|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$717.69 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$961.70
|
| Rate for Payer: Aetna Medicare |
$717.69
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$717.69
|
| Rate for Payer: BCN Medicare Advantage |
$717.69
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$961.70
|
| Rate for Payer: Cofinity Commercial |
$1,033.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.69
|
| Rate for Payer: Healthscope Commercial |
$861.23
|
| Rate for Payer: Healthscope Whirlpool |
$861.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.57
|
| Rate for Payer: Nomi Health Commercial |
$861.23
|
| Rate for Payer: PACE SWMI |
$717.69
|
| Rate for Payer: PHP Medicare Advantage |
$717.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$717.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.69
|
| Rate for Payer: UHC Medicare Advantage |
$717.69
|
| Rate for Payer: UHCCP DNSP |
$717.69
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$787.47 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$1,055.21
|
| Rate for Payer: Aetna Medicare |
$787.47
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$787.47
|
| Rate for Payer: BCN Medicare Advantage |
$787.47
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,133.96
|
| Rate for Payer: Cofinity Commercial |
$1,055.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.47
|
| Rate for Payer: Healthscope Commercial |
$944.96
|
| Rate for Payer: Healthscope Whirlpool |
$944.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.84
|
| Rate for Payer: Nomi Health Commercial |
$944.96
|
| Rate for Payer: PACE SWMI |
$787.47
|
| Rate for Payer: PHP Medicare Advantage |
$787.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$787.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.47
|
| Rate for Payer: UHC Medicare Advantage |
$787.47
|
| Rate for Payer: UHCCP DNSP |
$787.47
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$722.00 |
| Max. Negotiated Rate |
$1,173.25 |
| Rate for Payer: Aetna Commercial |
$1,055.21
|
| Rate for Payer: Aetna Medicare |
$787.47
|
| Rate for Payer: BCBS Complete |
$722.00
|
| Rate for Payer: BCBS MAPPO |
$787.47
|
| Rate for Payer: BCN Medicare Advantage |
$787.47
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.96
|
| Rate for Payer: Cofinity Commercial |
$1,055.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.47
|
| Rate for Payer: Healthscope Commercial |
$944.96
|
| Rate for Payer: Healthscope Whirlpool |
$944.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.84
|
| Rate for Payer: Nomi Health Commercial |
$944.96
|
| Rate for Payer: PACE SWMI |
$787.47
|
| Rate for Payer: PHP Medicare Advantage |
$787.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.25
|
| Rate for Payer: Priority Health Medicare |
$787.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.47
|
| Rate for Payer: UHC Medicare Advantage |
$787.47
|
| Rate for Payer: UHCCP DNSP |
$787.47
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$3,705.00
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$1,482.00 |
| Max. Negotiated Rate |
$2,408.25 |
| Rate for Payer: Aetna Commercial |
$2,023.86
|
| Rate for Payer: Aetna Medicare |
$1,510.34
|
| Rate for Payer: BCBS Complete |
$1,482.00
|
| Rate for Payer: BCBS MAPPO |
$1,510.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.34
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,174.89
|
| Rate for Payer: Cofinity Commercial |
$2,023.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.34
|
| Rate for Payer: Healthscope Commercial |
$1,812.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,812.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,585.86
|
| Rate for Payer: Nomi Health Commercial |
$1,812.41
|
| Rate for Payer: PACE SWMI |
$1,510.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.25
|
| Rate for Payer: Priority Health Medicare |
$1,510.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,510.34
|
| Rate for Payer: UHCCP DNSP |
$1,510.34
|
|
|
PR SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE
|
Professional
|
Both
|
$1,985.00
|
|
|
Service Code
|
HCPCS 64831
|
| Min. Negotiated Rate |
$668.23 |
| Max. Negotiated Rate |
$1,290.25 |
| Rate for Payer: Aetna Commercial |
$895.43
|
| Rate for Payer: Aetna Medicare |
$668.23
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: BCBS MAPPO |
$668.23
|
| Rate for Payer: BCN Medicare Advantage |
$668.23
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Commercial |
$962.25
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$668.23
|
| Rate for Payer: Healthscope Commercial |
$801.88
|
| Rate for Payer: Healthscope Whirlpool |
$801.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$701.64
|
| Rate for Payer: Nomi Health Commercial |
$801.88
|
| Rate for Payer: PACE SWMI |
$668.23
|
| Rate for Payer: PHP Medicare Advantage |
$668.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.25
|
| Rate for Payer: Priority Health Medicare |
$668.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$668.23
|
| Rate for Payer: UHC Medicare Advantage |
$668.23
|
| Rate for Payer: UHCCP DNSP |
$668.23
|
|
|
PR SUTURE EACH ADDITIONAL NERVE HAND/FOOT
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 64837
|
| Min. Negotiated Rate |
$348.27 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$466.68
|
| Rate for Payer: Aetna Medicare |
$348.27
|
| Rate for Payer: BCBS Complete |
$524.40
|
| Rate for Payer: BCBS MAPPO |
$348.27
|
| Rate for Payer: BCN Medicare Advantage |
$348.27
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cofinity Commercial |
$501.51
|
| Rate for Payer: Cofinity Commercial |
$466.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.27
|
| Rate for Payer: Healthscope Commercial |
$417.92
|
| Rate for Payer: Healthscope Whirlpool |
$417.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.68
|
| Rate for Payer: Nomi Health Commercial |
$417.92
|
| Rate for Payer: PACE SWMI |
$348.27
|
| Rate for Payer: PHP Medicare Advantage |
$348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.15
|
| Rate for Payer: Priority Health Medicare |
$348.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.27
|
| Rate for Payer: UHC Medicare Advantage |
$348.27
|
| Rate for Payer: UHCCP DNSP |
$348.27
|
|
|
PR SUTURE EACH ADDITIONAL PERIPHERAL NERVE
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 64859
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$1,061.45 |
| Rate for Payer: Aetna Commercial |
$316.79
|
| Rate for Payer: Aetna Medicare |
$236.41
|
| Rate for Payer: BCBS Complete |
$653.20
|
| Rate for Payer: BCBS MAPPO |
$236.41
|
| Rate for Payer: BCN Medicare Advantage |
$236.41
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cash Price |
$1,306.40
|
| Rate for Payer: Cofinity Commercial |
$340.43
|
| Rate for Payer: Cofinity Commercial |
$316.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.41
|
| Rate for Payer: Healthscope Commercial |
$283.69
|
| Rate for Payer: Healthscope Whirlpool |
$283.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.23
|
| Rate for Payer: Nomi Health Commercial |
$283.69
|
| Rate for Payer: PACE SWMI |
$236.41
|
| Rate for Payer: PHP Medicare Advantage |
$236.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.45
|
| Rate for Payer: Priority Health Medicare |
$236.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.41
|
| Rate for Payer: UHC Medicare Advantage |
$236.41
|
| Rate for Payer: UHCCP DNSP |
$236.41
|
|
|
PR SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY
|
Professional
|
Both
|
$3,048.00
|
|
|
Service Code
|
HCPCS 47900
|
| Min. Negotiated Rate |
$1,219.20 |
| Max. Negotiated Rate |
$1,981.20 |
| Rate for Payer: Aetna Commercial |
$1,794.29
|
| Rate for Payer: Aetna Medicare |
$1,339.02
|
| Rate for Payer: BCBS Complete |
$1,219.20
|
| Rate for Payer: BCBS MAPPO |
$1,339.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,339.02
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cofinity Commercial |
$1,928.19
|
| Rate for Payer: Cofinity Commercial |
$1,794.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,339.02
|
| Rate for Payer: Healthscope Commercial |
$1,606.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,606.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,405.97
|
| Rate for Payer: Nomi Health Commercial |
$1,606.82
|
| Rate for Payer: PACE SWMI |
$1,339.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,339.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.20
|
| Rate for Payer: Priority Health Medicare |
$1,339.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,339.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,339.02
|
| Rate for Payer: UHCCP DNSP |
$1,339.02
|
|
|
PR SUTURE FACIAL NERVE EXTRACRANIAL
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 64864
|
| Min. Negotiated Rate |
$823.37 |
| Max. Negotiated Rate |
$1,578.85 |
| Rate for Payer: Aetna Commercial |
$1,103.32
|
| Rate for Payer: Aetna Medicare |
$823.37
|
| Rate for Payer: BCBS Complete |
$971.60
|
| Rate for Payer: BCBS MAPPO |
$823.37
|
| Rate for Payer: BCN Medicare Advantage |
$823.37
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Cash Price |
$1,943.20
|
| Rate for Payer: Cofinity Commercial |
$1,185.65
|
| Rate for Payer: Cofinity Commercial |
$1,103.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.37
|
| Rate for Payer: Healthscope Commercial |
$988.04
|
| Rate for Payer: Healthscope Whirlpool |
$988.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.54
|
| Rate for Payer: Nomi Health Commercial |
$988.04
|
| Rate for Payer: PACE SWMI |
$823.37
|
| Rate for Payer: PHP Medicare Advantage |
$823.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,578.85
|
| Rate for Payer: Priority Health Medicare |
$823.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.37
|
| Rate for Payer: UHC Medicare Advantage |
$823.37
|
| Rate for Payer: UHCCP DNSP |
$823.37
|
|
|
PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT
|
Professional
|
Both
|
$3,037.00
|
|
|
Service Code
|
HCPCS 64865
|
| Min. Negotiated Rate |
$1,023.60 |
| Max. Negotiated Rate |
$1,974.05 |
| Rate for Payer: Aetna Commercial |
$1,371.62
|
| Rate for Payer: Aetna Medicare |
$1,023.60
|
| Rate for Payer: BCBS Complete |
$1,214.80
|
| Rate for Payer: BCBS MAPPO |
$1,023.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cash Price |
$2,429.60
|
| Rate for Payer: Cofinity Commercial |
$1,473.98
|
| Rate for Payer: Cofinity Commercial |
$1,371.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.60
|
| Rate for Payer: Healthscope Commercial |
$1,228.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,228.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.78
|
| Rate for Payer: Nomi Health Commercial |
$1,228.32
|
| Rate for Payer: PACE SWMI |
$1,023.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.05
|
| Rate for Payer: Priority Health Medicare |
$1,023.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.60
|
| Rate for Payer: UHCCP DNSP |
$1,023.60
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$1,008.15 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Aetna Commercial |
$1,395.90
|
| Rate for Payer: ASR ASR |
$1,504.47
|
| Rate for Payer: ASR Commercial |
$1,504.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.91
|
| Rate for Payer: BCN Commercial |
$1,202.49
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,457.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Healthscope Commercial |
$1,551.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,504.47
|
| Rate for Payer: Mclaren Commercial |
$1,395.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,318.35
|
| Rate for Payer: Nomi Health Commercial |
$1,271.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,364.88
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 27380
|
| Min. Negotiated Rate |
$595.26 |
| Max. Negotiated Rate |
$1,008.15 |
| Rate for Payer: Aetna Commercial |
$797.65
|
| Rate for Payer: Aetna Medicare |
$595.26
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: BCBS MAPPO |
$595.26
|
| Rate for Payer: BCN Medicare Advantage |
$595.26
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$857.17
|
| Rate for Payer: Cofinity Commercial |
$797.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.26
|
| Rate for Payer: Healthscope Commercial |
$714.31
|
| Rate for Payer: Healthscope Whirlpool |
$714.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.02
|
| Rate for Payer: Nomi Health Commercial |
$714.31
|
| Rate for Payer: PACE SWMI |
$595.26
|
| Rate for Payer: PHP Medicare Advantage |
$595.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health Medicare |
$595.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.26
|
| Rate for Payer: UHC Medicare Advantage |
$595.26
|
| Rate for Payer: UHCCP DNSP |
$595.26
|
|
|
PR SUTURE INFRAPATELLAR TENDON PRIMARY
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$1,008.15 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$1,395.90
|
| 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 |
$1,504.47
|
| Rate for Payer: ASR Commercial |
$1,504.47
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.11
|
| Rate for Payer: BCN Commercial |
$1,202.49
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$1,457.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,240.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$1,551.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,504.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$1,395.90
|
| 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 |
$1,318.35
|
| Rate for Payer: Nomi Health Commercial |
$1,271.82
|
| 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 |
$1,008.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,358.99
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,087.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,364.88
|
| 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 SUTURE INFRAPATELLAR TENDON PRIMARY
|
Professional
|
Both
|
$1,551.00
|
|
|
Service Code
|
HCPCS 27380
|
| Hospital Charge Code |
27380
|
| Min. Negotiated Rate |
$595.26 |
| Max. Negotiated Rate |
$1,008.15 |
| Rate for Payer: Aetna Commercial |
$797.65
|
| Rate for Payer: Aetna Medicare |
$595.26
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: BCBS MAPPO |
$595.26
|
| Rate for Payer: BCN Medicare Advantage |
$595.26
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cofinity Commercial |
$857.17
|
| Rate for Payer: Cofinity Commercial |
$797.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.26
|
| Rate for Payer: Healthscope Commercial |
$714.31
|
| Rate for Payer: Healthscope Whirlpool |
$714.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.02
|
| Rate for Payer: Nomi Health Commercial |
$714.31
|
| Rate for Payer: PACE SWMI |
$595.26
|
| Rate for Payer: PHP Medicare Advantage |
$595.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.15
|
| Rate for Payer: Priority Health Medicare |
$595.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.26
|
| Rate for Payer: UHC Medicare Advantage |
$595.26
|
| Rate for Payer: UHCCP DNSP |
$595.26
|
|
|
PR SUTURE MESENTERY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 44850
|
| Min. Negotiated Rate |
$725.87 |
| Max. Negotiated Rate |
$1,286.35 |
| Rate for Payer: Aetna Commercial |
$972.67
|
| Rate for Payer: Aetna Medicare |
$725.87
|
| Rate for Payer: BCBS Complete |
$791.60
|
| Rate for Payer: BCBS MAPPO |
$725.87
|
| Rate for Payer: BCN Medicare Advantage |
$725.87
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cofinity Commercial |
$972.67
|
| Rate for Payer: Cofinity Commercial |
$1,045.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.87
|
| Rate for Payer: Healthscope Commercial |
$871.04
|
| Rate for Payer: Healthscope Whirlpool |
$871.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$762.16
|
| Rate for Payer: Nomi Health Commercial |
$871.04
|
| Rate for Payer: PACE SWMI |
$725.87
|
| Rate for Payer: PHP Medicare Advantage |
$725.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.35
|
| Rate for Payer: Priority Health Medicare |
$725.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$725.87
|
| Rate for Payer: UHC Medicare Advantage |
$725.87
|
| Rate for Payer: UHCCP DNSP |
$725.87
|
|
|
PR SUTURE NERVE REQ SECONDARY/DELAYED SUTURE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 64872
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$159.52 |
| Rate for Payer: Aetna Commercial |
$148.45
|
| Rate for Payer: Aetna Medicare |
$110.78
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS MAPPO |
$110.78
|
| Rate for Payer: BCN Medicare Advantage |
$110.78
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$159.52
|
| Rate for Payer: Cofinity Commercial |
$148.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.78
|
| Rate for Payer: Healthscope Commercial |
$132.94
|
| Rate for Payer: Healthscope Whirlpool |
$132.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.32
|
| Rate for Payer: Nomi Health Commercial |
$132.94
|
| Rate for Payer: PACE SWMI |
$110.78
|
| Rate for Payer: PHP Medicare Advantage |
$110.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health Medicare |
$110.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.78
|
| Rate for Payer: UHC Medicare Advantage |
$110.78
|
| Rate for Payer: UHCCP DNSP |
$110.78
|
|
|
PR SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 64874
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$238.75 |
| Rate for Payer: Aetna Commercial |
$222.17
|
| Rate for Payer: Aetna Medicare |
$165.80
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS MAPPO |
$165.80
|
| Rate for Payer: BCN Medicare Advantage |
$165.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$238.75
|
| Rate for Payer: Cofinity Commercial |
$222.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.80
|
| Rate for Payer: Healthscope Commercial |
$198.96
|
| Rate for Payer: Healthscope Whirlpool |
$198.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.09
|
| Rate for Payer: Nomi Health Commercial |
$198.96
|
| Rate for Payer: PACE SWMI |
$165.80
|
| Rate for Payer: PHP Medicare Advantage |
$165.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health Medicare |
$165.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.80
|
| Rate for Payer: UHC Medicare Advantage |
$165.80
|
| Rate for Payer: UHCCP DNSP |
$165.80
|
|
|
PR SUTURE PHARYNX WOUND/INJURY
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 42900
|
| Min. Negotiated Rate |
$249.20 |
| Max. Negotiated Rate |
$456.94 |
| Rate for Payer: Aetna Commercial |
$425.21
|
| Rate for Payer: Aetna Medicare |
$317.32
|
| Rate for Payer: BCBS Complete |
$249.20
|
| Rate for Payer: BCBS MAPPO |
$317.32
|
| Rate for Payer: BCN Medicare Advantage |
$317.32
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cofinity Commercial |
$456.94
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.32
|
| Rate for Payer: Healthscope Commercial |
$380.78
|
| Rate for Payer: Healthscope Whirlpool |
$380.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.19
|
| Rate for Payer: Nomi Health Commercial |
$380.78
|
| Rate for Payer: PACE SWMI |
$317.32
|
| Rate for Payer: PHP Medicare Advantage |
$317.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.95
|
| Rate for Payer: Priority Health Medicare |
$317.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.32
|
| Rate for Payer: UHC Medicare Advantage |
$317.32
|
| Rate for Payer: UHCCP DNSP |
$317.32
|
|
|
PR SUTURE POSTERIOR TIBIAL NERVE
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 64840
|
| Min. Negotiated Rate |
$791.60 |
| Max. Negotiated Rate |
$1,336.45 |
| Rate for Payer: Aetna Commercial |
$1,243.64
|
| Rate for Payer: Aetna Medicare |
$928.09
|
| Rate for Payer: BCBS Complete |
$791.60
|
| Rate for Payer: BCBS MAPPO |
$928.09
|
| Rate for Payer: BCN Medicare Advantage |
$928.09
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cofinity Commercial |
$1,336.45
|
| Rate for Payer: Cofinity Commercial |
$1,243.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$928.09
|
| Rate for Payer: Healthscope Commercial |
$1,113.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,113.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$974.49
|
| Rate for Payer: Nomi Health Commercial |
$1,113.71
|
| Rate for Payer: PACE SWMI |
$928.09
|
| Rate for Payer: PHP Medicare Advantage |
$928.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,286.35
|
| Rate for Payer: Priority Health Medicare |
$928.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$928.09
|
| Rate for Payer: UHC Medicare Advantage |
$928.09
|
| Rate for Payer: UHCCP DNSP |
$928.09
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$1,903.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$579.36 |
| Max. Negotiated Rate |
$1,236.95 |
| Rate for Payer: Aetna Commercial |
$776.34
|
| Rate for Payer: Aetna Medicare |
$579.36
|
| Rate for Payer: BCBS Complete |
$761.20
|
| Rate for Payer: BCBS MAPPO |
$579.36
|
| Rate for Payer: BCN Medicare Advantage |
$579.36
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$834.28
|
| Rate for Payer: Cofinity Commercial |
$776.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.36
|
| Rate for Payer: Healthscope Commercial |
$695.23
|
| Rate for Payer: Healthscope Whirlpool |
$695.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$608.33
|
| Rate for Payer: Nomi Health Commercial |
$695.23
|
| Rate for Payer: PACE SWMI |
$579.36
|
| Rate for Payer: PHP Medicare Advantage |
$579.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: Priority Health Medicare |
$579.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$579.36
|
| Rate for Payer: UHC Medicare Advantage |
$579.36
|
| Rate for Payer: UHCCP DNSP |
$579.36
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$1,903.00
|
|
|
Service Code
|
HCPCS 27385
|
| Min. Negotiated Rate |
$579.36 |
| Max. Negotiated Rate |
$1,236.95 |
| Rate for Payer: Aetna Commercial |
$776.34
|
| Rate for Payer: Aetna Medicare |
$579.36
|
| Rate for Payer: BCBS Complete |
$761.20
|
| Rate for Payer: BCBS MAPPO |
$579.36
|
| Rate for Payer: BCN Medicare Advantage |
$579.36
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$834.28
|
| Rate for Payer: Cofinity Commercial |
$776.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.36
|
| Rate for Payer: Healthscope Commercial |
$695.23
|
| Rate for Payer: Healthscope Whirlpool |
$695.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$608.33
|
| Rate for Payer: Nomi Health Commercial |
$695.23
|
| Rate for Payer: PACE SWMI |
$579.36
|
| Rate for Payer: PHP Medicare Advantage |
$579.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: Priority Health Medicare |
$579.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$579.36
|
| Rate for Payer: UHC Medicare Advantage |
$579.36
|
| Rate for Payer: UHCCP DNSP |
$579.36
|
|
|
PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$1,236.95 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| 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 |
$1,845.91
|
| Rate for Payer: ASR Commercial |
$1,845.91
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,558.37
|
| Rate for Payer: BCN Commercial |
$1,475.40
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$1,788.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,522.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$1,903.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,845.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$1,712.70
|
| 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 |
$1,617.55
|
| Rate for Payer: Nomi Health Commercial |
$1,560.46
|
| 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 |
$1,236.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,667.41
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,334.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,674.64
|
| 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 SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$1,236.95 |
| Max. Negotiated Rate |
$1,903.00 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: ASR ASR |
$1,845.91
|
| Rate for Payer: ASR Commercial |
$1,845.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,550.75
|
| Rate for Payer: BCN Commercial |
$1,475.40
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Cofinity Commercial |
$1,788.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,522.40
|
| Rate for Payer: Healthscope Commercial |
$1,903.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,845.91
|
| Rate for Payer: Mclaren Commercial |
$1,712.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,617.55
|
| Rate for Payer: Nomi Health Commercial |
$1,560.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,674.64
|
|
|
PR SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$5,688.00
|
|
|
Service Code
|
HCPCS 33322
|
| Min. Negotiated Rate |
$1,330.91 |
| Max. Negotiated Rate |
$3,697.20 |
| Rate for Payer: Aetna Commercial |
$1,783.42
|
| Rate for Payer: Aetna Medicare |
$1,330.91
|
| Rate for Payer: BCBS Complete |
$2,275.20
|
| Rate for Payer: BCBS MAPPO |
$1,330.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,330.91
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Cash Price |
$4,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,916.51
|
| Rate for Payer: Cofinity Commercial |
$1,783.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,330.91
|
| Rate for Payer: Healthscope Commercial |
$1,597.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,597.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,397.46
|
| Rate for Payer: Nomi Health Commercial |
$1,597.09
|
| Rate for Payer: PACE SWMI |
$1,330.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,330.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,697.20
|
| Rate for Payer: Priority Health Medicare |
$1,330.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,330.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,330.91
|
| Rate for Payer: UHCCP DNSP |
$1,330.91
|
|
|
PR SUTURE/REPAIR TESTICULAR INJURY
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
HCPCS 54670
|
| Min. Negotiated Rate |
$391.41 |
| Max. Negotiated Rate |
$816.40 |
| Rate for Payer: Aetna Commercial |
$524.49
|
| Rate for Payer: Aetna Medicare |
$391.41
|
| Rate for Payer: BCBS Complete |
$502.40
|
| Rate for Payer: BCBS MAPPO |
$391.41
|
| Rate for Payer: BCN Medicare Advantage |
$391.41
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Cofinity Commercial |
$563.63
|
| Rate for Payer: Cofinity Commercial |
$524.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.41
|
| Rate for Payer: Healthscope Commercial |
$469.69
|
| Rate for Payer: Healthscope Whirlpool |
$469.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.98
|
| Rate for Payer: Nomi Health Commercial |
$469.69
|
| Rate for Payer: PACE SWMI |
$391.41
|
| Rate for Payer: PHP Medicare Advantage |
$391.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.40
|
| Rate for Payer: Priority Health Medicare |
$391.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.41
|
| Rate for Payer: UHC Medicare Advantage |
$391.41
|
| Rate for Payer: UHCCP DNSP |
$391.41
|
|
