BCN Commercial |
$2,718.34
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Cash Price |
$4,073.60
|
| Rate for Payer: Meridian Medicaid |
$1,147.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,092.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,309.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,902.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,902.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,842.66
|
| Rate for Payer: UHC Exchange |
$1,842.66
|
| Rate for Payer: UHCCP Medicaid |
$1,092.69
|
|
|
PR REPAIR MYELOMENINGOCELE > 5 CM DIAMETER
|
Professional
|
Both
|
$5,361.00
|
|
|
Service Code
|
HCPCS 63706
|
| Min. Negotiated Rate |
$1,210.91 |
| Max. Negotiated Rate |
$3,484.65 |
| Rate for Payer: Aetna Commercial |
$2,385.55
|
| Rate for Payer: Aetna Medicare |
$2,680.50
|
| Rate for Payer: BCBS Complete |
$1,271.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.41
|
| Rate for Payer: BCN Commercial |
$2,738.55
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Cash Price |
$4,288.80
|
| Rate for Payer: Meridian Medicaid |
$1,271.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,210.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,484.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,218.36
|
| Rate for Payer: Priority Health Narrow Network |
$3,218.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,094.85
|
| Rate for Payer: UHC Exchange |
$2,094.85
|
| Rate for Payer: UHCCP Medicaid |
$1,210.91
|
|
|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$511.72 |
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna Medicare |
$198.00
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS Trust/PPO |
$511.72
|
| Rate for Payer: BCN Commercial |
$274.15
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.55
|
| Rate for Payer: Priority Health Narrow Network |
$148.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.50
|
| Rate for Payer: UHC Exchange |
$136.50
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Commercial |
$847.07
|
| Rate for Payer: Aetna Medicare |
$908.00
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: BCN Commercial |
$995.44
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.06
|
| Rate for Payer: Priority Health Narrow Network |
$938.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$677.14
|
| Rate for Payer: UHC Exchange |
$677.14
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$522.49 |
| Max. Negotiated Rate |
$1,519.78 |
| Rate for Payer: Aetna Commercial |
$1,304.87
|
| Rate for Payer: Aetna Medicare |
$843.50
|
| Rate for Payer: BCBS Complete |
$687.50
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$1,519.78
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Meridian Medicaid |
$687.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.40
|
| Rate for Payer: UHC Exchange |
$1,072.40
|
| Rate for Payer: UHCCP Medicaid |
$654.76
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$432.68 |
| Max. Negotiated Rate |
$2,991.30 |
| Rate for Payer: Aetna Commercial |
$1,440.34
|
| Rate for Payer: Aetna Medicare |
$2,301.00
|
| Rate for Payer: BCBS Complete |
$737.82
|
| Rate for Payer: BCBS Trust/PPO |
$432.68
|
| Rate for Payer: BCN Commercial |
$1,583.80
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Meridian Medicaid |
$737.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$702.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,666.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,666.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,229.84
|
| Rate for Payer: UHC Exchange |
$1,229.84
|
| Rate for Payer: UHCCP Medicaid |
$702.69
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$335.47 |
| Max. Negotiated Rate |
$1,879.15 |
| Rate for Payer: Aetna Commercial |
$1,409.77
|
| Rate for Payer: Aetna Medicare |
$1,445.50
|
| Rate for Payer: BCBS Complete |
$720.15
|
| Rate for Payer: BCBS Trust/PPO |
$335.47
|
| Rate for Payer: BCN Commercial |
$1,548.13
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Meridian Medicaid |
$720.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,623.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,623.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,213.36
|
| Rate for Payer: UHC Exchange |
$1,213.36
|
| Rate for Payer: UHCCP Medicaid |
$685.86
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$1,219.23 |
| Rate for Payer: Aetna Commercial |
$1,052.49
|
| Rate for Payer: Aetna Medicare |
$700.50
|
| Rate for Payer: BCBS Complete |
$540.78
|
| Rate for Payer: BCBS Trust/PPO |
$448.70
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Meridian Medicaid |
$540.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,219.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,219.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$894.70
|
| Rate for Payer: UHC Exchange |
$894.70
|
| Rate for Payer: UHCCP Medicaid |
$515.03
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$400.01 |
| Max. Negotiated Rate |
$2,281.73 |
| Rate for Payer: Aetna Commercial |
$821.23
|
| Rate for Payer: Aetna Medicare |
$659.00
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,281.73
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.55
|
| Rate for Payer: Priority Health Narrow Network |
$950.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.55
|
| Rate for Payer: UHC Exchange |
$723.55
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,903.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$567.86 |
| Max. Negotiated Rate |
$2,536.95 |
| Rate for Payer: Aetna Commercial |
$1,167.83
|
| Rate for Payer: Aetna Medicare |
$1,951.50
|
| Rate for Payer: BCBS Complete |
$596.25
|
| Rate for Payer: BCBS Trust/PPO |
$677.28
|
| Rate for Payer: BCN Commercial |
$1,281.80
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Meridian Medicaid |
$596.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,536.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,010.93
|
| Rate for Payer: UHC Exchange |
$1,010.93
|
| Rate for Payer: UHCCP Medicaid |
$567.86
|
|
