|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$130.36 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$264.57
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: BCBS Complete |
$136.88
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$724.30
|
| Rate for Payer: BCN Commercial |
$411.96
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$264.57
|
| Rate for Payer: Cofinity Commercial |
$284.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$236.93
|
| Rate for Payer: Healthscope Whirlpool |
$236.93
|
| Rate for Payer: Meridian Medicaid |
$136.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.31
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health Narrow Network |
$284.31
|
| Rate for Payer: UHC Medicare Advantage |
$203.36
|
|
|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$959.39 |
| Rate for Payer: Aetna Commercial |
$196.99
|
| Rate for Payer: Aetna Medicare |
$147.01
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$147.01
|
| Rate for Payer: BCBS Trust/PPO |
$959.39
|
| Rate for Payer: BCN Commercial |
$324.48
|
| Rate for Payer: BCN Medicare Advantage |
$147.01
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$211.69
|
| Rate for Payer: Cofinity Commercial |
$196.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.01
|
| Rate for Payer: Healthscope Commercial |
$176.41
|
| Rate for Payer: Healthscope Whirlpool |
$176.41
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$154.36
|
| Rate for Payer: PACE SWMI |
$147.01
|
| Rate for Payer: PHP Medicare Advantage |
$147.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.93
|
| Rate for Payer: Priority Health Medicare |
$147.01
|
| Rate for Payer: Priority Health Narrow Network |
$213.93
|
| Rate for Payer: UHC Medicare Advantage |
$151.42
|
|
|
PR ABRASION 1 LESION
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$433.00 |
| Rate for Payer: Aetna Commercial |
$389.70
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$420.01
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$335.70
|
| Rate for Payer: BCN Commercial |
$335.70
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cofinity Commercial |
$407.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$433.00
|
| Rate for Payer: Healthscope Whirlpool |
$420.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$389.70
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.05
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.03
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$307.43
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.04
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
PR ABRASION 1 LESION
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$433.00 |
| Rate for Payer: Aetna Commercial |
$389.70
|
| Rate for Payer: ASR ASR |
$420.01
|
| Rate for Payer: BCBS Trust/PPO |
$335.70
|
| Rate for Payer: BCN Commercial |
$335.70
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cofinity Commercial |
$407.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.40
|
| Rate for Payer: Healthscope Commercial |
$433.00
|
| Rate for Payer: Healthscope Whirlpool |
$420.01
|
| Rate for Payer: Mclaren Commercial |
$389.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.04
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$1,937.00
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$674.11 |
| Max. Negotiated Rate |
$1,687.70 |
| Rate for Payer: Aetna Commercial |
$1,456.35
|
| Rate for Payer: Aetna Medicare |
$1,086.83
|
| Rate for Payer: BCBS Complete |
$744.98
|
| Rate for Payer: BCBS MAPPO |
$1,086.83
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$1,615.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,086.83
|
| Rate for Payer: Cash Price |
$1,549.60
|
| Rate for Payer: Cash Price |
$1,549.60
|
| Rate for Payer: Cofinity Commercial |
$1,565.04
|
| Rate for Payer: Cofinity Commercial |
$1,456.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,086.83
|
| Rate for Payer: Healthscope Commercial |
$1,304.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,304.20
|
| Rate for Payer: Meridian Medicaid |
$744.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,141.17
|
| Rate for Payer: PACE SWMI |
$1,086.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,086.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$709.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,687.70
|
| Rate for Payer: Priority Health Medicare |
$1,086.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,687.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,119.43
|
|
|
PR ACNE SURGERY
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$137.04 |
| Rate for Payer: Aetna Commercial |
$68.14
|
| Rate for Payer: Aetna Medicare |
$50.85
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS MAPPO |
$50.85
|
| Rate for Payer: BCBS Trust/PPO |
$22.20
|
| Rate for Payer: BCN Commercial |
$137.04
|
| Rate for Payer: BCN Medicare Advantage |
$50.85
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$73.22
|
| Rate for Payer: Cofinity Commercial |
$68.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.85
|
| Rate for Payer: Healthscope Commercial |
$61.02
|
| Rate for Payer: Healthscope Whirlpool |
$61.02
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.39
|
| Rate for Payer: PACE SWMI |
$50.85
|
| Rate for Payer: PHP Medicare Advantage |
$50.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.30
|
| Rate for Payer: Priority Health Medicare |
$50.85
|
| Rate for Payer: Priority Health Narrow Network |
$63.30
|
| Rate for Payer: UHC Medicare Advantage |
$52.38
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 92570
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,989.05 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$28.32
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$28.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,989.05
|
| Rate for Payer: BCN Commercial |
$46.92
|
| Rate for Payer: BCN Medicare Advantage |
$28.32
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$37.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.32
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Healthscope Whirlpool |
$33.98
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.74
|
| Rate for Payer: PACE SWMI |
$28.32
|
| Rate for Payer: PHP Medicare Advantage |
$28.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.62
|
| Rate for Payer: Priority Health Medicare |
$28.32
|
| Rate for Payer: Priority Health Narrow Network |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$29.17
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$641.88 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS Complete |
$236.80
|
| Rate for Payer: BCBS MAPPO |
$131.00
|
| Rate for Payer: BCBS MAPPO |
$131.00
|
| Rate for Payer: BCBS Trust/PPO |
$641.88
|
| Rate for Payer: BCBS Trust/PPO |
$641.88
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Medicare Advantage |
$131.00
|
| Rate for Payer: BCN Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cash Price |
$473.60
|
| Rate for Payer: Cofinity Commercial |
$175.54
|
| Rate for Payer: Cofinity Commercial |
$188.64
|
| Rate for Payer: Cofinity Commercial |
$175.54
|
| Rate for Payer: Cofinity Commercial |
$188.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.00
|
| Rate for Payer: Healthscope Commercial |
$157.20
|
| Rate for Payer: Healthscope Commercial |
$157.20
|
| Rate for Payer: Healthscope Whirlpool |
$157.20
|
| Rate for Payer: Healthscope Whirlpool |
$157.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.55
|
| Rate for Payer: PACE SWMI |
$131.00
|
| Rate for Payer: PACE SWMI |
$131.00
|
| Rate for Payer: PHP Medicare Advantage |
$131.00
|
| Rate for Payer: PHP Medicare Advantage |
$131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.39
|
| Rate for Payer: Priority Health Medicare |
$131.00
|
| Rate for Payer: Priority Health Medicare |
$131.00
|
| Rate for Payer: Priority Health Narrow Network |
$186.39
|
| Rate for Payer: Priority Health Narrow Network |
$186.39
|
| Rate for Payer: UHC Medicare Advantage |
$134.93
|
| Rate for Payer: UHC Medicare Advantage |
$134.93
|
|
|
PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 97155
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,401.05 |
| Rate for Payer: Aetna Commercial |
$20.80
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.05
|
| Rate for Payer: BCN Commercial |
$25.38
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.84
|
| Rate for Payer: Priority Health Narrow Network |
$32.84
|
|
|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00673
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00674
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$1,152.22 |
| Rate for Payer: Aetna Commercial |
$278.24
|
| Rate for Payer: Aetna Medicare |
$207.64
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$207.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: BCN Medicare Advantage |
$207.64
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$278.24
|
| Rate for Payer: Cofinity Commercial |
$299.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.64
|
| Rate for Payer: Healthscope Commercial |
$249.17
|
| Rate for Payer: Healthscope Whirlpool |
$249.17
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.02
|
| Rate for Payer: PACE SWMI |
$207.64
|
| Rate for Payer: PHP Medicare Advantage |
$207.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.31
|
| Rate for Payer: Priority Health Medicare |
$207.64
|
| Rate for Payer: Priority Health Narrow Network |
$376.31
|
| Rate for Payer: UHC Medicare Advantage |
$213.87
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$302.68
|
| Rate for Payer: Aetna Medicare |
$225.88
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$225.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: BCN Medicare Advantage |
$225.88
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$325.27
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.88
|
| Rate for Payer: Healthscope Commercial |
$271.06
|
| Rate for Payer: Healthscope Whirlpool |
$271.06
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.17
|
| Rate for Payer: PACE SWMI |
$225.88
|
| Rate for Payer: PHP Medicare Advantage |
$225.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.81
|
| Rate for Payer: Priority Health Medicare |
$225.88
|
| Rate for Payer: Priority Health Narrow Network |
$409.81
|
| Rate for Payer: UHC Medicare Advantage |
$232.66
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$975.24 |
| Rate for Payer: Aetna Commercial |
$322.32
|
| Rate for Payer: Aetna Medicare |
$240.54
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$240.54
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$361.13
|
| Rate for Payer: BCN Medicare Advantage |
$240.54
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$322.32
|
| Rate for Payer: Cofinity Commercial |
$346.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.54
|
| Rate for Payer: Healthscope Commercial |
$288.65
|
| Rate for Payer: Healthscope Whirlpool |
$288.65
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$252.57
|
| Rate for Payer: PACE SWMI |
$240.54
|
| Rate for Payer: PHP Medicare Advantage |
$240.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.52
|
| Rate for Payer: Priority Health Medicare |
$240.54
|
| Rate for Payer: Priority Health Narrow Network |
$434.52
|
| Rate for Payer: UHC Medicare Advantage |
$247.76
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$1,082.49 |
| Rate for Payer: Aetna Commercial |
$259.61
|
| Rate for Payer: Aetna Medicare |
$193.74
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$193.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.49
|
| Rate for Payer: BCN Commercial |
$292.23
|
| Rate for Payer: BCN Medicare Advantage |
$193.74
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$278.99
|
| Rate for Payer: Cofinity Commercial |
$259.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.74
|
| Rate for Payer: Healthscope Commercial |
$232.49
|
| Rate for Payer: Healthscope Whirlpool |
$232.49
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.43
|
| Rate for Payer: PACE SWMI |
$193.74
|
| Rate for Payer: PHP Medicare Advantage |
$193.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.62
|
| Rate for Payer: Priority Health Medicare |
$193.74
|
| Rate for Payer: Priority Health Narrow Network |
$351.62
|
| Rate for Payer: UHC Medicare Advantage |
$199.55
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.28
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Cofinity Commercial |
$0.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$0.65
|
| Rate for Payer: Healthscope Whirlpool |
$0.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$323.76 |
| Max. Negotiated Rate |
$979.03 |
| Rate for Payer: Aetna Commercial |
$655.33
|
| Rate for Payer: Aetna Medicare |
$489.05
|
| Rate for Payer: BCBS Complete |
$339.95
|
| Rate for Payer: BCBS MAPPO |
$489.05
|
| Rate for Payer: BCBS Trust/PPO |
$979.03
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: BCN Medicare Advantage |
$489.05
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$704.23
|
| Rate for Payer: Cofinity Commercial |
$655.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.05
|
| Rate for Payer: Healthscope Commercial |
$586.86
|
| Rate for Payer: Healthscope Whirlpool |
$586.86
|
| Rate for Payer: Meridian Medicaid |
$339.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.50
|
| Rate for Payer: PACE SWMI |
$489.05
|
| Rate for Payer: PHP Medicare Advantage |
$489.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.39
|
| Rate for Payer: Priority Health Medicare |
$489.05
|
| Rate for Payer: Priority Health Narrow Network |
$617.39
|
| Rate for Payer: UHC Medicare Advantage |
$503.72
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$418.76 |
| Max. Negotiated Rate |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$852.90
|
| Rate for Payer: Aetna Medicare |
$636.49
|
| Rate for Payer: BCBS Complete |
$439.70
|
| Rate for Payer: BCBS MAPPO |
$636.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.07
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$636.49
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$916.55
|
| Rate for Payer: Cofinity Commercial |
$852.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.49
|
| Rate for Payer: Healthscope Commercial |
$763.79
|
| Rate for Payer: Healthscope Whirlpool |
$763.79
|
| Rate for Payer: Meridian Medicaid |
$439.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$668.31
|
| Rate for Payer: PACE SWMI |
$636.49
|
| Rate for Payer: PHP Medicare Advantage |
$636.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$800.29
|
| Rate for Payer: Priority Health Medicare |
$636.49
|
| Rate for Payer: Priority Health Narrow Network |
$800.29
|
| Rate for Payer: UHC Medicare Advantage |
$655.58
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$226.01 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Aetna Commercial |
$1,135.23
|
| Rate for Payer: Aetna Medicare |
$847.19
|
| Rate for Payer: BCBS Complete |
$582.61
|
| Rate for Payer: BCBS MAPPO |
$847.19
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: BCN Commercial |
$1,586.25
|
| Rate for Payer: BCN Medicare Advantage |
$847.19
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$1,135.23
|
| Rate for Payer: Cofinity Commercial |
$1,219.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$847.19
|
| Rate for Payer: Healthscope Commercial |
$1,016.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.63
|
| Rate for Payer: Meridian Medicaid |
$582.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$889.55
|
| Rate for Payer: PACE SWMI |
$847.19
|
| Rate for Payer: PHP Medicare Advantage |
$847.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,185.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,062.53
|
| Rate for Payer: Priority Health Medicare |
$847.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,062.53
|
| Rate for Payer: UHC Medicare Advantage |
$872.61
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$486.49 |
| Max. Negotiated Rate |
$1,457.41 |
| Rate for Payer: Aetna Commercial |
$989.72
|
| Rate for Payer: Aetna Medicare |
$738.60
|
| Rate for Payer: BCBS Complete |
$510.81
|
| Rate for Payer: BCBS MAPPO |
$738.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.41
|
| Rate for Payer: BCN Commercial |
$1,347.28
|
| Rate for Payer: BCN Medicare Advantage |
$738.60
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cofinity Commercial |
$989.72
|
| Rate for Payer: Cofinity Commercial |
$1,063.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.60
|
| Rate for Payer: Healthscope Commercial |
$886.32
|
| Rate for Payer: Healthscope Whirlpool |
$886.32
|
| Rate for Payer: Meridian Medicaid |
$510.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$775.53
|
| Rate for Payer: PACE SWMI |
$738.60
|
| Rate for Payer: PHP Medicare Advantage |
$738.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$486.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,108.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.18
|
| Rate for Payer: Priority Health Medicare |
$738.60
|
| Rate for Payer: Priority Health Narrow Network |
$930.18
|
| Rate for Payer: UHC Medicare Advantage |
$760.76
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,026.22 |
| Rate for Payer: Aetna Commercial |
$1,305.00
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$1,406.50
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.18
|
| Rate for Payer: BCN Commercial |
$1,124.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$1,363.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$1,450.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$1,305.00
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.50
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.50
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,276.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$920.78
|
| Rate for Payer: Aetna Medicare |
$687.15
|
| Rate for Payer: BCBS Complete |
$475.70
|
| Rate for Payer: BCBS MAPPO |
$687.15
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$687.15
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$920.78
|
| Rate for Payer: Cofinity Commercial |
$989.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.15
|
| Rate for Payer: Healthscope Commercial |
$824.58
|
| Rate for Payer: Healthscope Whirlpool |
$824.58
|
| Rate for Payer: Meridian Medicaid |
$475.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$721.51
|
| Rate for Payer: PACE SWMI |
$687.15
|
| Rate for Payer: PHP Medicare Advantage |
$687.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.05
|
| Rate for Payer: Priority Health Medicare |
$687.15
|
| Rate for Payer: Priority Health Narrow Network |
$866.05
|
| Rate for Payer: UHC Medicare Advantage |
$707.76
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$1,305.00
|
| Rate for Payer: ASR ASR |
$1,406.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.18
|
| Rate for Payer: BCN Commercial |
$1,124.18
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$1,363.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.00
|
| Rate for Payer: Healthscope Commercial |
$1,450.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.50
|
| Rate for Payer: Mclaren Commercial |
$1,305.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,276.00
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$920.78
|
| Rate for Payer: Aetna Medicare |
$687.15
|
| Rate for Payer: BCBS Complete |
$475.70
|
| Rate for Payer: BCBS MAPPO |
$687.15
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$687.15
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$989.50
|
| Rate for Payer: Cofinity Commercial |
$920.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.15
|
| Rate for Payer: Healthscope Commercial |
$824.58
|
| Rate for Payer: Healthscope Whirlpool |
$824.58
|
| Rate for Payer: Meridian Medicaid |
$475.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$721.51
|
| Rate for Payer: PACE SWMI |
$687.15
|
| Rate for Payer: PHP Medicare Advantage |
$687.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.05
|
| Rate for Payer: Priority Health Medicare |
$687.15
|
| Rate for Payer: Priority Health Narrow Network |
$866.05
|
| Rate for Payer: UHC Medicare Advantage |
$707.76
|
|
