|
PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$2,950.00
|
|
|
Service Code
|
HCPCS 47605
|
| Min. Negotiated Rate |
$721.43 |
| Max. Negotiated Rate |
$2,065.00 |
| Rate for Payer: Aetna Commercial |
$1,504.03
|
| Rate for Payer: Aetna Medicare |
$1,122.41
|
| Rate for Payer: BCBS Complete |
$757.50
|
| Rate for Payer: BCBS MAPPO |
$1,122.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,918.79
|
| Rate for Payer: BCN Commercial |
$1,648.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,122.41
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cofinity Commercial |
$1,616.27
|
| Rate for Payer: Cofinity Commercial |
$1,504.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,122.41
|
| Rate for Payer: Healthscope Commercial |
$1,346.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,346.89
|
| Rate for Payer: Meridian Medicaid |
$757.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,178.53
|
| Rate for Payer: PACE SWMI |
$1,122.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,122.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.24
|
| Rate for Payer: Priority Health Medicare |
$1,122.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,983.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,156.08
|
|
|
PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT
|
Professional
|
Both
|
$3,245.00
|
|
|
Service Code
|
HCPCS 47610
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$2,271.50 |
| Rate for Payer: Aetna Commercial |
$1,671.44
|
| Rate for Payer: Aetna Medicare |
$1,247.34
|
| Rate for Payer: BCBS Complete |
$838.02
|
| Rate for Payer: BCBS MAPPO |
$1,247.34
|
| Rate for Payer: BCBS Trust/PPO |
$141.58
|
| Rate for Payer: BCN Commercial |
$1,829.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,247.34
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cofinity Commercial |
$1,671.44
|
| Rate for Payer: Cofinity Commercial |
$1,796.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,247.34
|
| Rate for Payer: Healthscope Commercial |
$1,496.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.81
|
| Rate for Payer: Meridian Medicaid |
$838.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,309.71
|
| Rate for Payer: PACE SWMI |
$1,247.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,247.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,271.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,200.79
|
| Rate for Payer: Priority Health Medicare |
$1,247.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,200.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,284.76
|
|
|
PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 47490
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$4,357.95 |
| Rate for Payer: Aetna Commercial |
$429.32
|
| Rate for Payer: Aetna Medicare |
$320.39
|
| Rate for Payer: BCBS Complete |
$218.96
|
| Rate for Payer: BCBS MAPPO |
$320.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,357.95
|
| Rate for Payer: BCN Commercial |
$480.37
|
| Rate for Payer: BCN Medicare Advantage |
$320.39
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$461.36
|
| Rate for Payer: Cofinity Commercial |
$429.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.39
|
| Rate for Payer: Healthscope Commercial |
$384.47
|
| Rate for Payer: Healthscope Whirlpool |
$384.47
|
| Rate for Payer: Meridian Medicaid |
$218.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.41
|
| Rate for Payer: PACE SWMI |
$320.39
|
| Rate for Payer: PHP Medicare Advantage |
$320.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.98
|
| Rate for Payer: Priority Health Medicare |
$320.39
|
| Rate for Payer: Priority Health Narrow Network |
$577.98
|
| Rate for Payer: UHC Medicare Advantage |
$330.00
|
|
|
PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP
|
Professional
|
Both
|
$2,358.00
|
|
|
Service Code
|
HCPCS 47420
|
| Min. Negotiated Rate |
$855.62 |
| Max. Negotiated Rate |
$2,338.95 |
| Rate for Payer: Aetna Commercial |
$1,774.33
|
| Rate for Payer: Aetna Medicare |
$1,324.13
|
| Rate for Payer: BCBS Complete |
$898.40
|
| Rate for Payer: BCBS MAPPO |
$1,324.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.71
|
| Rate for Payer: BCN Commercial |
$1,943.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,324.13
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cofinity Commercial |
$1,774.33
|
| Rate for Payer: Cofinity Commercial |
$1,906.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,324.13
|
| Rate for Payer: Healthscope Commercial |
$1,588.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,588.96
|
| Rate for Payer: Meridian Medicaid |
$898.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,390.34
|
| Rate for Payer: PACE SWMI |
$1,324.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,324.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,650.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,338.95
|
| Rate for Payer: Priority Health Medicare |
$1,324.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,338.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,363.85
|
|
|
PR CHOLERA IMMUNIZATION,INJECTABLE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 90725
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
|
|
PR CHOLINESTERASE INHIBITOR CHALLENGE TEST
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 95857
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$220.30 |
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: Aetna Medicare |
$27.75
|
| Rate for Payer: BCBS Complete |
$18.78
|
| Rate for Payer: BCBS MAPPO |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$220.30
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: BCN Medicare Advantage |
$27.75
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$37.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.75
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Healthscope Whirlpool |
$33.30
|
| Rate for Payer: Meridian Medicaid |
$18.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.14
|
| Rate for Payer: PACE SWMI |
$27.75
|
| Rate for Payer: PHP Medicare Advantage |
$27.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.73
|
| Rate for Payer: Priority Health Medicare |
$27.75
|
| Rate for Payer: Priority Health Narrow Network |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$28.58
|
|
|
PR CHORIONIC VILLUS SAMPLING
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 59015
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$175.58
|
| Rate for Payer: Aetna Medicare |
$131.03
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$131.03
|
| Rate for Payer: BCBS Trust/PPO |
$143.17
|
| Rate for Payer: BCN Commercial |
$231.15
|
| Rate for Payer: BCN Medicare Advantage |
$131.03
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$188.68
|
| Rate for Payer: Cofinity Commercial |
$175.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.03
|
| Rate for Payer: Healthscope Commercial |
$157.24
|
| Rate for Payer: Healthscope Whirlpool |
$157.24
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.58
|
| Rate for Payer: PACE SWMI |
$131.03
|
| Rate for Payer: PHP Medicare Advantage |
$131.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.62
|
| Rate for Payer: Priority Health Medicare |
$131.03
|
| Rate for Payer: Priority Health Narrow Network |
$184.62
|
| Rate for Payer: UHC Medicare Advantage |
$134.96
|
|
|
PR CHROMOTUBATION OVIDUCT W/MATERIALS
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 58350
|
| Min. Negotiated Rate |
$61.34 |
| Max. Negotiated Rate |
$508.22 |
| Rate for Payer: Aetna Commercial |
$124.77
|
| Rate for Payer: Aetna Medicare |
$93.11
|
| Rate for Payer: BCBS Complete |
$64.41
|
| Rate for Payer: BCBS MAPPO |
$93.11
|
| Rate for Payer: BCBS Trust/PPO |
$508.22
|
| Rate for Payer: BCN Commercial |
$228.22
|
| Rate for Payer: BCN Medicare Advantage |
$93.11
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Commercial |
$134.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.11
|
| Rate for Payer: Healthscope Commercial |
$111.73
|
| Rate for Payer: Healthscope Whirlpool |
$111.73
|
| Rate for Payer: Meridian Medicaid |
$64.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.77
|
| Rate for Payer: PACE SWMI |
$93.11
|
| Rate for Payer: PHP Medicare Advantage |
$93.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.35
|
| Rate for Payer: Priority Health Medicare |
$93.11
|
| Rate for Payer: Priority Health Narrow Network |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$95.90
|
|
|
PR CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE
|
Professional
|
Both
|
$3,466.00
|
|
|
Service Code
|
HCPCS 24940
|
| Min. Negotiated Rate |
$602.42 |
| Max. Negotiated Rate |
$11,675.93 |
| Rate for Payer: Aetna Commercial |
$1,439.82
|
| Rate for Payer: BCBS Complete |
$632.54
|
| Rate for Payer: BCBS Trust/PPO |
$730.11
|
| Rate for Payer: BCN Commercial |
$11,675.93
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Meridian Medicaid |
$632.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$602.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,426.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,668.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,668.80
|
|
|
PR CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 94772
|
| Min. Negotiated Rate |
$253.20 |
| Max. Negotiated Rate |
$544.82 |
| Rate for Payer: Aetna Commercial |
$318.52
|
| Rate for Payer: BCBS Complete |
$253.20
|
| Rate for Payer: BCBS Trust/PPO |
$518.79
|
| Rate for Payer: BCN Commercial |
$544.82
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.25
|
| Rate for Payer: Priority Health Narrow Network |
$417.25
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
54161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$990.33 |
| Max. Negotiated Rate |
$2,263.10 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Medicare |
$1,810.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: ASR ASR |
$1,467.61
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.03
|
| Rate for Payer: BCN Commercial |
$1,173.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,422.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Healthscope Commercial |
$1,513.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,467.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,810.48
|
| Rate for Payer: Mclaren Commercial |
$1,361.70
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,286.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Commercial |
$1,991.53
|
| Rate for Payer: PHP Medicaid |
$990.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,376.83
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,074.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,331.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
54161
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Aetna Commercial |
$258.00
|
| Rate for Payer: Aetna Medicare |
$192.54
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS MAPPO |
$192.54
|
| Rate for Payer: BCBS Trust/PPO |
$496.07
|
| Rate for Payer: BCN Commercial |
$285.39
|
| Rate for Payer: BCN Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$277.26
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.54
|
| Rate for Payer: Healthscope Commercial |
$231.05
|
| Rate for Payer: Healthscope Whirlpool |
$231.05
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.17
|
| Rate for Payer: PACE SWMI |
$192.54
|
| Rate for Payer: PHP Medicare Advantage |
$192.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.57
|
| Rate for Payer: Priority Health Medicare |
$192.54
|
| Rate for Payer: Priority Health Narrow Network |
$315.57
|
| Rate for Payer: UHC Medicare Advantage |
$198.32
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
54161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,059.10 |
| Max. Negotiated Rate |
$1,513.00 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: ASR ASR |
$1,467.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.03
|
| Rate for Payer: BCN Commercial |
$1,173.03
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,422.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.40
|
| Rate for Payer: Healthscope Commercial |
$1,513.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,467.61
|
| Rate for Payer: Mclaren Commercial |
$1,361.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,331.44
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 54161
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Aetna Commercial |
$258.00
|
| Rate for Payer: Aetna Medicare |
$192.54
|
| Rate for Payer: BCBS Complete |
$132.40
|
| Rate for Payer: BCBS MAPPO |
$192.54
|
| Rate for Payer: BCBS Trust/PPO |
$496.07
|
| Rate for Payer: BCN Commercial |
$285.39
|
| Rate for Payer: BCN Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$277.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.54
|
| Rate for Payer: Healthscope Commercial |
$231.05
|
| Rate for Payer: Healthscope Whirlpool |
$231.05
|
| Rate for Payer: Meridian Medicaid |
$132.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.17
|
| Rate for Payer: PACE SWMI |
$192.54
|
| Rate for Payer: PHP Medicare Advantage |
$192.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,059.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.57
|
| Rate for Payer: Priority Health Medicare |
$192.54
|
| Rate for Payer: Priority Health Narrow Network |
$315.57
|
| Rate for Payer: UHC Medicare Advantage |
$198.32
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 54160
|
| Min. Negotiated Rate |
$92.87 |
| Max. Negotiated Rate |
$2,797.35 |
| Rate for Payer: Aetna Commercial |
$190.35
|
| Rate for Payer: Aetna Medicare |
$142.05
|
| Rate for Payer: BCBS Complete |
$97.51
|
| Rate for Payer: BCBS MAPPO |
$142.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,797.35
|
| Rate for Payer: BCN Commercial |
$321.06
|
| Rate for Payer: BCN Medicare Advantage |
$142.05
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$204.55
|
| Rate for Payer: Cofinity Commercial |
$190.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.05
|
| Rate for Payer: Healthscope Commercial |
$170.46
|
| Rate for Payer: Healthscope Whirlpool |
$170.46
|
| Rate for Payer: Meridian Medicaid |
$97.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.15
|
| Rate for Payer: PACE SWMI |
$142.05
|
| Rate for Payer: PHP Medicare Advantage |
$142.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.35
|
| Rate for Payer: Priority Health Medicare |
$142.05
|
| Rate for Payer: Priority Health Narrow Network |
$232.35
|
| Rate for Payer: UHC Medicare Advantage |
$146.31
|
|
|
PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 54150
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$1,797.28 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Medicare |
$95.11
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: BCBS MAPPO |
$95.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.28
|
| Rate for Payer: BCN Commercial |
$216.98
|
| Rate for Payer: BCN Medicare Advantage |
$95.11
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$136.96
|
| Rate for Payer: Cofinity Commercial |
$127.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.11
|
| Rate for Payer: Healthscope Commercial |
$114.13
|
| Rate for Payer: Healthscope Whirlpool |
$114.13
|
| Rate for Payer: Meridian Medicaid |
$63.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.87
|
| Rate for Payer: PACE SWMI |
$95.11
|
| Rate for Payer: PHP Medicare Advantage |
$95.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.00
|
| Rate for Payer: Priority Health Medicare |
$95.11
|
| Rate for Payer: Priority Health Narrow Network |
$154.00
|
| Rate for Payer: UHC Medicare Advantage |
$97.96
|
|
|
PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 61050
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$519.32 |
| Rate for Payer: Aetna Commercial |
$105.04
|
| Rate for Payer: Aetna Medicare |
$78.39
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$78.39
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCN Commercial |
$115.82
|
| Rate for Payer: BCN Medicare Advantage |
$78.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$105.04
|
| Rate for Payer: Cofinity Commercial |
$112.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.39
|
| Rate for Payer: Healthscope Commercial |
$94.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.07
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.31
|
| Rate for Payer: PACE SWMI |
$78.39
|
| Rate for Payer: PHP Medicare Advantage |
$78.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.19
|
| Rate for Payer: Priority Health Medicare |
$78.39
|
| Rate for Payer: Priority Health Narrow Network |
$134.19
|
| Rate for Payer: UHC Medicare Advantage |
$80.74
|
|
|
PR CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 23120
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$956.69 |
| Rate for Payer: Aetna Commercial |
$776.46
|
| Rate for Payer: Aetna Medicare |
$579.45
|
| Rate for Payer: BCBS Complete |
$402.57
|
| Rate for Payer: BCBS MAPPO |
$579.45
|
| Rate for Payer: BCBS Trust/PPO |
$34.34
|
| Rate for Payer: BCN Commercial |
$956.69
|
| Rate for Payer: BCN Medicare Advantage |
$579.45
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$834.41
|
| Rate for Payer: Cofinity Commercial |
$776.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.45
|
| Rate for Payer: Healthscope Commercial |
$695.34
|
| Rate for Payer: Healthscope Whirlpool |
$695.34
|
| Rate for Payer: Meridian Medicaid |
$402.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$608.42
|
| Rate for Payer: PACE SWMI |
$579.45
|
| Rate for Payer: PHP Medicare Advantage |
$579.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.93
|
| Rate for Payer: Priority Health Medicare |
$579.45
|
| Rate for Payer: Priority Health Narrow Network |
$907.93
|
| Rate for Payer: UHC Medicare Advantage |
$596.83
|
|
|
PR CLAVICULECTOMY TOTAL
|
Professional
|
Both
|
$1,568.00
|
|
|
Service Code
|
HCPCS 23125
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$1,097.60 |
| Rate for Payer: Aetna Commercial |
$940.00
|
| Rate for Payer: Aetna Medicare |
$701.49
|
| Rate for Payer: BCBS Complete |
$483.76
|
| Rate for Payer: BCBS MAPPO |
$701.49
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$1,047.24
|
| Rate for Payer: BCN Medicare Advantage |
$701.49
|
| Rate for Payer: Cash Price |
$1,254.40
|
| Rate for Payer: Cash Price |
$1,254.40
|
| Rate for Payer: Cofinity Commercial |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$1,010.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.49
|
| Rate for Payer: Healthscope Commercial |
$841.79
|
| Rate for Payer: Healthscope Whirlpool |
$841.79
|
| Rate for Payer: Meridian Medicaid |
$483.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$736.56
|
| Rate for Payer: PACE SWMI |
$701.49
|
| Rate for Payer: PHP Medicare Advantage |
$701.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,094.32
|
| Rate for Payer: Priority Health Medicare |
$701.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,094.32
|
| Rate for Payer: UHC Medicare Advantage |
$722.53
|
|
|
PR CLOSED RX PELVIC RING FX/SUBLUX
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 27193
|
| Min. Negotiated Rate |
$380.40 |
| Max. Negotiated Rate |
$665.70 |
| Rate for Payer: BCBS Complete |
$380.40
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.70
|
|
|
PR CLOSED RX PELV RING FX/SUBLUX,MANIP
|
Professional
|
Both
|
$1,903.00
|
|
|
Service Code
|
HCPCS 27194
|
| Min. Negotiated Rate |
$761.20 |
| Max. Negotiated Rate |
$1,332.10 |
| Rate for Payer: BCBS Complete |
$761.20
|
| Rate for Payer: Cash Price |
$1,522.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.10
|
|
|
PR CLOSED RX RIB FRACTURE
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 21800
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
|
|
PR CLOSED TREATMENT COCCYGEAL FRACTURE
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 27200
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$1,904.52 |
| Rate for Payer: Aetna Commercial |
$249.23
|
| Rate for Payer: Aetna Medicare |
$185.99
|
| Rate for Payer: BCBS Complete |
$133.74
|
| Rate for Payer: BCBS MAPPO |
$185.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,904.52
|
| Rate for Payer: BCN Commercial |
$279.53
|
| Rate for Payer: BCN Medicare Advantage |
$185.99
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Cofinity Commercial |
$267.83
|
| Rate for Payer: Cofinity Commercial |
$249.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.99
|
| Rate for Payer: Healthscope Commercial |
$223.19
|
| Rate for Payer: Healthscope Whirlpool |
$223.19
|
| Rate for Payer: Meridian Medicaid |
$133.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.29
|
| Rate for Payer: PACE SWMI |
$185.99
|
| Rate for Payer: PHP Medicare Advantage |
$185.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.65
|
| Rate for Payer: Priority Health Medicare |
$185.99
|
| Rate for Payer: Priority Health Narrow Network |
$294.65
|
| Rate for Payer: UHC Medicare Advantage |
$191.57
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27768
|
| Min. Negotiated Rate |
$295.64 |
| Max. Negotiated Rate |
$3,241.12 |
| Rate for Payer: Aetna Commercial |
$593.57
|
| Rate for Payer: Aetna Medicare |
$442.96
|
| Rate for Payer: BCBS Complete |
$310.42
|
| Rate for Payer: BCBS MAPPO |
$442.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,241.12
|
| Rate for Payer: BCN Commercial |
$667.54
|
| Rate for Payer: BCN Medicare Advantage |
$442.96
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$637.86
|
| Rate for Payer: Cofinity Commercial |
$593.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.96
|
| Rate for Payer: Healthscope Commercial |
$531.55
|
| Rate for Payer: Healthscope Whirlpool |
$531.55
|
| Rate for Payer: Meridian Medicaid |
$310.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$465.11
|
| Rate for Payer: PACE SWMI |
$442.96
|
| Rate for Payer: PHP Medicare Advantage |
$442.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$697.55
|
| Rate for Payer: Priority Health Medicare |
$442.96
|
| Rate for Payer: Priority Health Narrow Network |
$697.55
|
| Rate for Payer: UHC Medicare Advantage |
$456.25
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$713.00
|
|
|
Service Code
|
HCPCS 27767
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$563.09 |
| Rate for Payer: Aetna Commercial |
$383.33
|
| Rate for Payer: Aetna Medicare |
$286.07
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$286.07
|
| Rate for Payer: BCBS Trust/PPO |
$563.09
|
| Rate for Payer: BCN Commercial |
$438.35
|
| Rate for Payer: BCN Medicare Advantage |
$286.07
|
| Rate for Payer: Cash Price |
$570.40
|
| Rate for Payer: Cash Price |
$570.40
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Cofinity Commercial |
$383.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.07
|
| Rate for Payer: Healthscope Commercial |
$343.28
|
| Rate for Payer: Healthscope Whirlpool |
$343.28
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$300.37
|
| Rate for Payer: PACE SWMI |
$286.07
|
| Rate for Payer: PHP Medicare Advantage |
$286.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.49
|
| Rate for Payer: Priority Health Medicare |
$286.07
|
| Rate for Payer: Priority Health Narrow Network |
$455.49
|
| Rate for Payer: UHC Medicare Advantage |
$294.65
|
|
