|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$9,119.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$3,647.60 |
| Max. Negotiated Rate |
$6,883.13 |
| Rate for Payer: Aetna Commercial |
$6,405.13
|
| Rate for Payer: Aetna Medicare |
$4,779.95
|
| Rate for Payer: BCBS Complete |
$3,647.60
|
| Rate for Payer: BCBS MAPPO |
$4,779.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,779.95
|
| Rate for Payer: Cash Price |
$7,295.20
|
| Rate for Payer: Cash Price |
$7,295.20
|
| Rate for Payer: Cofinity Commercial |
$6,883.13
|
| Rate for Payer: Cofinity Commercial |
$6,405.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,779.95
|
| Rate for Payer: Healthscope Commercial |
$5,735.94
|
| Rate for Payer: Healthscope Whirlpool |
$5,735.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,018.95
|
| Rate for Payer: Nomi Health Commercial |
$5,735.94
|
| Rate for Payer: PACE SWMI |
$4,779.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,779.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,927.35
|
| Rate for Payer: Priority Health Medicare |
$4,779.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,779.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,779.95
|
| Rate for Payer: UHCCP DNSP |
$4,779.95
|
|
|
PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$585.99 |
| Rate for Payer: Aetna Commercial |
$545.30
|
| Rate for Payer: Aetna Medicare |
$406.94
|
| Rate for Payer: BCBS Complete |
$303.20
|
| Rate for Payer: BCBS MAPPO |
$406.94
|
| Rate for Payer: BCN Medicare Advantage |
$406.94
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$585.99
|
| Rate for Payer: Cofinity Commercial |
$545.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.94
|
| Rate for Payer: Healthscope Commercial |
$488.33
|
| Rate for Payer: Healthscope Whirlpool |
$488.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.29
|
| Rate for Payer: Nomi Health Commercial |
$488.33
|
| Rate for Payer: PACE SWMI |
$406.94
|
| Rate for Payer: PHP Medicare Advantage |
$406.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health Medicare |
$406.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.94
|
| Rate for Payer: UHC Medicare Advantage |
$406.94
|
| Rate for Payer: UHCCP DNSP |
$406.94
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$475.20 |
| Max. Negotiated Rate |
$774.63 |
| Rate for Payer: Aetna Commercial |
$720.84
|
| Rate for Payer: Aetna Medicare |
$537.94
|
| Rate for Payer: BCBS Complete |
$475.20
|
| Rate for Payer: BCBS MAPPO |
$537.94
|
| Rate for Payer: BCN Medicare Advantage |
$537.94
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$774.63
|
| Rate for Payer: Cofinity Commercial |
$720.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.94
|
| Rate for Payer: Healthscope Commercial |
$645.53
|
| Rate for Payer: Healthscope Whirlpool |
$645.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.84
|
| Rate for Payer: Nomi Health Commercial |
$645.53
|
| Rate for Payer: PACE SWMI |
$537.94
|
| Rate for Payer: PHP Medicare Advantage |
$537.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.20
|
| Rate for Payer: Priority Health Medicare |
$537.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.94
|
| Rate for Payer: UHC Medicare Advantage |
$537.94
|
| Rate for Payer: UHCCP DNSP |
$537.94
|
|
|
PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA
|
Professional
|
Both
|
$2,992.00
|
|
|
Service Code
|
HCPCS 46716
|
| Min. Negotiated Rate |
$1,196.80 |
| Max. Negotiated Rate |
$1,944.80 |
| Rate for Payer: Aetna Commercial |
$1,604.03
|
| Rate for Payer: Aetna Medicare |
$1,197.04
|
| Rate for Payer: BCBS Complete |
$1,196.80
|
| Rate for Payer: BCBS MAPPO |
$1,197.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,197.04
|
| Rate for Payer: Cash Price |
$2,393.60
|
| Rate for Payer: Cash Price |
$2,393.60
|
| Rate for Payer: Cofinity Commercial |
$1,723.74
|
| Rate for Payer: Cofinity Commercial |
$1,604.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,197.04
|
| Rate for Payer: Healthscope Commercial |
$1,436.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,436.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,256.89
|
| Rate for Payer: Nomi Health Commercial |
$1,436.45
|
| Rate for Payer: PACE SWMI |
$1,197.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.80
|
| Rate for Payer: Priority Health Medicare |
$1,197.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,197.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,197.04
|
| Rate for Payer: UHCCP DNSP |
$1,197.04
|
|
|
PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ
|
Professional
|
Both
|
$10,278.00
|
|
|
Service Code
|
HCPCS 39503
|
| Min. Negotiated Rate |
$4,111.20 |
| Max. Negotiated Rate |
$8,044.47 |
| Rate for Payer: Aetna Commercial |
$7,485.83
|
| Rate for Payer: Aetna Medicare |
$5,586.44
|
| Rate for Payer: BCBS Complete |
$4,111.20
|
| Rate for Payer: BCBS MAPPO |
$5,586.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.44
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cofinity Commercial |
$8,044.47
|
| Rate for Payer: Cofinity Commercial |
$7,485.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.44
|
| Rate for Payer: Healthscope Commercial |
$6,703.73
|
| Rate for Payer: Healthscope Whirlpool |
$6,703.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.76
|
| Rate for Payer: Nomi Health Commercial |
$6,703.73
|
| Rate for Payer: PACE SWMI |
$5,586.44
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,680.70
|
| Rate for Payer: Priority Health Medicare |
$5,586.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.44
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.44
|
| Rate for Payer: UHCCP DNSP |
$5,586.44
|
|
|
PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 53449
|
| Min. Negotiated Rate |
$466.00 |
| Max. Negotiated Rate |
$844.42 |
| Rate for Payer: Aetna Commercial |
$785.78
|
| Rate for Payer: Aetna Medicare |
$586.40
|
| Rate for Payer: BCBS Complete |
$466.00
|
| Rate for Payer: BCBS MAPPO |
$586.40
|
| Rate for Payer: BCN Medicare Advantage |
$586.40
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$844.42
|
| Rate for Payer: Cofinity Commercial |
$785.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.40
|
| Rate for Payer: Healthscope Commercial |
$703.68
|
| Rate for Payer: Healthscope Whirlpool |
$703.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.72
|
| Rate for Payer: Nomi Health Commercial |
$703.68
|
| Rate for Payer: PACE SWMI |
$586.40
|
| Rate for Payer: PHP Medicare Advantage |
$586.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health Medicare |
$586.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.40
|
| Rate for Payer: UHC Medicare Advantage |
$586.40
|
| Rate for Payer: UHCCP DNSP |
$586.40
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE
|
Professional
|
Both
|
$3,865.00
|
|
|
Service Code
|
HCPCS 27472
|
| Min. Negotiated Rate |
$1,218.33 |
| Max. Negotiated Rate |
$2,512.25 |
| Rate for Payer: Aetna Commercial |
$1,632.56
|
| Rate for Payer: Aetna Medicare |
$1,218.33
|
| Rate for Payer: BCBS Complete |
$1,546.00
|
| Rate for Payer: BCBS MAPPO |
$1,218.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.33
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Cofinity Commercial |
$1,632.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.33
|
| Rate for Payer: Healthscope Commercial |
$1,462.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,462.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.25
|
| Rate for Payer: Nomi Health Commercial |
$1,462.00
|
| Rate for Payer: PACE SWMI |
$1,218.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,512.25
|
| Rate for Payer: Priority Health Medicare |
$1,218.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.33
|
| Rate for Payer: UHCCP DNSP |
$1,218.33
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/O GRF
|
Professional
|
Both
|
$2,927.00
|
|
|
Service Code
|
HCPCS 27470
|
| Min. Negotiated Rate |
$1,136.51 |
| Max. Negotiated Rate |
$1,902.55 |
| Rate for Payer: Aetna Commercial |
$1,522.92
|
| Rate for Payer: Aetna Medicare |
$1,136.51
|
| Rate for Payer: BCBS Complete |
$1,170.80
|
| Rate for Payer: BCBS MAPPO |
$1,136.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.51
|
| Rate for Payer: Cash Price |
$2,341.60
|
| Rate for Payer: Cash Price |
$2,341.60
|
| Rate for Payer: Cofinity Commercial |
$1,636.57
|
| Rate for Payer: Cofinity Commercial |
$1,522.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.51
|
| Rate for Payer: Healthscope Commercial |
$1,363.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,363.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,193.34
|
| Rate for Payer: Nomi Health Commercial |
$1,363.81
|
| Rate for Payer: PACE SWMI |
$1,136.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.55
|
| Rate for Payer: Priority Health Medicare |
$1,136.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,136.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,136.51
|
| Rate for Payer: UHCCP DNSP |
$1,136.51
|
|
|
PR RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH
|
Professional
|
Both
|
$5,421.00
|
|
|
Service Code
|
HCPCS 27725
|
| Min. Negotiated Rate |
$1,171.90 |
| Max. Negotiated Rate |
$3,523.65 |
| Rate for Payer: Aetna Commercial |
$1,570.35
|
| Rate for Payer: Aetna Medicare |
$1,171.90
|
| Rate for Payer: BCBS Complete |
$2,168.40
|
| Rate for Payer: BCBS MAPPO |
$1,171.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,171.90
|
| Rate for Payer: Cash Price |
$4,336.80
|
| Rate for Payer: Cash Price |
$4,336.80
|
| Rate for Payer: Cofinity Commercial |
$1,687.54
|
| Rate for Payer: Cofinity Commercial |
$1,570.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,171.90
|
| Rate for Payer: Healthscope Commercial |
$1,406.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,230.49
|
| Rate for Payer: Nomi Health Commercial |
$1,406.28
|
| Rate for Payer: PACE SWMI |
$1,171.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,171.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,523.65
|
| Rate for Payer: Priority Health Medicare |
$1,171.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,171.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,171.90
|
| Rate for Payer: UHCCP DNSP |
$1,171.90
|
|
|
PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,771.00
|
|
|
Service Code
|
HCPCS 27724
|
| Min. Negotiated Rate |
$1,208.33 |
| Max. Negotiated Rate |
$3,101.15 |
| Rate for Payer: Aetna Commercial |
$1,619.16
|
| Rate for Payer: Aetna Medicare |
$1,208.33
|
| Rate for Payer: BCBS Complete |
$1,908.40
|
| Rate for Payer: BCBS MAPPO |
$1,208.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,208.33
|
| Rate for Payer: Cash Price |
$3,816.80
|
| Rate for Payer: Cash Price |
$3,816.80
|
| Rate for Payer: Cofinity Commercial |
$1,740.00
|
| Rate for Payer: Cofinity Commercial |
$1,619.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,208.33
|
| Rate for Payer: Healthscope Commercial |
$1,450.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,450.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,268.75
|
| Rate for Payer: Nomi Health Commercial |
$1,450.00
|
| Rate for Payer: PACE SWMI |
$1,208.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,208.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,101.15
|
| Rate for Payer: Priority Health Medicare |
$1,208.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,208.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,208.33
|
| Rate for Payer: UHCCP DNSP |
$1,208.33
|
|
|
PR RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 28322
|
| Min. Negotiated Rate |
$526.40 |
| Max. Negotiated Rate |
$855.40 |
| Rate for Payer: Aetna Commercial |
$743.19
|
| Rate for Payer: Aetna Medicare |
$554.62
|
| Rate for Payer: BCBS Complete |
$526.40
|
| Rate for Payer: BCBS MAPPO |
$554.62
|
| Rate for Payer: BCN Medicare Advantage |
$554.62
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$798.65
|
| Rate for Payer: Cofinity Commercial |
$743.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.62
|
| Rate for Payer: Healthscope Commercial |
$665.54
|
| Rate for Payer: Healthscope Whirlpool |
$665.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.35
|
| Rate for Payer: Nomi Health Commercial |
$665.54
|
| Rate for Payer: PACE SWMI |
$554.62
|
| Rate for Payer: PHP Medicare Advantage |
$554.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health Medicare |
$554.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.62
|
| Rate for Payer: UHC Medicare Advantage |
$554.62
|
| Rate for Payer: UHCCP DNSP |
$554.62
|
|
|
PR RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS
|
Professional
|
Both
|
$7,025.00
|
|
|
Service Code
|
HCPCS 33496
|
| Min. Negotiated Rate |
$1,591.45 |
| Max. Negotiated Rate |
$4,566.25 |
| Rate for Payer: Aetna Commercial |
$2,132.54
|
| Rate for Payer: Aetna Medicare |
$1,591.45
|
| Rate for Payer: BCBS Complete |
$2,810.00
|
| Rate for Payer: BCBS MAPPO |
$1,591.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.45
|
| Rate for Payer: Cash Price |
$5,620.00
|
| Rate for Payer: Cash Price |
$5,620.00
|
| Rate for Payer: Cofinity Commercial |
$2,291.69
|
| Rate for Payer: Cofinity Commercial |
$2,132.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.45
|
| Rate for Payer: Healthscope Commercial |
$1,909.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,909.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,671.02
|
| Rate for Payer: Nomi Health Commercial |
$1,909.74
|
| Rate for Payer: PACE SWMI |
$1,591.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,566.25
|
| Rate for Payer: Priority Health Medicare |
$1,591.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,591.45
|
| Rate for Payer: UHCCP DNSP |
$1,591.45
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,241.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$1,000.77 |
| Max. Negotiated Rate |
$2,106.65 |
| Rate for Payer: Aetna Commercial |
$1,341.03
|
| Rate for Payer: Aetna Medicare |
$1,000.77
|
| Rate for Payer: BCBS Complete |
$1,296.40
|
| Rate for Payer: BCBS MAPPO |
$1,000.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.77
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,441.11
|
| Rate for Payer: Cofinity Commercial |
$1,341.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.77
|
| Rate for Payer: Healthscope Commercial |
$1,200.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,050.81
|
| Rate for Payer: Nomi Health Commercial |
$1,200.92
|
| Rate for Payer: PACE SWMI |
$1,000.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.65
|
| Rate for Payer: Priority Health Medicare |
$1,000.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,000.77
|
| Rate for Payer: UHCCP DNSP |
$1,000.77
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 25415
|
| Min. Negotiated Rate |
$933.93 |
| Max. Negotiated Rate |
$2,128.75 |
| Rate for Payer: Aetna Commercial |
$1,251.47
|
| Rate for Payer: Aetna Medicare |
$933.93
|
| Rate for Payer: BCBS Complete |
$1,310.00
|
| Rate for Payer: BCBS MAPPO |
$933.93
|
| Rate for Payer: BCN Medicare Advantage |
$933.93
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,344.86
|
| Rate for Payer: Cofinity Commercial |
$1,251.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.93
|
| Rate for Payer: Healthscope Commercial |
$1,120.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.63
|
| Rate for Payer: Nomi Health Commercial |
$1,120.72
|
| Rate for Payer: PACE SWMI |
$933.93
|
| Rate for Payer: PHP Medicare Advantage |
$933.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.75
|
| Rate for Payer: Priority Health Medicare |
$933.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.93
|
| Rate for Payer: UHC Medicare Advantage |
$933.93
|
| Rate for Payer: UHCCP DNSP |
$933.93
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$774.63 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$1,038.00
|
| Rate for Payer: Aetna Medicare |
$774.63
|
| Rate for Payer: BCBS Complete |
$1,053.20
|
| Rate for Payer: BCBS MAPPO |
$774.63
|
| Rate for Payer: BCN Medicare Advantage |
$774.63
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,115.47
|
| Rate for Payer: Cofinity Commercial |
$1,038.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.63
|
| Rate for Payer: Healthscope Commercial |
$929.56
|
| Rate for Payer: Healthscope Whirlpool |
$929.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.36
|
| Rate for Payer: Nomi Health Commercial |
$929.56
|
| Rate for Payer: PACE SWMI |
$774.63
|
| Rate for Payer: PHP Medicare Advantage |
$774.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health Medicare |
$774.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.63
|
| Rate for Payer: UHC Medicare Advantage |
$774.63
|
| Rate for Payer: UHCCP DNSP |
$774.63
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$2,109.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$843.60 |
| Max. Negotiated Rate |
$1,416.21 |
| Rate for Payer: Aetna Commercial |
$1,317.86
|
| Rate for Payer: Aetna Medicare |
$983.48
|
| Rate for Payer: BCBS Complete |
$843.60
|
| Rate for Payer: BCBS MAPPO |
$983.48
|
| Rate for Payer: BCN Medicare Advantage |
$983.48
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,416.21
|
| Rate for Payer: Cofinity Commercial |
$1,317.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$983.48
|
| Rate for Payer: Healthscope Commercial |
$1,180.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,180.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,032.65
|
| Rate for Payer: Nomi Health Commercial |
$1,180.18
|
| Rate for Payer: PACE SWMI |
$983.48
|
| Rate for Payer: PHP Medicare Advantage |
$983.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.85
|
| Rate for Payer: Priority Health Medicare |
$983.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$983.48
|
| Rate for Payer: UHC Medicare Advantage |
$983.48
|
| Rate for Payer: UHCCP DNSP |
$983.48
|
|
|
PR RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$550.40 |
| Max. Negotiated Rate |
$1,070.35 |
| Rate for Payer: Aetna Commercial |
$996.02
|
| Rate for Payer: Aetna Medicare |
$743.30
|
| Rate for Payer: BCBS Complete |
$550.40
|
| Rate for Payer: BCBS MAPPO |
$743.30
|
| Rate for Payer: BCN Medicare Advantage |
$743.30
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$996.02
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.30
|
| Rate for Payer: Healthscope Commercial |
$891.96
|
| Rate for Payer: Healthscope Whirlpool |
$891.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$780.47
|
| Rate for Payer: Nomi Health Commercial |
$891.96
|
| Rate for Payer: PACE SWMI |
$743.30
|
| Rate for Payer: PHP Medicare Advantage |
$743.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.40
|
| Rate for Payer: Priority Health Medicare |
$743.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$743.30
|
| Rate for Payer: UHC Medicare Advantage |
$743.30
|
| Rate for Payer: UHCCP DNSP |
$743.30
|
|
|
PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 30468
|
| Min. Negotiated Rate |
$161.44 |
| Max. Negotiated Rate |
$272.35 |
| Rate for Payer: Aetna Commercial |
$216.33
|
| Rate for Payer: Aetna Medicare |
$161.44
|
| Rate for Payer: BCBS Complete |
$167.60
|
| Rate for Payer: BCBS MAPPO |
$161.44
|
| Rate for Payer: BCN Medicare Advantage |
$161.44
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cofinity Commercial |
$232.47
|
| Rate for Payer: Cofinity Commercial |
$216.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.44
|
| Rate for Payer: Healthscope Commercial |
$193.73
|
| Rate for Payer: Healthscope Whirlpool |
$193.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.51
|
| Rate for Payer: Nomi Health Commercial |
$193.73
|
| Rate for Payer: PACE SWMI |
$161.44
|
| Rate for Payer: PHP Medicare Advantage |
$161.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.35
|
| Rate for Payer: Priority Health Medicare |
$161.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.44
|
| Rate for Payer: UHC Medicare Advantage |
$161.44
|
| Rate for Payer: UHCCP DNSP |
$161.44
|
|
|
PR RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 43336
|
| Min. Negotiated Rate |
$1,090.00 |
| Max. Negotiated Rate |
$2,006.51 |
| Rate for Payer: Aetna Commercial |
$1,867.17
|
| Rate for Payer: Aetna Medicare |
$1,393.41
|
| Rate for Payer: BCBS Complete |
$1,090.00
|
| Rate for Payer: BCBS MAPPO |
$1,393.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,393.41
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$2,006.51
|
| Rate for Payer: Cofinity Commercial |
$1,867.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,393.41
|
| Rate for Payer: Healthscope Commercial |
$1,672.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,672.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,463.08
|
| Rate for Payer: Nomi Health Commercial |
$1,672.09
|
| Rate for Payer: PACE SWMI |
$1,393.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,393.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health Medicare |
$1,393.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,393.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,393.41
|
| Rate for Payer: UHCCP DNSP |
$1,393.41
|
|
|
PR RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH
|
Professional
|
Both
|
$2,118.00
|
|
|
Service Code
|
HCPCS 43332
|
| Min. Negotiated Rate |
$847.20 |
| Max. Negotiated Rate |
$1,602.42 |
| Rate for Payer: Aetna Commercial |
$1,491.14
|
| Rate for Payer: Aetna Medicare |
$1,112.79
|
| Rate for Payer: BCBS Complete |
$847.20
|
| Rate for Payer: BCBS MAPPO |
$1,112.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,112.79
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cash Price |
$1,694.40
|
| Rate for Payer: Cofinity Commercial |
$1,602.42
|
| Rate for Payer: Cofinity Commercial |
$1,491.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,112.79
|
| Rate for Payer: Healthscope Commercial |
$1,335.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,168.43
|
| Rate for Payer: Nomi Health Commercial |
$1,335.35
|
| Rate for Payer: PACE SWMI |
$1,112.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,112.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,376.70
|
| Rate for Payer: Priority Health Medicare |
$1,112.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,112.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,112.79
|
| Rate for Payer: UHCCP DNSP |
$1,112.79
|
|
|
PR RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH
|
Professional
|
Both
|
$2,801.00
|
|
|
Service Code
|
HCPCS 43335
|
| Min. Negotiated Rate |
$1,120.40 |
| Max. Negotiated Rate |
$1,847.85 |
| Rate for Payer: Aetna Commercial |
$1,719.53
|
| Rate for Payer: Aetna Medicare |
$1,283.23
|
| Rate for Payer: BCBS Complete |
$1,120.40
|
| Rate for Payer: BCBS MAPPO |
$1,283.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,283.23
|
| Rate for Payer: Cash Price |
$2,240.80
|
| Rate for Payer: Cash Price |
$2,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,847.85
|
| Rate for Payer: Cofinity Commercial |
$1,719.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,283.23
|
| Rate for Payer: Healthscope Commercial |
$1,539.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,539.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,347.39
|
| Rate for Payer: Nomi Health Commercial |
$1,539.88
|
| Rate for Payer: PACE SWMI |
$1,283.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,283.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,820.65
|
| Rate for Payer: Priority Health Medicare |
$1,283.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,283.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,283.23
|
| Rate for Payer: UHCCP DNSP |
$1,283.23
|
|
|
PR RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH
|
Professional
|
Both
|
$3,439.00
|
|
|
Service Code
|
HCPCS 43334
|
| Min. Negotiated Rate |
$1,194.57 |
| Max. Negotiated Rate |
$2,235.35 |
| Rate for Payer: Aetna Commercial |
$1,600.72
|
| Rate for Payer: Aetna Medicare |
$1,194.57
|
| Rate for Payer: BCBS Complete |
$1,375.60
|
| Rate for Payer: BCBS MAPPO |
$1,194.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,194.57
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cash Price |
$2,751.20
|
| Rate for Payer: Cofinity Commercial |
$1,720.18
|
| Rate for Payer: Cofinity Commercial |
$1,600.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,194.57
|
| Rate for Payer: Healthscope Commercial |
$1,433.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,433.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,254.30
|
| Rate for Payer: Nomi Health Commercial |
$1,433.48
|
| Rate for Payer: PACE SWMI |
$1,194.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,194.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,235.35
|
| Rate for Payer: Priority Health Medicare |
$1,194.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,194.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,194.57
|
| Rate for Payer: UHCCP DNSP |
$1,194.57
|
|
|
PR RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 49621
|
| Min. Negotiated Rate |
$620.00 |
| Max. Negotiated Rate |
$1,056.05 |
| Rate for Payer: Aetna Commercial |
$982.72
|
| Rate for Payer: Aetna Medicare |
$733.37
|
| Rate for Payer: BCBS Complete |
$620.00
|
| Rate for Payer: BCBS MAPPO |
$733.37
|
| Rate for Payer: BCN Medicare Advantage |
$733.37
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Commercial |
$982.72
|
| Rate for Payer: Cofinity Commercial |
$1,056.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.37
|
| Rate for Payer: Healthscope Commercial |
$880.04
|
| Rate for Payer: Healthscope Whirlpool |
$880.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.04
|
| Rate for Payer: Nomi Health Commercial |
$880.04
|
| Rate for Payer: PACE SWMI |
$733.37
|
| Rate for Payer: PHP Medicare Advantage |
$733.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,007.50
|
| Rate for Payer: Priority Health Medicare |
$733.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.37
|
| Rate for Payer: UHC Medicare Advantage |
$733.37
|
| Rate for Payer: UHCCP DNSP |
$733.37
|
|
|
PR RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 49622
|
| Min. Negotiated Rate |
$764.40 |
| Max. Negotiated Rate |
$1,315.56 |
| Rate for Payer: Aetna Commercial |
$1,224.20
|
| Rate for Payer: Aetna Medicare |
$913.58
|
| Rate for Payer: BCBS Complete |
$764.40
|
| Rate for Payer: BCBS MAPPO |
$913.58
|
| Rate for Payer: BCN Medicare Advantage |
$913.58
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,315.56
|
| Rate for Payer: Cofinity Commercial |
$1,224.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$913.58
|
| Rate for Payer: Healthscope Commercial |
$1,096.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,096.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$959.26
|
| Rate for Payer: Nomi Health Commercial |
$1,096.30
|
| Rate for Payer: PACE SWMI |
$913.58
|
| Rate for Payer: PHP Medicare Advantage |
$913.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.15
|
| Rate for Payer: Priority Health Medicare |
$913.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$913.58
|
| Rate for Payer: UHC Medicare Advantage |
$913.58
|
| Rate for Payer: UHCCP DNSP |
$913.58
|
|
|
PR RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS
|
Professional
|
Both
|
$7,564.00
|
|
|
Service Code
|
HCPCS 33925
|
| Min. Negotiated Rate |
$1,647.56 |
| Max. Negotiated Rate |
$4,916.60 |
| Rate for Payer: Aetna Commercial |
$2,207.73
|
| Rate for Payer: Aetna Medicare |
$1,647.56
|
| Rate for Payer: BCBS Complete |
$3,025.60
|
| Rate for Payer: BCBS MAPPO |
$1,647.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,647.56
|
| Rate for Payer: Cash Price |
$6,051.20
|
| Rate for Payer: Cash Price |
$6,051.20
|
| Rate for Payer: Cofinity Commercial |
$2,372.49
|
| Rate for Payer: Cofinity Commercial |
$2,207.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,647.56
|
| Rate for Payer: Healthscope Commercial |
$1,977.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,977.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,729.94
|
| Rate for Payer: Nomi Health Commercial |
$1,977.07
|
| Rate for Payer: PACE SWMI |
$1,647.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,647.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,916.60
|
| Rate for Payer: Priority Health Medicare |
$1,647.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,647.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,647.56
|
| Rate for Payer: UHCCP DNSP |
$1,647.56
|
|
