|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$1,449.66 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,449.66
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
|
|
PR APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$1,039.69 |
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Medicare |
$19.05
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.69
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Medicare Advantage |
$19.05
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$27.43
|
| Rate for Payer: Cofinity Commercial |
$25.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$22.86
|
| Rate for Payer: Healthscope Whirlpool |
$22.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.00
|
| Rate for Payer: PACE SWMI |
$19.05
|
| Rate for Payer: PHP Medicare Advantage |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$19.05
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$19.62
|
|
|
PR APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$18.71
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$13.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.00
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.96
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$18.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Healthscope Whirlpool |
$16.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.66
|
| Rate for Payer: PACE SWMI |
$13.96
|
| Rate for Payer: PHP Medicare Advantage |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$13.96
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.38
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$121.19 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS MAPPO |
$44.48
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: BCN Medicare Advantage |
$44.48
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$64.05
|
| Rate for Payer: Cofinity Commercial |
$59.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.48
|
| Rate for Payer: Healthscope Commercial |
$53.38
|
| Rate for Payer: Healthscope Whirlpool |
$53.38
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.70
|
| Rate for Payer: PACE SWMI |
$44.48
|
| Rate for Payer: PHP Medicare Advantage |
$44.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.67
|
| Rate for Payer: Priority Health Medicare |
$44.48
|
| Rate for Payer: Priority Health Narrow Network |
$54.67
|
| Rate for Payer: UHC Medicare Advantage |
$45.81
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$258.94
|
| Rate for Payer: Aetna Medicare |
$193.24
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$193.24
|
| Rate for Payer: BCBS Trust/PPO |
$383.40
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: BCN Medicare Advantage |
$193.24
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cofinity Commercial |
$278.27
|
| Rate for Payer: Cofinity Commercial |
$258.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.24
|
| Rate for Payer: Healthscope Commercial |
$231.89
|
| Rate for Payer: Healthscope Whirlpool |
$231.89
|
| Rate for Payer: Meridian Medicaid |
$129.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.90
|
| Rate for Payer: PACE SWMI |
$193.24
|
| Rate for Payer: PHP Medicare Advantage |
$193.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.41
|
| Rate for Payer: Priority Health Medicare |
$193.24
|
| Rate for Payer: Priority Health Narrow Network |
$238.41
|
| Rate for Payer: UHC Medicare Advantage |
$199.04
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$109.89
|
| Rate for Payer: Aetna Medicare |
$82.01
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS MAPPO |
$82.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: BCN Medicare Advantage |
$82.01
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Cofinity Commercial |
$118.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.01
|
| Rate for Payer: Healthscope Commercial |
$98.41
|
| Rate for Payer: Healthscope Whirlpool |
$98.41
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.11
|
| Rate for Payer: PACE SWMI |
$82.01
|
| Rate for Payer: PHP Medicare Advantage |
$82.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.52
|
| Rate for Payer: Priority Health Medicare |
$82.01
|
| Rate for Payer: Priority Health Narrow Network |
$101.52
|
| Rate for Payer: UHC Medicare Advantage |
$84.47
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$2,026.22 |
| Rate for Payer: Aetna Commercial |
$245.70
|
| 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 |
$264.81
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$211.66
|
| Rate for Payer: BCN Commercial |
$211.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$273.00
|
| Rate for Payer: Healthscope Whirlpool |
$264.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$245.70
|
| 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 |
$232.05
|
| 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 |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.43
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$193.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$245.70
|
| Rate for Payer: ASR ASR |
$264.81
|
| Rate for Payer: BCBS Trust/PPO |
$211.66
|
| Rate for Payer: BCN Commercial |
$211.66
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Healthscope Commercial |
$273.00
|
| Rate for Payer: Healthscope Whirlpool |
$264.81
|
| Rate for Payer: Mclaren Commercial |
$245.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.24
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$109.89
|
| Rate for Payer: Aetna Medicare |
$82.01
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS MAPPO |
$82.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: BCN Medicare Advantage |
$82.01
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$118.09
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.01
|
| Rate for Payer: Healthscope Commercial |
$98.41
|
| Rate for Payer: Healthscope Whirlpool |
$98.41
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.11
|
| Rate for Payer: PACE SWMI |
$82.01
|
| Rate for Payer: PHP Medicare Advantage |
$82.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.52
|
| Rate for Payer: Priority Health Medicare |
$82.01
|
| Rate for Payer: Priority Health Narrow Network |
$101.52
|
| Rate for Payer: UHC Medicare Advantage |
$84.47
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$21.91
|
| Rate for Payer: Aetna Medicare |
$16.35
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS MAPPO |
$16.35
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$16.35
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$21.91
|
| Rate for Payer: Cofinity Commercial |
$23.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.35
|
| Rate for Payer: Healthscope Commercial |
$19.62
|
| Rate for Payer: Healthscope Whirlpool |
$19.62
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.17
|
| Rate for Payer: PACE SWMI |
$16.35
|
| Rate for Payer: PHP Medicare Advantage |
$16.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.14
|
| Rate for Payer: Priority Health Medicare |
$16.35
|
| Rate for Payer: Priority Health Narrow Network |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$16.84
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Aetna Commercial |
$878.09
|
| Rate for Payer: Aetna Medicare |
$655.29
|
| Rate for Payer: BCBS Complete |
$452.22
|
| Rate for Payer: BCBS MAPPO |
$655.29
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Commercial |
$978.82
|
| Rate for Payer: BCN Medicare Advantage |
$655.29
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$943.62
|
| Rate for Payer: Cofinity Commercial |
$878.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.29
|
| Rate for Payer: Healthscope Commercial |
$786.35
|
| Rate for Payer: Healthscope Whirlpool |
$786.35
|
| Rate for Payer: Meridian Medicaid |
$452.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$688.05
|
| Rate for Payer: PACE SWMI |
$655.29
|
| Rate for Payer: PHP Medicare Advantage |
$655.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,022.83
|
| Rate for Payer: Priority Health Medicare |
$655.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,022.83
|
| Rate for Payer: UHC Medicare Advantage |
$674.95
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$296.92 |
| Max. Negotiated Rate |
$1,044.40 |
| Rate for Payer: Aetna Commercial |
$600.43
|
| Rate for Payer: Aetna Medicare |
$448.08
|
| Rate for Payer: BCBS Complete |
$311.77
|
| Rate for Payer: BCBS MAPPO |
$448.08
|
| Rate for Payer: BCBS Trust/PPO |
$512.98
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: BCN Medicare Advantage |
$448.08
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cofinity Commercial |
$645.24
|
| Rate for Payer: Cofinity Commercial |
$600.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.08
|
| Rate for Payer: Healthscope Commercial |
$537.70
|
| Rate for Payer: Healthscope Whirlpool |
$537.70
|
| Rate for Payer: Meridian Medicaid |
$311.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$470.48
|
| Rate for Payer: PACE SWMI |
$448.08
|
| Rate for Payer: PHP Medicare Advantage |
$448.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.68
|
| Rate for Payer: Priority Health Medicare |
$448.08
|
| Rate for Payer: Priority Health Narrow Network |
$703.68
|
| Rate for Payer: UHC Medicare Advantage |
$461.52
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$1,402.00
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$981.40 |
| Rate for Payer: Aetna Commercial |
$778.66
|
| Rate for Payer: Aetna Medicare |
$581.09
|
| Rate for Payer: BCBS Complete |
$402.12
|
| Rate for Payer: BCBS MAPPO |
$581.09
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: BCN Commercial |
$869.36
|
| Rate for Payer: BCN Medicare Advantage |
$581.09
|
| Rate for Payer: Cash Price |
$1,121.60
|
| Rate for Payer: Cash Price |
$1,121.60
|
| Rate for Payer: Cofinity Commercial |
$836.77
|
| Rate for Payer: Cofinity Commercial |
$778.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.09
|
| Rate for Payer: Healthscope Commercial |
$697.31
|
| Rate for Payer: Healthscope Whirlpool |
$697.31
|
| Rate for Payer: Meridian Medicaid |
$402.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$610.14
|
| Rate for Payer: PACE SWMI |
$581.09
|
| Rate for Payer: PHP Medicare Advantage |
$581.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.44
|
| Rate for Payer: Priority Health Medicare |
$581.09
|
| Rate for Payer: Priority Health Narrow Network |
$908.44
|
| Rate for Payer: UHC Medicare Advantage |
$598.52
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$2,899.00
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$237.21 |
| Max. Negotiated Rate |
$2,029.30 |
| Rate for Payer: Aetna Commercial |
$870.92
|
| Rate for Payer: Aetna Medicare |
$649.94
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS MAPPO |
$649.94
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$971.00
|
| Rate for Payer: BCN Medicare Advantage |
$649.94
|
| Rate for Payer: Cash Price |
$2,319.20
|
| Rate for Payer: Cash Price |
$2,319.20
|
| Rate for Payer: Cofinity Commercial |
$935.91
|
| Rate for Payer: Cofinity Commercial |
$870.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.94
|
| Rate for Payer: Healthscope Commercial |
$779.93
|
| Rate for Payer: Healthscope Whirlpool |
$779.93
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$682.44
|
| Rate for Payer: PACE SWMI |
$649.94
|
| Rate for Payer: PHP Medicare Advantage |
$649.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,029.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,014.66
|
| Rate for Payer: Priority Health Medicare |
$649.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,014.66
|
| Rate for Payer: UHC Medicare Advantage |
$669.44
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$503.53 |
| Max. Negotiated Rate |
$2,852.82 |
| Rate for Payer: Aetna Commercial |
$1,027.82
|
| Rate for Payer: Aetna Medicare |
$767.03
|
| Rate for Payer: BCBS Complete |
$528.71
|
| Rate for Payer: BCBS MAPPO |
$767.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.82
|
| Rate for Payer: BCN Commercial |
$1,144.48
|
| Rate for Payer: BCN Medicare Advantage |
$767.03
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,027.82
|
| Rate for Payer: Cofinity Commercial |
$1,104.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.03
|
| Rate for Payer: Healthscope Commercial |
$920.44
|
| Rate for Payer: Healthscope Whirlpool |
$920.44
|
| Rate for Payer: Meridian Medicaid |
$528.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$805.38
|
| Rate for Payer: PACE SWMI |
$767.03
|
| Rate for Payer: PHP Medicare Advantage |
$767.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$503.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.94
|
| Rate for Payer: Priority Health Medicare |
$767.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.94
|
| Rate for Payer: UHC Medicare Advantage |
$790.04
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$3,038.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$592.35 |
| Max. Negotiated Rate |
$2,126.60 |
| Rate for Payer: Aetna Commercial |
$1,214.78
|
| Rate for Payer: Aetna Medicare |
$906.55
|
| Rate for Payer: BCBS Complete |
$621.97
|
| Rate for Payer: BCBS MAPPO |
$906.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.73
|
| Rate for Payer: BCN Commercial |
$1,348.75
|
| Rate for Payer: BCN Medicare Advantage |
$906.55
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cash Price |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$1,305.43
|
| Rate for Payer: Cofinity Commercial |
$1,214.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$906.55
|
| Rate for Payer: Healthscope Commercial |
$1,087.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.86
|
| Rate for Payer: Meridian Medicaid |
$621.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$951.88
|
| Rate for Payer: PACE SWMI |
$906.55
|
| Rate for Payer: PHP Medicare Advantage |
$906.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,409.40
|
| Rate for Payer: Priority Health Medicare |
$906.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,409.40
|
| Rate for Payer: UHC Medicare Advantage |
$933.75
|
|
|
PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 36600
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$789.28 |
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Aetna Medicare |
$14.66
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$789.28
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: BCN Medicare Advantage |
$14.66
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$21.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Healthscope Whirlpool |
$17.59
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.39
|
| Rate for Payer: PACE SWMI |
$14.66
|
| Rate for Payer: PHP Medicare Advantage |
$14.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.41
|
| Rate for Payer: Priority Health Medicare |
$14.66
|
| Rate for Payer: Priority Health Narrow Network |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$15.10
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$413.01 |
| Max. Negotiated Rate |
$1,535.80 |
| Rate for Payer: Aetna Commercial |
$870.46
|
| Rate for Payer: Aetna Medicare |
$649.60
|
| Rate for Payer: BCBS Complete |
$433.66
|
| Rate for Payer: BCBS MAPPO |
$649.60
|
| Rate for Payer: BCBS Trust/PPO |
$869.05
|
| Rate for Payer: BCN Commercial |
$946.08
|
| Rate for Payer: BCN Medicare Advantage |
$649.60
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Cash Price |
$1,755.20
|
| Rate for Payer: Cofinity Commercial |
$870.46
|
| Rate for Payer: Cofinity Commercial |
$935.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.60
|
| Rate for Payer: Healthscope Commercial |
$779.52
|
| Rate for Payer: Healthscope Whirlpool |
$779.52
|
| Rate for Payer: Meridian Medicaid |
$433.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$682.08
|
| Rate for Payer: PACE SWMI |
$649.60
|
| Rate for Payer: PHP Medicare Advantage |
$649.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.88
|
| Rate for Payer: Priority Health Medicare |
$649.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.88
|
| Rate for Payer: UHC Medicare Advantage |
$669.09
|
|
|
PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 33987
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$321.84 |
| Rate for Payer: Aetna Commercial |
$273.41
|
| Rate for Payer: Aetna Medicare |
$204.04
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$204.04
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$295.65
|
| Rate for Payer: BCN Medicare Advantage |
$204.04
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cofinity Commercial |
$293.82
|
| Rate for Payer: Cofinity Commercial |
$273.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.04
|
| Rate for Payer: Healthscope Commercial |
$244.85
|
| Rate for Payer: Healthscope Whirlpool |
$244.85
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.24
|
| Rate for Payer: PACE SWMI |
$204.04
|
| Rate for Payer: PHP Medicare Advantage |
$204.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.84
|
| Rate for Payer: Priority Health Medicare |
$204.04
|
| Rate for Payer: Priority Health Narrow Network |
$321.84
|
| Rate for Payer: UHC Medicare Advantage |
$210.16
|
|
|
PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
|
Professional
|
Both
|
$4,329.00
|
|
|
Service Code
|
HCPCS 22551
|
| Min. Negotiated Rate |
$1,096.95 |
| Max. Negotiated Rate |
$12,500.50 |
| Rate for Payer: Aetna Commercial |
$2,277.06
|
| Rate for Payer: Aetna Medicare |
$1,699.30
|
| Rate for Payer: BCBS Complete |
$1,151.80
|
| Rate for Payer: BCBS MAPPO |
$1,699.30
|
| Rate for Payer: BCBS Trust/PPO |
$12,500.50
|
| Rate for Payer: BCN Commercial |
$2,498.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,699.30
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cofinity Commercial |
$2,277.06
|
| Rate for Payer: Cofinity Commercial |
$2,446.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,699.30
|
| Rate for Payer: Healthscope Commercial |
$2,039.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,039.16
|
| Rate for Payer: Meridian Medicaid |
$1,151.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,784.26
|
| Rate for Payer: PACE SWMI |
$1,699.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,699.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,096.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,610.95
|
| Rate for Payer: Priority Health Medicare |
$1,699.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,610.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,750.28
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2
|
Professional
|
Both
|
$4,820.00
|
|
|
Service Code
|
HCPCS 22554
|
| Min. Negotiated Rate |
$407.75 |
| Max. Negotiated Rate |
$3,374.00 |
| Rate for Payer: Aetna Commercial |
$1,685.18
|
| Rate for Payer: Aetna Medicare |
$1,257.60
|
| Rate for Payer: BCBS Complete |
$857.47
|
| Rate for Payer: BCBS MAPPO |
$1,257.60
|
| Rate for Payer: BCBS Trust/PPO |
$407.75
|
| Rate for Payer: BCN Commercial |
$2,043.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.60
|
| Rate for Payer: Cash Price |
$3,856.00
|
| Rate for Payer: Cash Price |
$3,856.00
|
| Rate for Payer: Cofinity Commercial |
$1,685.18
|
| Rate for Payer: Cofinity Commercial |
$1,810.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.60
|
| Rate for Payer: Healthscope Commercial |
$1,509.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,509.12
|
| Rate for Payer: Meridian Medicaid |
$857.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,320.48
|
| Rate for Payer: PACE SWMI |
$1,257.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$816.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,374.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,939.45
|
| Rate for Payer: Priority Health Medicare |
$1,257.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,939.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,295.33
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC LUMBAR
|
Professional
|
Both
|
$3,127.92
|
|
|
Service Code
|
HCPCS 22558
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,462.22 |
| Rate for Payer: Aetna Commercial |
$2,035.57
|
| Rate for Payer: Aetna Medicare |
$1,519.08
|
| Rate for Payer: BCBS Complete |
$1,029.91
|
| Rate for Payer: BCBS MAPPO |
$1,519.08
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$2,462.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,519.08
|
| Rate for Payer: Cash Price |
$2,502.34
|
| Rate for Payer: Cash Price |
$2,502.34
|
| Rate for Payer: Cofinity Commercial |
$2,035.57
|
| Rate for Payer: Cofinity Commercial |
$2,187.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,519.08
|
| Rate for Payer: Healthscope Commercial |
$1,822.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,822.90
|
| Rate for Payer: Meridian Medicaid |
$1,029.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,595.03
|
| Rate for Payer: PACE SWMI |
$1,519.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,519.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$980.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,336.74
|
| Rate for Payer: Priority Health Medicare |
$1,519.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,336.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,564.65
|
|
|
PR ARTHRD ANT INTERBODY MIN DSC THORACIC
|
Professional
|
Both
|
$5,866.00
|
|
|
Service Code
|
HCPCS 22556
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$4,106.20 |
| Rate for Payer: Aetna Commercial |
$2,230.98
|
| Rate for Payer: Aetna Medicare |
$1,664.91
|
| Rate for Payer: BCBS Complete |
$1,141.74
|
| Rate for Payer: BCBS MAPPO |
$1,664.91
|
| Rate for Payer: BCBS Trust/PPO |
$350.50
|
| Rate for Payer: BCN Commercial |
$2,700.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,664.91
|
| Rate for Payer: Cash Price |
$4,692.80
|
| Rate for Payer: Cash Price |
$4,692.80
|
| Rate for Payer: Cofinity Commercial |
$2,397.47
|
| Rate for Payer: Cofinity Commercial |
$2,230.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,664.91
|
| Rate for Payer: Healthscope Commercial |
$1,997.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,997.89
|
| Rate for Payer: Meridian Medicaid |
$1,141.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,748.16
|
| Rate for Payer: PACE SWMI |
$1,664.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,664.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,562.95
|
| Rate for Payer: Priority Health Medicare |
$1,664.91
|
| Rate for Payer: Priority Health Narrow Network |
$2,562.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,714.86
|
|
|
PR ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 22552
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$707.70 |
| Rate for Payer: Aetna Commercial |
$529.98
|
| Rate for Payer: Aetna Medicare |
$395.51
|
| Rate for Payer: BCBS Complete |
$265.03
|
| Rate for Payer: BCBS MAPPO |
$395.51
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$576.64
|
| Rate for Payer: BCN Medicare Advantage |
$395.51
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cofinity Commercial |
$569.53
|
| Rate for Payer: Cofinity Commercial |
$529.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.51
|
| Rate for Payer: Healthscope Commercial |
$474.61
|
| Rate for Payer: Healthscope Whirlpool |
$474.61
|
| Rate for Payer: Meridian Medicaid |
$265.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$415.29
|
| Rate for Payer: PACE SWMI |
$395.51
|
| Rate for Payer: PHP Medicare Advantage |
$395.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.57
|
| Rate for Payer: Priority Health Medicare |
$395.51
|
| Rate for Payer: Priority Health Narrow Network |
$602.57
|
| Rate for Payer: UHC Medicare Advantage |
$407.38
|
|
|
PR ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
HCPCS 22585
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$1,143.80 |
| Rate for Payer: Aetna Commercial |
$434.66
|
| Rate for Payer: Aetna Medicare |
$324.37
|
| Rate for Payer: BCBS Complete |
$216.72
|
| Rate for Payer: BCBS MAPPO |
$324.37
|
| Rate for Payer: BCBS Trust/PPO |
$233.52
|
| Rate for Payer: BCN Commercial |
$520.86
|
| Rate for Payer: BCN Medicare Advantage |
$324.37
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cash Price |
$1,307.20
|
| Rate for Payer: Cofinity Commercial |
$467.09
|
| Rate for Payer: Cofinity Commercial |
$434.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.37
|
| Rate for Payer: Healthscope Commercial |
$389.24
|
| Rate for Payer: Healthscope Whirlpool |
$389.24
|
| Rate for Payer: Meridian Medicaid |
$216.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.59
|
| Rate for Payer: PACE SWMI |
$324.37
|
| Rate for Payer: PHP Medicare Advantage |
$324.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$494.31
|
| Rate for Payer: Priority Health Medicare |
$324.37
|
| Rate for Payer: Priority Health Narrow Network |
$494.31
|
| Rate for Payer: UHC Medicare Advantage |
$334.10
|
|
