|
PR REPAIR NAIL BED
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 11760
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$103.46
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: BCBS MAPPO |
$103.46
|
| Rate for Payer: BCN Medicare Advantage |
$103.46
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$148.98
|
| Rate for Payer: Cofinity Commercial |
$138.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.46
|
| Rate for Payer: Healthscope Commercial |
$124.15
|
| Rate for Payer: Healthscope Whirlpool |
$124.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.63
|
| Rate for Payer: Nomi Health Commercial |
$124.15
|
| Rate for Payer: PACE SWMI |
$103.46
|
| Rate for Payer: PHP Medicare Advantage |
$103.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health Medicare |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.46
|
| Rate for Payer: UHC Medicare Advantage |
$103.46
|
| Rate for Payer: UHCCP DNSP |
$103.46
|
|
|
PR REPAIR NASAL SEPTAL PERFORATIONS
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
HCPCS 30630
|
| Min. Negotiated Rate |
$621.18 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Commercial |
$832.38
|
| Rate for Payer: Aetna Medicare |
$621.18
|
| Rate for Payer: BCBS Complete |
$726.40
|
| Rate for Payer: BCBS MAPPO |
$621.18
|
| Rate for Payer: BCN Medicare Advantage |
$621.18
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cofinity Commercial |
$894.50
|
| Rate for Payer: Cofinity Commercial |
$832.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.18
|
| Rate for Payer: Healthscope Commercial |
$745.42
|
| Rate for Payer: Healthscope Whirlpool |
$745.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$652.24
|
| Rate for Payer: Nomi Health Commercial |
$745.42
|
| Rate for Payer: PACE SWMI |
$621.18
|
| Rate for Payer: PHP Medicare Advantage |
$621.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.40
|
| Rate for Payer: Priority Health Medicare |
$621.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.18
|
| Rate for Payer: UHC Medicare Advantage |
$621.18
|
| Rate for Payer: UHCCP DNSP |
$621.18
|
|
|
PR REPAIR NASAL VESTIBULAR STENOSIS
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 30465
|
| Min. Negotiated Rate |
$674.80 |
| Max. Negotiated Rate |
$1,377.73 |
| Rate for Payer: Aetna Commercial |
$1,282.06
|
| Rate for Payer: Aetna Medicare |
$956.76
|
| Rate for Payer: BCBS Complete |
$674.80
|
| Rate for Payer: BCBS MAPPO |
$956.76
|
| Rate for Payer: BCN Medicare Advantage |
$956.76
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.73
|
| Rate for Payer: Cofinity Commercial |
$1,282.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.76
|
| Rate for Payer: Healthscope Commercial |
$1,148.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,148.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.60
|
| Rate for Payer: Nomi Health Commercial |
$1,148.11
|
| Rate for Payer: PACE SWMI |
$956.76
|
| Rate for Payer: PHP Medicare Advantage |
$956.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health Medicare |
$956.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.76
|
| Rate for Payer: UHC Medicare Advantage |
$956.76
|
| Rate for Payer: UHCCP DNSP |
$956.76
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS 24435
|
| Min. Negotiated Rate |
$1,040.63 |
| Max. Negotiated Rate |
$2,991.30 |
| Rate for Payer: Aetna Commercial |
$1,394.44
|
| Rate for Payer: Aetna Medicare |
$1,040.63
|
| Rate for Payer: BCBS Complete |
$1,840.80
|
| Rate for Payer: BCBS MAPPO |
$1,040.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.63
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cash Price |
$3,681.60
|
| Rate for Payer: Cofinity Commercial |
$1,498.51
|
| Rate for Payer: Cofinity Commercial |
$1,394.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.63
|
| Rate for Payer: Healthscope Commercial |
$1,248.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,248.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.66
|
| Rate for Payer: Nomi Health Commercial |
$1,248.76
|
| Rate for Payer: PACE SWMI |
$1,040.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,991.30
|
| Rate for Payer: Priority Health Medicare |
$1,040.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.63
|
| Rate for Payer: UHCCP DNSP |
$1,040.63
|
|
|
PR REPAIR NON/MALUNION HUMERUS W/O GRAFT
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24430
|
| Min. Negotiated Rate |
$1,018.61 |
| Max. Negotiated Rate |
$1,879.15 |
| Rate for Payer: Aetna Commercial |
$1,364.94
|
| Rate for Payer: Aetna Medicare |
$1,018.61
|
| Rate for Payer: BCBS Complete |
$1,156.40
|
| Rate for Payer: BCBS MAPPO |
$1,018.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.61
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cash Price |
$2,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,466.80
|
| Rate for Payer: Cofinity Commercial |
$1,364.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.61
|
| Rate for Payer: Healthscope Commercial |
$1,222.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,222.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.54
|
| Rate for Payer: Nomi Health Commercial |
$1,222.33
|
| Rate for Payer: PACE SWMI |
$1,018.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.15
|
| Rate for Payer: Priority Health Medicare |
$1,018.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.61
|
| Rate for Payer: UHCCP DNSP |
$1,018.61
|
|
|
PR REPAIR NONUNION CARPAL BONE EACH BONE
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 25431
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$1,098.40 |
| Rate for Payer: Aetna Commercial |
$1,022.13
|
| Rate for Payer: Aetna Medicare |
$762.78
|
| Rate for Payer: BCBS Complete |
$560.40
|
| Rate for Payer: BCBS MAPPO |
$762.78
|
| Rate for Payer: BCN Medicare Advantage |
$762.78
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$1,022.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.78
|
| Rate for Payer: Healthscope Commercial |
$915.34
|
| Rate for Payer: Healthscope Whirlpool |
$915.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$800.92
|
| Rate for Payer: Nomi Health Commercial |
$915.34
|
| Rate for Payer: PACE SWMI |
$762.78
|
| Rate for Payer: PHP Medicare Advantage |
$762.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health Medicare |
$762.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.78
|
| Rate for Payer: UHC Medicare Advantage |
$762.78
|
| Rate for Payer: UHCCP DNSP |
$762.78
|
|
|
PR REPAIR NONUNION/MALUNION TARSAL BONES
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 28320
|
| Min. Negotiated Rate |
$527.20 |
| Max. Negotiated Rate |
$856.70 |
| Rate for Payer: Aetna Commercial |
$793.49
|
| Rate for Payer: Aetna Medicare |
$592.16
|
| Rate for Payer: BCBS Complete |
$527.20
|
| Rate for Payer: BCBS MAPPO |
$592.16
|
| Rate for Payer: BCN Medicare Advantage |
$592.16
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cofinity Commercial |
$852.71
|
| Rate for Payer: Cofinity Commercial |
$793.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.16
|
| Rate for Payer: Healthscope Commercial |
$710.59
|
| Rate for Payer: Healthscope Whirlpool |
$710.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.77
|
| Rate for Payer: Nomi Health Commercial |
$710.59
|
| Rate for Payer: PACE SWMI |
$592.16
|
| Rate for Payer: PHP Medicare Advantage |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.70
|
| Rate for Payer: Priority Health Medicare |
$592.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.16
|
| Rate for Payer: UHC Medicare Advantage |
$592.16
|
| Rate for Payer: UHCCP DNSP |
$592.16
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT
|
Professional
|
Both
|
$3,903.00
|
|
|
Service Code
|
HCPCS 27720
|
| Min. Negotiated Rate |
$841.45 |
| Max. Negotiated Rate |
$2,536.95 |
| Rate for Payer: Aetna Commercial |
$1,127.54
|
| Rate for Payer: Aetna Medicare |
$841.45
|
| Rate for Payer: BCBS Complete |
$1,561.20
|
| Rate for Payer: BCBS MAPPO |
$841.45
|
| Rate for Payer: BCN Medicare Advantage |
$841.45
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cash Price |
$3,122.40
|
| Rate for Payer: Cofinity Commercial |
$1,211.69
|
| Rate for Payer: Cofinity Commercial |
$1,127.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$841.45
|
| Rate for Payer: Healthscope Commercial |
$1,009.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,009.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$883.52
|
| Rate for Payer: Nomi Health Commercial |
$1,009.74
|
| Rate for Payer: PACE SWMI |
$841.45
|
| Rate for Payer: PHP Medicare Advantage |
$841.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,536.95
|
| Rate for Payer: Priority Health Medicare |
$841.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$841.45
|
| Rate for Payer: UHC Medicare Advantage |
$841.45
|
| Rate for Payer: UHCCP DNSP |
$841.45
|
|
|
PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT
|
Professional
|
Both
|
$3,827.00
|
|
|
Service Code
|
HCPCS 27722
|
| Min. Negotiated Rate |
$863.98 |
| Max. Negotiated Rate |
$2,487.55 |
| Rate for Payer: Aetna Commercial |
$1,157.73
|
| Rate for Payer: Aetna Medicare |
$863.98
|
| Rate for Payer: BCBS Complete |
$1,530.80
|
| Rate for Payer: BCBS MAPPO |
$863.98
|
| Rate for Payer: BCN Medicare Advantage |
$863.98
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cash Price |
$3,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,244.13
|
| Rate for Payer: Cofinity Commercial |
$1,157.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.98
|
| Rate for Payer: Healthscope Commercial |
$1,036.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,036.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.18
|
| Rate for Payer: Nomi Health Commercial |
$1,036.78
|
| Rate for Payer: PACE SWMI |
$863.98
|
| Rate for Payer: PHP Medicare Advantage |
$863.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.55
|
| Rate for Payer: Priority Health Medicare |
$863.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.98
|
| Rate for Payer: UHC Medicare Advantage |
$863.98
|
| Rate for Payer: UHCCP DNSP |
$863.98
|
|
|
PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 54437
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$934.95 |
| Rate for Payer: Aetna Commercial |
$870.02
|
| Rate for Payer: Aetna Medicare |
$649.27
|
| Rate for Payer: BCBS Complete |
$555.20
|
| Rate for Payer: BCBS MAPPO |
$649.27
|
| Rate for Payer: BCN Medicare Advantage |
$649.27
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$934.95
|
| Rate for Payer: Cofinity Commercial |
$870.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.27
|
| Rate for Payer: Healthscope Commercial |
$779.12
|
| Rate for Payer: Healthscope Whirlpool |
$779.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$681.73
|
| Rate for Payer: Nomi Health Commercial |
$779.12
|
| Rate for Payer: PACE SWMI |
$649.27
|
| Rate for Payer: PHP Medicare Advantage |
$649.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health Medicare |
$649.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$649.27
|
| Rate for Payer: UHC Medicare Advantage |
$649.27
|
| Rate for Payer: UHCCP DNSP |
$649.27
|
|
|
PR REPAIR PATENT DUCTUS ARTERIOSUS BY LIGATION
|
Professional
|
Both
|
$4,402.00
|
|
|
Service Code
|
HCPCS 33820
|
| Min. Negotiated Rate |
$931.08 |
| Max. Negotiated Rate |
$2,861.30 |
| Rate for Payer: Aetna Commercial |
$1,247.65
|
| Rate for Payer: Aetna Medicare |
$931.08
|
| Rate for Payer: BCBS Complete |
$1,760.80
|
| Rate for Payer: BCBS MAPPO |
$931.08
|
| Rate for Payer: BCN Medicare Advantage |
$931.08
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cash Price |
$3,521.60
|
| Rate for Payer: Cofinity Commercial |
$1,340.76
|
| Rate for Payer: Cofinity Commercial |
$1,247.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.08
|
| Rate for Payer: Healthscope Commercial |
$1,117.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,117.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.63
|
| Rate for Payer: Nomi Health Commercial |
$1,117.30
|
| Rate for Payer: PACE SWMI |
$931.08
|
| Rate for Payer: PHP Medicare Advantage |
$931.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,861.30
|
| Rate for Payer: Priority Health Medicare |
$931.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.08
|
| Rate for Payer: UHC Medicare Advantage |
$931.08
|
| Rate for Payer: UHCCP DNSP |
$931.08
|
|
|
PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21743
|
| Min. Negotiated Rate |
$1,656.40 |
| Max. Negotiated Rate |
$2,691.65 |
| Rate for Payer: Aetna Medicare |
$2,070.50
|
| Rate for Payer: BCBS Complete |
$1,656.40
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
|
|
PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN
|
Professional
|
Both
|
$4,141.00
|
|
|
Service Code
|
HCPCS 21740
|
| Min. Negotiated Rate |
$992.65 |
| Max. Negotiated Rate |
$2,691.65 |
| Rate for Payer: Aetna Commercial |
$1,330.15
|
| Rate for Payer: Aetna Medicare |
$992.65
|
| Rate for Payer: BCBS Complete |
$1,656.40
|
| Rate for Payer: BCBS MAPPO |
$992.65
|
| Rate for Payer: BCN Medicare Advantage |
$992.65
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cash Price |
$3,312.80
|
| Rate for Payer: Cofinity Commercial |
$1,429.42
|
| Rate for Payer: Cofinity Commercial |
$1,330.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.65
|
| Rate for Payer: Healthscope Commercial |
$1,191.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,191.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.28
|
| Rate for Payer: Nomi Health Commercial |
$1,191.18
|
| Rate for Payer: PACE SWMI |
$992.65
|
| Rate for Payer: PHP Medicare Advantage |
$992.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.65
|
| Rate for Payer: Priority Health Medicare |
$992.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.65
|
| Rate for Payer: UHC Medicare Advantage |
$992.65
|
| Rate for Payer: UHCCP DNSP |
$992.65
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$1,691.30 |
| Rate for Payer: Aetna Commercial |
$847.71
|
| Rate for Payer: Aetna Medicare |
$632.62
|
| Rate for Payer: BCBS Complete |
$1,040.80
|
| Rate for Payer: BCBS MAPPO |
$632.62
|
| Rate for Payer: BCN Medicare Advantage |
$632.62
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$910.97
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.62
|
| Rate for Payer: Healthscope Commercial |
$759.14
|
| Rate for Payer: Healthscope Whirlpool |
$759.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.25
|
| Rate for Payer: Nomi Health Commercial |
$759.14
|
| Rate for Payer: PACE SWMI |
$632.62
|
| Rate for Payer: PHP Medicare Advantage |
$632.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health Medicare |
$632.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$632.62
|
| Rate for Payer: UHCCP DNSP |
$632.62
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27650
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$1,691.30 |
| Rate for Payer: Aetna Commercial |
$847.71
|
| Rate for Payer: Aetna Medicare |
$632.62
|
| Rate for Payer: BCBS Complete |
$1,040.80
|
| Rate for Payer: BCBS MAPPO |
$632.62
|
| Rate for Payer: BCN Medicare Advantage |
$632.62
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$910.97
|
| Rate for Payer: Cofinity Commercial |
$847.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.62
|
| Rate for Payer: Healthscope Commercial |
$759.14
|
| Rate for Payer: Healthscope Whirlpool |
$759.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.25
|
| Rate for Payer: Nomi Health Commercial |
$759.14
|
| Rate for Payer: PACE SWMI |
$632.62
|
| Rate for Payer: PHP Medicare Advantage |
$632.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: Priority Health Medicare |
$632.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.62
|
| Rate for Payer: UHC Medicare Advantage |
$632.62
|
| Rate for Payer: UHCCP DNSP |
$632.62
|
|
|
PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
OP
|
$2,602.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$1,691.30 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,341.80
|
| 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 |
$2,523.94
|
| Rate for Payer: ASR Commercial |
$2,523.94
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,130.78
|
| Rate for Payer: BCN Commercial |
$2,017.33
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$2,445.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,602.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,523.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,341.80
|
| 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 |
$2,211.70
|
| Rate for Payer: Nomi Health Commercial |
$2,133.64
|
| 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 |
$1,691.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,279.87
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,824.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,289.76
|
| 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 REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON
|
Facility
|
IP
|
$2,602.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
27650
|
| Min. Negotiated Rate |
$1,691.30 |
| Max. Negotiated Rate |
$2,602.00 |
| Rate for Payer: Aetna Commercial |
$2,341.80
|
| Rate for Payer: ASR ASR |
$2,523.94
|
| Rate for Payer: ASR Commercial |
$2,523.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,120.37
|
| Rate for Payer: BCN Commercial |
$2,017.33
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cofinity Commercial |
$2,445.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,081.60
|
| Rate for Payer: Healthscope Commercial |
$2,602.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,523.94
|
| Rate for Payer: Mclaren Commercial |
$2,341.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,211.70
|
| Rate for Payer: Nomi Health Commercial |
$2,133.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,289.76
|
|
|
PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 27407
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$1,179.10 |
| Rate for Payer: Aetna Commercial |
$1,033.02
|
| Rate for Payer: Aetna Medicare |
$770.91
|
| Rate for Payer: BCBS Complete |
$725.60
|
| Rate for Payer: BCBS MAPPO |
$770.91
|
| Rate for Payer: BCN Medicare Advantage |
$770.91
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,110.11
|
| Rate for Payer: Cofinity Commercial |
$1,033.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.91
|
| Rate for Payer: Healthscope Commercial |
$925.09
|
| Rate for Payer: Healthscope Whirlpool |
$925.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.46
|
| Rate for Payer: Nomi Health Commercial |
$925.09
|
| Rate for Payer: PACE SWMI |
$770.91
|
| Rate for Payer: PHP Medicare Advantage |
$770.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health Medicare |
$770.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.91
|
| Rate for Payer: UHC Medicare Advantage |
$770.91
|
| Rate for Payer: UHCCP DNSP |
$770.91
|
|
|
PR REPAIR RECTOCELE SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
HCPCS 45560
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$954.86 |
| Rate for Payer: Aetna Commercial |
$888.55
|
| Rate for Payer: Aetna Medicare |
$663.10
|
| Rate for Payer: BCBS Complete |
$515.20
|
| Rate for Payer: BCBS MAPPO |
$663.10
|
| Rate for Payer: BCN Medicare Advantage |
$663.10
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cofinity Commercial |
$954.86
|
| Rate for Payer: Cofinity Commercial |
$888.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.10
|
| Rate for Payer: Healthscope Commercial |
$795.72
|
| Rate for Payer: Healthscope Whirlpool |
$795.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.25
|
| Rate for Payer: Nomi Health Commercial |
$795.72
|
| Rate for Payer: PACE SWMI |
$663.10
|
| Rate for Payer: PHP Medicare Advantage |
$663.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.20
|
| Rate for Payer: Priority Health Medicare |
$663.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.10
|
| Rate for Payer: UHC Medicare Advantage |
$663.10
|
| Rate for Payer: UHCCP DNSP |
$663.10
|
|
|
PR REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 27654
|
| Min. Negotiated Rate |
$689.76 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$924.28
|
| Rate for Payer: Aetna Medicare |
$689.76
|
| Rate for Payer: BCBS Complete |
$1,110.00
|
| Rate for Payer: BCBS MAPPO |
$689.76
|
| Rate for Payer: BCN Medicare Advantage |
$689.76
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$993.25
|
| Rate for Payer: Cofinity Commercial |
$924.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.76
|
| Rate for Payer: Healthscope Commercial |
$827.71
|
| Rate for Payer: Healthscope Whirlpool |
$827.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.25
|
| Rate for Payer: Nomi Health Commercial |
$827.71
|
| Rate for Payer: PACE SWMI |
$689.76
|
| Rate for Payer: PHP Medicare Advantage |
$689.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health Medicare |
$689.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.76
|
| Rate for Payer: UHC Medicare Advantage |
$689.76
|
| Rate for Payer: UHCCP DNSP |
$689.76
|
|
|
PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL
|
Professional
|
Both
|
$2,993.00
|
|
|
Service Code
|
HCPCS 27698
|
| Min. Negotiated Rate |
$614.15 |
| Max. Negotiated Rate |
$1,945.45 |
| Rate for Payer: Aetna Commercial |
$822.96
|
| Rate for Payer: Aetna Medicare |
$614.15
|
| Rate for Payer: BCBS Complete |
$1,197.20
|
| Rate for Payer: BCBS MAPPO |
$614.15
|
| Rate for Payer: BCN Medicare Advantage |
$614.15
|
| Rate for Payer: Cash Price |
$2,394.40
|
| Rate for Payer: Cash Price |
$2,394.40
|
| Rate for Payer: Cofinity Commercial |
$884.38
|
| Rate for Payer: Cofinity Commercial |
$822.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.15
|
| Rate for Payer: Healthscope Commercial |
$736.98
|
| Rate for Payer: Healthscope Whirlpool |
$736.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$644.86
|
| Rate for Payer: Nomi Health Commercial |
$736.98
|
| Rate for Payer: PACE SWMI |
$614.15
|
| Rate for Payer: PHP Medicare Advantage |
$614.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.45
|
| Rate for Payer: Priority Health Medicare |
$614.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.15
|
| Rate for Payer: UHC Medicare Advantage |
$614.15
|
| Rate for Payer: UHCCP DNSP |
$614.15
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE COMPLEX
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 26562
|
| Min. Negotiated Rate |
$904.40 |
| Max. Negotiated Rate |
$1,882.90 |
| Rate for Payer: Aetna Commercial |
$1,752.14
|
| Rate for Payer: Aetna Medicare |
$1,307.57
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$1,307.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,307.57
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$1,882.90
|
| Rate for Payer: Cofinity Commercial |
$1,752.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,307.57
|
| Rate for Payer: Healthscope Commercial |
$1,569.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,372.95
|
| Rate for Payer: Nomi Health Commercial |
$1,569.08
|
| Rate for Payer: PACE SWMI |
$1,307.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,307.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$1,307.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,307.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,307.57
|
| Rate for Payer: UHCCP DNSP |
$1,307.57
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26560
|
| Min. Negotiated Rate |
$593.48 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$795.26
|
| Rate for Payer: Aetna Medicare |
$593.48
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$593.48
|
| Rate for Payer: BCN Medicare Advantage |
$593.48
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$854.61
|
| Rate for Payer: Cofinity Commercial |
$795.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.48
|
| Rate for Payer: Healthscope Commercial |
$712.18
|
| Rate for Payer: Healthscope Whirlpool |
$712.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.15
|
| Rate for Payer: Nomi Health Commercial |
$712.18
|
| Rate for Payer: PACE SWMI |
$593.48
|
| Rate for Payer: PHP Medicare Advantage |
$593.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$593.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$593.48
|
| Rate for Payer: UHC Medicare Advantage |
$593.48
|
| Rate for Payer: UHCCP DNSP |
$593.48
|
|
|
PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT
|
Professional
|
Both
|
$2,404.00
|
|
|
Service Code
|
HCPCS 26561
|
| Min. Negotiated Rate |
$928.15 |
| Max. Negotiated Rate |
$1,562.60 |
| Rate for Payer: Aetna Commercial |
$1,243.72
|
| Rate for Payer: Aetna Medicare |
$928.15
|
| Rate for Payer: BCBS Complete |
$961.60
|
| Rate for Payer: BCBS MAPPO |
$928.15
|
| Rate for Payer: BCN Medicare Advantage |
$928.15
|
| Rate for Payer: Cash Price |
$1,923.20
|
| Rate for Payer: Cash Price |
$1,923.20
|
| Rate for Payer: Cofinity Commercial |
$1,336.54
|
| Rate for Payer: Cofinity Commercial |
$1,243.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.15
|
| Rate for Payer: Healthscope Commercial |
$1,113.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,113.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.56
|
| Rate for Payer: Nomi Health Commercial |
$1,113.78
|
| Rate for Payer: PACE SWMI |
$928.15
|
| Rate for Payer: PHP Medicare Advantage |
$928.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,562.60
|
| Rate for Payer: Priority Health Medicare |
$928.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.15
|
| Rate for Payer: UHC Medicare Advantage |
$928.15
|
| Rate for Payer: UHCCP DNSP |
$928.15
|
|
|
PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON
|
Professional
|
Both
|
$761.00
|
|
|
Service Code
|
HCPCS 28208
|
| Min. Negotiated Rate |
$304.40 |
| Max. Negotiated Rate |
$494.65 |
| Rate for Payer: Aetna Commercial |
$410.50
|
| Rate for Payer: Aetna Medicare |
$306.34
|
| Rate for Payer: BCBS Complete |
$304.40
|
| Rate for Payer: BCBS MAPPO |
$306.34
|
| Rate for Payer: BCN Medicare Advantage |
$306.34
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cash Price |
$608.80
|
| Rate for Payer: Cofinity Commercial |
$441.13
|
| Rate for Payer: Cofinity Commercial |
$410.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.34
|
| Rate for Payer: Healthscope Commercial |
$367.61
|
| Rate for Payer: Healthscope Whirlpool |
$367.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.66
|
| Rate for Payer: Nomi Health Commercial |
$367.61
|
| Rate for Payer: PACE SWMI |
$306.34
|
| Rate for Payer: PHP Medicare Advantage |
$306.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.65
|
| Rate for Payer: Priority Health Medicare |
$306.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.34
|
| Rate for Payer: UHC Medicare Advantage |
$306.34
|
| Rate for Payer: UHCCP DNSP |
$306.34
|
|
