|
PR CARDIOPULMONARY EXERCISE TESTING
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 94621
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$256.23 |
| Rate for Payer: Aetna Commercial |
$195.28
|
| Rate for Payer: Aetna Medicare |
$145.73
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$145.73
|
| Rate for Payer: BCBS Trust/PPO |
$256.23
|
| Rate for Payer: BCN Commercial |
$222.83
|
| Rate for Payer: BCN Medicare Advantage |
$145.73
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$209.85
|
| Rate for Payer: Cofinity Commercial |
$195.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.73
|
| Rate for Payer: Healthscope Commercial |
$174.88
|
| Rate for Payer: Healthscope Whirlpool |
$174.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.02
|
| Rate for Payer: PACE SWMI |
$145.73
|
| Rate for Payer: PHP Medicare Advantage |
$145.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.81
|
| Rate for Payer: Priority Health Medicare |
$145.73
|
| Rate for Payer: Priority Health Narrow Network |
$204.81
|
| Rate for Payer: UHC Medicare Advantage |
$150.10
|
|
|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$115.23 |
| Max. Negotiated Rate |
$2,166.03 |
| Rate for Payer: Aetna Commercial |
$241.58
|
| Rate for Payer: Aetna Medicare |
$180.28
|
| Rate for Payer: BCBS Complete |
$120.99
|
| Rate for Payer: BCBS MAPPO |
$180.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.03
|
| Rate for Payer: BCN Commercial |
$475.97
|
| Rate for Payer: BCN Medicare Advantage |
$180.28
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cofinity Commercial |
$241.58
|
| Rate for Payer: Cofinity Commercial |
$259.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.28
|
| Rate for Payer: Healthscope Commercial |
$216.34
|
| Rate for Payer: Healthscope Whirlpool |
$216.34
|
| Rate for Payer: Meridian Medicaid |
$120.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$189.29
|
| Rate for Payer: PACE SWMI |
$180.28
|
| Rate for Payer: PHP Medicare Advantage |
$180.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.40
|
| Rate for Payer: Priority Health Medicare |
$180.28
|
| Rate for Payer: Priority Health Narrow Network |
$254.40
|
| Rate for Payer: UHC Medicare Advantage |
$185.69
|
|
|
PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP
|
Professional
|
Both
|
$6,712.00
|
|
|
Service Code
|
HCPCS 33315
|
| Min. Negotiated Rate |
$1,201.32 |
| Max. Negotiated Rate |
$4,698.40 |
| Rate for Payer: Aetna Commercial |
$2,526.90
|
| Rate for Payer: Aetna Medicare |
$1,885.75
|
| Rate for Payer: BCBS Complete |
$1,261.39
|
| Rate for Payer: BCBS MAPPO |
$1,885.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,311.77
|
| Rate for Payer: BCN Commercial |
$2,745.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,885.75
|
| Rate for Payer: Cash Price |
$5,369.60
|
| Rate for Payer: Cash Price |
$5,369.60
|
| Rate for Payer: Cofinity Commercial |
$2,715.48
|
| Rate for Payer: Cofinity Commercial |
$2,526.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,885.75
|
| Rate for Payer: Healthscope Commercial |
$2,262.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,262.90
|
| Rate for Payer: Meridian Medicaid |
$1,261.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,980.04
|
| Rate for Payer: PACE SWMI |
$1,885.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,885.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,201.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,698.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,988.53
|
| Rate for Payer: Priority Health Medicare |
$1,885.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,988.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,942.32
|
|
|
PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP
|
Professional
|
Both
|
$4,528.00
|
|
|
Service Code
|
HCPCS 33310
|
| Min. Negotiated Rate |
$733.15 |
| Max. Negotiated Rate |
$3,169.60 |
| Rate for Payer: Aetna Commercial |
$1,537.57
|
| Rate for Payer: Aetna Medicare |
$1,147.44
|
| Rate for Payer: BCBS Complete |
$769.81
|
| Rate for Payer: BCBS MAPPO |
$1,147.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.64
|
| Rate for Payer: BCN Commercial |
$1,678.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,147.44
|
| Rate for Payer: Cash Price |
$3,622.40
|
| Rate for Payer: Cash Price |
$3,622.40
|
| Rate for Payer: Cofinity Commercial |
$1,652.31
|
| Rate for Payer: Cofinity Commercial |
$1,537.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,147.44
|
| Rate for Payer: Healthscope Commercial |
$1,376.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.93
|
| Rate for Payer: Meridian Medicaid |
$769.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,204.81
|
| Rate for Payer: PACE SWMI |
$1,147.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,147.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,169.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,827.28
|
| Rate for Payer: Priority Health Medicare |
$1,147.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,827.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,181.86
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 93660
|
| Min. Negotiated Rate |
$153.82 |
| Max. Negotiated Rate |
$3,564.97 |
| Rate for Payer: Aetna Commercial |
$206.12
|
| Rate for Payer: Aetna Medicare |
$153.82
|
| Rate for Payer: BCBS Complete |
$224.80
|
| Rate for Payer: BCBS MAPPO |
$153.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,564.97
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: BCN Medicare Advantage |
$153.82
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$206.12
|
| Rate for Payer: Cofinity Commercial |
$221.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.82
|
| Rate for Payer: Healthscope Commercial |
$184.58
|
| Rate for Payer: Healthscope Whirlpool |
$184.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.51
|
| Rate for Payer: PACE SWMI |
$153.82
|
| Rate for Payer: PHP Medicare Advantage |
$153.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.03
|
| Rate for Payer: Priority Health Medicare |
$153.82
|
| Rate for Payer: Priority Health Narrow Network |
$226.03
|
| Rate for Payer: UHC Medicare Advantage |
$158.43
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
92960
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$343.70 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna Medicare |
$105.46
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS MAPPO |
$105.46
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$248.59
|
| Rate for Payer: BCN Medicare Advantage |
$105.46
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$151.86
|
| Rate for Payer: Cofinity Commercial |
$141.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$126.55
|
| Rate for Payer: Healthscope Whirlpool |
$126.55
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.73
|
| Rate for Payer: PACE SWMI |
$105.46
|
| Rate for Payer: PHP Medicare Advantage |
$105.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.84
|
| Rate for Payer: Priority Health Medicare |
$105.46
|
| Rate for Payer: Priority Health Narrow Network |
$150.84
|
| Rate for Payer: UHC Medicare Advantage |
$108.62
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$343.70 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna Medicare |
$105.46
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS MAPPO |
$105.46
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$248.59
|
| Rate for Payer: BCN Medicare Advantage |
$105.46
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$151.86
|
| Rate for Payer: Cofinity Commercial |
$141.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$126.55
|
| Rate for Payer: Healthscope Whirlpool |
$126.55
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.73
|
| Rate for Payer: PACE SWMI |
$105.46
|
| Rate for Payer: PHP Medicare Advantage |
$105.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.84
|
| Rate for Payer: Priority Health Medicare |
$105.46
|
| Rate for Payer: Priority Health Narrow Network |
$150.84
|
| Rate for Payer: UHC Medicare Advantage |
$108.62
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$316.44 |
| Max. Negotiated Rate |
$763.48 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Medicare |
$578.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.12
|
| Rate for Payer: ASR ASR |
$476.27
|
| Rate for Payer: BCBS Complete |
$332.29
|
| Rate for Payer: BCBS MAPPO |
$578.50
|
| Rate for Payer: BCBS Trust/PPO |
$380.67
|
| Rate for Payer: BCN Commercial |
$380.67
|
| Rate for Payer: BCN Medicare Advantage |
$578.50
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$461.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.50
|
| Rate for Payer: Healthscope Commercial |
$491.00
|
| Rate for Payer: Healthscope Whirlpool |
$476.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$578.50
|
| Rate for Payer: Mclaren Commercial |
$441.90
|
| Rate for Payer: Mclaren Medicaid |
$316.44
|
| Rate for Payer: Mclaren Medicare |
$578.50
|
| Rate for Payer: Meridian Medicaid |
$332.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$607.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.35
|
| Rate for Payer: PACE Medicare |
$549.58
|
| Rate for Payer: PACE SWMI |
$578.50
|
| Rate for Payer: PHP Commercial |
$636.35
|
| Rate for Payer: PHP Medicaid |
$316.44
|
| Rate for Payer: PHP Medicare Advantage |
$578.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$763.48
|
| Rate for Payer: Priority Health Medicare |
$578.50
|
| Rate for Payer: Priority Health Narrow Network |
$610.78
|
| Rate for Payer: Railroad Medicare Medicare |
$578.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.08
|
| Rate for Payer: UHC Medicare Advantage |
$595.86
|
| Rate for Payer: VA VA |
$578.50
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$343.70 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: ASR ASR |
$476.27
|
| Rate for Payer: BCBS Trust/PPO |
$380.67
|
| Rate for Payer: BCN Commercial |
$380.67
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$461.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Healthscope Commercial |
$491.00
|
| Rate for Payer: Healthscope Whirlpool |
$476.27
|
| Rate for Payer: Mclaren Commercial |
$441.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.08
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$349.89 |
| Rate for Payer: Aetna Commercial |
$320.55
|
| Rate for Payer: Aetna Medicare |
$239.22
|
| Rate for Payer: BCBS Complete |
$160.14
|
| Rate for Payer: BCBS MAPPO |
$239.22
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$349.89
|
| Rate for Payer: BCN Medicare Advantage |
$239.22
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$344.48
|
| Rate for Payer: Cofinity Commercial |
$320.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.22
|
| Rate for Payer: Healthscope Commercial |
$287.06
|
| Rate for Payer: Healthscope Whirlpool |
$287.06
|
| Rate for Payer: Meridian Medicaid |
$160.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.18
|
| Rate for Payer: PACE SWMI |
$239.22
|
| Rate for Payer: PHP Medicare Advantage |
$239.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.57
|
| Rate for Payer: Priority Health Medicare |
$239.22
|
| Rate for Payer: Priority Health Narrow Network |
$338.57
|
| Rate for Payer: UHC Medicare Advantage |
$246.40
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare |
$2.47
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$2.47
|
| Rate for Payer: BCBS Trust/PPO |
$179.62
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$2.47
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.47
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Healthscope Whirlpool |
$2.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.59
|
| Rate for Payer: PACE SWMI |
$2.47
|
| Rate for Payer: PHP Medicare Advantage |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.43
|
| Rate for Payer: Priority Health Medicare |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.43
|
| Rate for Payer: UHC Medicare Advantage |
$2.54
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$594.87 |
| Rate for Payer: Aetna Commercial |
$38.75
|
| Rate for Payer: Aetna Medicare |
$28.92
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$28.92
|
| Rate for Payer: BCBS Trust/PPO |
$594.87
|
| Rate for Payer: BCN Commercial |
$58.04
|
| Rate for Payer: BCN Medicare Advantage |
$28.92
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$41.64
|
| Rate for Payer: Cofinity Commercial |
$38.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Healthscope Whirlpool |
$31.81
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.37
|
| Rate for Payer: PACE SWMI |
$28.92
|
| Rate for Payer: PHP Medicare Advantage |
$28.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.26
|
| Rate for Payer: Priority Health Medicare |
$28.92
|
| Rate for Payer: Priority Health Narrow Network |
$37.26
|
| Rate for Payer: UHC Medicare Advantage |
$29.79
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,167.60 |
| Rate for Payer: Aetna Commercial |
$652.47
|
| Rate for Payer: Aetna Medicare |
$486.92
|
| Rate for Payer: BCBS Complete |
$338.60
|
| Rate for Payer: BCBS MAPPO |
$486.92
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: BCN Commercial |
$731.55
|
| Rate for Payer: BCN Medicare Advantage |
$486.92
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$701.16
|
| Rate for Payer: Cofinity Commercial |
$652.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.92
|
| Rate for Payer: Healthscope Commercial |
$584.30
|
| Rate for Payer: Healthscope Whirlpool |
$584.30
|
| Rate for Payer: Meridian Medicaid |
$338.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$511.27
|
| Rate for Payer: PACE SWMI |
$486.92
|
| Rate for Payer: PHP Medicare Advantage |
$486.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.44
|
| Rate for Payer: Priority Health Medicare |
$486.92
|
| Rate for Payer: Priority Health Narrow Network |
$764.44
|
| Rate for Payer: UHC Medicare Advantage |
$501.53
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,668.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$1,668.00 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: ASR ASR |
$1,617.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.20
|
| Rate for Payer: BCN Commercial |
$1,293.20
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,567.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.40
|
| Rate for Payer: Healthscope Commercial |
$1,668.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,617.96
|
| Rate for Payer: Mclaren Commercial |
$1,501.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,467.84
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,668.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$3,596.44 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Aetna Medicare |
$2,877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: ASR ASR |
$1,617.96
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.20
|
| Rate for Payer: BCN Commercial |
$1,293.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,567.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,668.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,617.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,877.15
|
| Rate for Payer: Mclaren Commercial |
$1,501.20
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.80
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$3,164.86
|
| Rate for Payer: PHP Medicaid |
$1,573.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.88
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,467.84
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,167.60 |
| Rate for Payer: Aetna Commercial |
$652.47
|
| Rate for Payer: Aetna Medicare |
$486.92
|
| Rate for Payer: BCBS Complete |
$338.60
|
| Rate for Payer: BCBS MAPPO |
$486.92
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: BCN Commercial |
$731.55
|
| Rate for Payer: BCN Medicare Advantage |
$486.92
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$701.16
|
| Rate for Payer: Cofinity Commercial |
$652.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.92
|
| Rate for Payer: Healthscope Commercial |
$584.30
|
| Rate for Payer: Healthscope Whirlpool |
$584.30
|
| Rate for Payer: Meridian Medicaid |
$338.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$511.27
|
| Rate for Payer: PACE SWMI |
$486.92
|
| Rate for Payer: PHP Medicare Advantage |
$486.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.44
|
| Rate for Payer: Priority Health Medicare |
$486.92
|
| Rate for Payer: Priority Health Narrow Network |
$764.44
|
| Rate for Payer: UHC Medicare Advantage |
$501.53
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$403.21 |
| Max. Negotiated Rate |
$1,570.80 |
| Rate for Payer: Aetna Commercial |
$819.85
|
| Rate for Payer: Aetna Medicare |
$611.83
|
| Rate for Payer: BCBS Complete |
$423.37
|
| Rate for Payer: BCBS MAPPO |
$611.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,436.98
|
| Rate for Payer: BCN Commercial |
$916.27
|
| Rate for Payer: BCN Medicare Advantage |
$611.83
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cofinity Commercial |
$881.04
|
| Rate for Payer: Cofinity Commercial |
$819.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.83
|
| Rate for Payer: Healthscope Commercial |
$734.20
|
| Rate for Payer: Healthscope Whirlpool |
$734.20
|
| Rate for Payer: Meridian Medicaid |
$423.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$642.42
|
| Rate for Payer: PACE SWMI |
$611.83
|
| Rate for Payer: PHP Medicare Advantage |
$611.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.48
|
| Rate for Payer: Priority Health Medicare |
$611.83
|
| Rate for Payer: Priority Health Narrow Network |
$957.48
|
| Rate for Payer: UHC Medicare Advantage |
$630.18
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$309.92 |
| Max. Negotiated Rate |
$8,557.53 |
| Rate for Payer: Aetna Commercial |
$624.36
|
| Rate for Payer: Aetna Medicare |
$465.94
|
| Rate for Payer: BCBS Complete |
$325.42
|
| Rate for Payer: BCBS MAPPO |
$465.94
|
| Rate for Payer: BCBS Trust/PPO |
$8,557.53
|
| Rate for Payer: BCN Commercial |
$701.25
|
| Rate for Payer: BCN Medicare Advantage |
$465.94
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$624.36
|
| Rate for Payer: Cofinity Commercial |
$670.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.94
|
| Rate for Payer: Healthscope Commercial |
$559.13
|
| Rate for Payer: Healthscope Whirlpool |
$559.13
|
| Rate for Payer: Meridian Medicaid |
$325.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.24
|
| Rate for Payer: PACE SWMI |
$465.94
|
| Rate for Payer: PHP Medicare Advantage |
$465.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.78
|
| Rate for Payer: Priority Health Medicare |
$465.94
|
| Rate for Payer: Priority Health Narrow Network |
$732.78
|
| Rate for Payer: UHC Medicare Advantage |
$479.92
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$739.43 |
| Rate for Payer: Aetna Commercial |
$632.77
|
| Rate for Payer: Aetna Medicare |
$472.22
|
| Rate for Payer: BCBS Complete |
$326.98
|
| Rate for Payer: BCBS MAPPO |
$472.22
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$707.61
|
| Rate for Payer: BCN Medicare Advantage |
$472.22
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$632.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.22
|
| Rate for Payer: Healthscope Commercial |
$566.66
|
| Rate for Payer: Healthscope Whirlpool |
$566.66
|
| Rate for Payer: Meridian Medicaid |
$326.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.83
|
| Rate for Payer: PACE SWMI |
$472.22
|
| Rate for Payer: PHP Medicare Advantage |
$472.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.43
|
| Rate for Payer: Priority Health Medicare |
$472.22
|
| Rate for Payer: Priority Health Narrow Network |
$739.43
|
| Rate for Payer: UHC Medicare Advantage |
$486.39
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$1,015.50 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Medicare |
$812.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: ASR ASR |
$389.94
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$311.67
|
| Rate for Payer: BCN Commercial |
$311.67
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$377.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$402.00
|
| Rate for Payer: Healthscope Whirlpool |
$389.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$361.80
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$893.64
|
| Rate for Payer: PHP Medicaid |
$444.38
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.82
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$285.42
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.76
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$72.48
|
| Rate for Payer: Aetna Medicare |
$54.09
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$54.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$54.09
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Cofinity Commercial |
$77.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$64.91
|
| Rate for Payer: Healthscope Whirlpool |
$64.91
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.79
|
| Rate for Payer: PACE SWMI |
$54.09
|
| Rate for Payer: PHP Medicare Advantage |
$54.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.01
|
| Rate for Payer: Priority Health Medicare |
$54.09
|
| Rate for Payer: Priority Health Narrow Network |
$97.01
|
| Rate for Payer: UHC Medicare Advantage |
$55.71
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: ASR ASR |
$389.94
|
| Rate for Payer: BCBS Trust/PPO |
$311.67
|
| Rate for Payer: BCN Commercial |
$311.67
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$377.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Healthscope Commercial |
$402.00
|
| Rate for Payer: Healthscope Whirlpool |
$389.94
|
| Rate for Payer: Mclaren Commercial |
$361.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.76
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$72.48
|
| Rate for Payer: Aetna Medicare |
$54.09
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$54.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$54.09
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$77.89
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$64.91
|
| Rate for Payer: Healthscope Whirlpool |
$64.91
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.79
|
| Rate for Payer: PACE SWMI |
$54.09
|
| Rate for Payer: PHP Medicare Advantage |
$54.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.01
|
| Rate for Payer: Priority Health Medicare |
$54.09
|
| Rate for Payer: Priority Health Narrow Network |
$97.01
|
| Rate for Payer: UHC Medicare Advantage |
$55.71
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$1,696.90 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$27.06
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.90
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$27.06
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$36.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$32.47
|
| Rate for Payer: Healthscope Whirlpool |
$32.47
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.41
|
| Rate for Payer: PACE SWMI |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$27.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.13
|
| Rate for Payer: Priority Health Medicare |
$27.06
|
| Rate for Payer: Priority Health Narrow Network |
$35.13
|
| Rate for Payer: UHC Medicare Advantage |
$27.87
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCN Commercial |
$26.15
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
|
