|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$668.83 |
| Rate for Payer: Aetna Commercial |
$28.33
|
| Rate for Payer: Aetna Medicare |
$21.14
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$668.83
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: BCN Medicare Advantage |
$21.14
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$28.33
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$25.37
|
| Rate for Payer: Healthscope Whirlpool |
$25.37
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.20
|
| Rate for Payer: PACE SWMI |
$21.14
|
| Rate for Payer: PHP Medicare Advantage |
$21.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$21.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.06
|
| Rate for Payer: UHC Medicare Advantage |
$21.77
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL CNF
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 28297
|
| Min. Negotiated Rate |
$387.45 |
| Max. Negotiated Rate |
$1,499.26 |
| Rate for Payer: Aetna Commercial |
$789.65
|
| Rate for Payer: Aetna Medicare |
$589.29
|
| Rate for Payer: BCBS Complete |
$406.82
|
| Rate for Payer: BCBS MAPPO |
$589.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.37
|
| Rate for Payer: BCN Commercial |
$1,499.26
|
| Rate for Payer: BCN Medicare Advantage |
$589.29
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$848.58
|
| Rate for Payer: Cofinity Commercial |
$789.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.29
|
| Rate for Payer: Healthscope Commercial |
$707.15
|
| Rate for Payer: Healthscope Whirlpool |
$707.15
|
| Rate for Payer: Meridian Medicaid |
$406.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.75
|
| Rate for Payer: PACE SWMI |
$589.29
|
| Rate for Payer: PHP Medicare Advantage |
$589.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$918.15
|
| Rate for Payer: Priority Health Medicare |
$589.29
|
| Rate for Payer: Priority Health Narrow Network |
$918.15
|
| Rate for Payer: UHC Medicare Advantage |
$606.97
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 28299
|
| Min. Negotiated Rate |
$383.61 |
| Max. Negotiated Rate |
$1,651.30 |
| Rate for Payer: Aetna Commercial |
$774.49
|
| Rate for Payer: Aetna Medicare |
$577.98
|
| Rate for Payer: BCBS Complete |
$402.79
|
| Rate for Payer: BCBS MAPPO |
$577.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$1,468.47
|
| Rate for Payer: BCN Medicare Advantage |
$577.98
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$774.49
|
| Rate for Payer: Cofinity Commercial |
$832.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.98
|
| Rate for Payer: Healthscope Commercial |
$693.58
|
| Rate for Payer: Healthscope Whirlpool |
$693.58
|
| Rate for Payer: Meridian Medicaid |
$402.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$606.88
|
| Rate for Payer: PACE SWMI |
$577.98
|
| Rate for Payer: PHP Medicare Advantage |
$577.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.27
|
| Rate for Payer: Priority Health Medicare |
$577.98
|
| Rate for Payer: Priority Health Narrow Network |
$900.27
|
| Rate for Payer: UHC Medicare Advantage |
$595.32
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$330.79 |
| Max. Negotiated Rate |
$1,537.90 |
| Rate for Payer: Aetna Commercial |
$669.81
|
| Rate for Payer: Aetna Medicare |
$499.86
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: BCBS MAPPO |
$499.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.56
|
| Rate for Payer: BCN Commercial |
$1,288.16
|
| Rate for Payer: BCN Medicare Advantage |
$499.86
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cofinity Commercial |
$719.80
|
| Rate for Payer: Cofinity Commercial |
$669.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.86
|
| Rate for Payer: Healthscope Commercial |
$599.83
|
| Rate for Payer: Healthscope Whirlpool |
$599.83
|
| Rate for Payer: Meridian Medicaid |
$347.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$524.85
|
| Rate for Payer: PACE SWMI |
$499.86
|
| Rate for Payer: PHP Medicare Advantage |
$499.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$330.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.74
|
| Rate for Payer: Priority Health Medicare |
$499.86
|
| Rate for Payer: Priority Health Narrow Network |
$778.74
|
| Rate for Payer: UHC Medicare Advantage |
$514.86
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 28295
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,564.75 |
| Rate for Payer: Aetna Commercial |
$798.24
|
| Rate for Payer: Aetna Medicare |
$595.70
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS MAPPO |
$595.70
|
| Rate for Payer: BCBS Trust/PPO |
$982.11
|
| Rate for Payer: BCN Commercial |
$1,564.75
|
| Rate for Payer: BCN Medicare Advantage |
$595.70
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$798.24
|
| Rate for Payer: Cofinity Commercial |
$857.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.70
|
| Rate for Payer: Healthscope Commercial |
$714.84
|
| Rate for Payer: Healthscope Whirlpool |
$714.84
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$625.48
|
| Rate for Payer: PACE SWMI |
$595.70
|
| Rate for Payer: PHP Medicare Advantage |
$595.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,128.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.42
|
| Rate for Payer: Priority Health Medicare |
$595.70
|
| Rate for Payer: Priority Health Narrow Network |
$931.42
|
| Rate for Payer: UHC Medicare Advantage |
$613.57
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 28298
|
| Min. Negotiated Rate |
$327.59 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$661.06
|
| Rate for Payer: Aetna Medicare |
$493.33
|
| Rate for Payer: BCBS Complete |
$343.97
|
| Rate for Payer: BCBS MAPPO |
$493.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.48
|
| Rate for Payer: BCN Commercial |
$1,212.90
|
| Rate for Payer: BCN Medicare Advantage |
$493.33
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$710.40
|
| Rate for Payer: Cofinity Commercial |
$661.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.33
|
| Rate for Payer: Healthscope Commercial |
$592.00
|
| Rate for Payer: Healthscope Whirlpool |
$592.00
|
| Rate for Payer: Meridian Medicaid |
$343.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$518.00
|
| Rate for Payer: PACE SWMI |
$493.33
|
| Rate for Payer: PHP Medicare Advantage |
$493.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,311.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.04
|
| Rate for Payer: Priority Health Medicare |
$493.33
|
| Rate for Payer: Priority Health Narrow Network |
$769.04
|
| Rate for Payer: UHC Medicare Advantage |
$508.13
|
|
|
PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL
|
Professional
|
Both
|
$1,745.00
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$1,544.75 |
| Rate for Payer: Aetna Commercial |
$630.74
|
| Rate for Payer: Aetna Medicare |
$470.70
|
| Rate for Payer: BCBS Complete |
$329.22
|
| Rate for Payer: BCBS MAPPO |
$470.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.75
|
| Rate for Payer: BCN Commercial |
$1,011.07
|
| Rate for Payer: BCN Medicare Advantage |
$470.70
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cofinity Commercial |
$677.81
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.70
|
| Rate for Payer: Healthscope Commercial |
$564.84
|
| Rate for Payer: Healthscope Whirlpool |
$564.84
|
| Rate for Payer: Meridian Medicaid |
$329.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$494.24
|
| Rate for Payer: PACE SWMI |
$470.70
|
| Rate for Payer: PHP Medicare Advantage |
$470.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.83
|
| Rate for Payer: Priority Health Medicare |
$470.70
|
| Rate for Payer: Priority Health Narrow Network |
$734.83
|
| Rate for Payer: UHC Medicare Advantage |
$484.82
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,357.30 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$1,745.10
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$1,880.83
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.31
|
| Rate for Payer: BCN Commercial |
$1,503.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$1,822.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$1,939.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$1,745.10
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,648.15
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,764.49
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,706.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,357.30 |
| Max. Negotiated Rate |
$1,939.00 |
| Rate for Payer: Aetna Commercial |
$1,745.10
|
| Rate for Payer: ASR ASR |
$1,880.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.31
|
| Rate for Payer: BCN Commercial |
$1,503.31
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$1,822.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.20
|
| Rate for Payer: Healthscope Commercial |
$1,939.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.83
|
| Rate for Payer: Mclaren Commercial |
$1,745.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,648.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,706.32
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$949.55 |
| Max. Negotiated Rate |
$2,603.55 |
| Rate for Payer: Aetna Commercial |
$1,981.34
|
| Rate for Payer: Aetna Medicare |
$1,478.61
|
| Rate for Payer: BCBS Complete |
$997.03
|
| Rate for Payer: BCBS MAPPO |
$1,478.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$2,163.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,478.61
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cofinity Commercial |
$2,129.20
|
| Rate for Payer: Cofinity Commercial |
$1,981.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,478.61
|
| Rate for Payer: Healthscope Commercial |
$1,774.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,774.33
|
| Rate for Payer: Meridian Medicaid |
$997.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,552.54
|
| Rate for Payer: PACE SWMI |
$1,478.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,478.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$949.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,603.55
|
| Rate for Payer: Priority Health Medicare |
$1,478.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,603.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.97
|
|
|
PR COSMETIC CORRECTION OF INVERTED NIPPLES
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 00557
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG
|
Professional
|
Both
|
$6,133.00
|
|
|
Service Code
|
HCPCS 63064
|
| Min. Negotiated Rate |
$631.85 |
| Max. Negotiated Rate |
$4,293.10 |
| Rate for Payer: Aetna Commercial |
$2,395.61
|
| Rate for Payer: Aetna Medicare |
$1,787.77
|
| Rate for Payer: BCBS Complete |
$1,205.69
|
| Rate for Payer: BCBS MAPPO |
$1,787.77
|
| Rate for Payer: BCBS Trust/PPO |
$631.85
|
| Rate for Payer: BCN Commercial |
$2,887.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,787.77
|
| Rate for Payer: Cash Price |
$4,906.40
|
| Rate for Payer: Cash Price |
$4,906.40
|
| Rate for Payer: Cofinity Commercial |
$2,395.61
|
| Rate for Payer: Cofinity Commercial |
$2,574.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,787.77
|
| Rate for Payer: Healthscope Commercial |
$2,145.32
|
| Rate for Payer: Healthscope Whirlpool |
$2,145.32
|
| Rate for Payer: Meridian Medicaid |
$1,205.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,877.16
|
| Rate for Payer: PACE SWMI |
$1,787.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,787.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,148.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,293.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,038.93
|
| Rate for Payer: Priority Health Medicare |
$1,787.77
|
| Rate for Payer: Priority Health Narrow Network |
$3,038.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,841.40
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 63066
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$1,472.10 |
| Rate for Payer: Aetna Commercial |
$277.47
|
| Rate for Payer: Aetna Medicare |
$207.07
|
| Rate for Payer: BCBS Complete |
$137.99
|
| Rate for Payer: BCBS MAPPO |
$207.07
|
| Rate for Payer: BCBS Trust/PPO |
$766.04
|
| Rate for Payer: BCN Commercial |
$330.92
|
| Rate for Payer: BCN Medicare Advantage |
$207.07
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$298.18
|
| Rate for Payer: Cofinity Commercial |
$277.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.07
|
| Rate for Payer: Healthscope Commercial |
$248.48
|
| Rate for Payer: Healthscope Whirlpool |
$248.48
|
| Rate for Payer: Meridian Medicaid |
$137.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$217.42
|
| Rate for Payer: PACE SWMI |
$207.07
|
| Rate for Payer: PHP Medicare Advantage |
$207.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.23
|
| Rate for Payer: Priority Health Medicare |
$207.07
|
| Rate for Payer: Priority Health Narrow Network |
$348.23
|
| Rate for Payer: UHC Medicare Advantage |
$213.28
|
|
|
PR COUDE TIP URINARY CATHETER
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4352
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCN Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
|
|
PR COUNSEL IMMUNE <21 16-30 M
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS G0314
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
|
|
PR COUNSEL IMMUNE <21 5-15 M
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0315
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
PR COUNSEL LUNG SCRN LDCT
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$735.92 |
| Rate for Payer: Aetna Commercial |
$33.84
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$735.92
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$36.36
|
| Rate for Payer: Cofinity Commercial |
$33.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$30.30
|
| Rate for Payer: Healthscope Whirlpool |
$30.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.13
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health Narrow Network |
$34.13
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
|
|
PR CPAP VENTILATION CPAP INITIATION&MGMT
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 94660
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$313.28 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Aetna Medicare |
$36.28
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS Trust/PPO |
$313.28
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$43.54
|
| Rate for Payer: Healthscope Whirlpool |
$43.54
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.96
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health Narrow Network |
$48.96
|
| Rate for Payer: UHC Medicare Advantage |
$37.37
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 99489
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,256.83 |
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Aetna Medicare |
$49.10
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$49.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.83
|
| Rate for Payer: BCN Commercial |
$74.52
|
| Rate for Payer: BCN Medicare Advantage |
$49.10
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$54.01
|
| Rate for Payer: Healthscope Whirlpool |
$54.01
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.56
|
| Rate for Payer: PACE SWMI |
$49.10
|
| Rate for Payer: PHP Medicare Advantage |
$49.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$49.10
|
| Rate for Payer: Priority Health Narrow Network |
$63.39
|
| Rate for Payer: UHC Medicare Advantage |
$50.57
|
|
|
PR CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$10,100.00
|
|
|
Service Code
|
HCPCS 61698
|
| Min. Negotiated Rate |
$905.51 |
| Max. Negotiated Rate |
$9,419.88 |
| Rate for Payer: Aetna Commercial |
$6,240.85
|
| Rate for Payer: Aetna Medicare |
$4,657.35
|
| Rate for Payer: BCBS Complete |
$3,129.08
|
| Rate for Payer: BCBS MAPPO |
$4,657.35
|
| Rate for Payer: BCBS Trust/PPO |
$905.51
|
| Rate for Payer: BCN Commercial |
$9,419.88
|
| Rate for Payer: BCN Medicare Advantage |
$4,657.35
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cofinity Commercial |
$6,706.58
|
| Rate for Payer: Cofinity Commercial |
$6,240.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,657.35
|
| Rate for Payer: Healthscope Commercial |
$5,588.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,588.82
|
| Rate for Payer: Meridian Medicaid |
$3,129.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,890.22
|
| Rate for Payer: PACE SWMI |
$4,657.35
|
| Rate for Payer: PHP Medicare Advantage |
$4,657.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,070.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,867.68
|
| Rate for Payer: Priority Health Medicare |
$4,657.35
|
| Rate for Payer: Priority Health Narrow Network |
$7,867.68
|
| Rate for Payer: UHC Medicare Advantage |
$4,797.07
|
|
|
PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 0055T
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$448.43 |
| Rate for Payer: Aetna Commercial |
$210.14
|
| Rate for Payer: BCBS Complete |
$154.02
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Meridian Medicaid |
$154.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
|
|
PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES
|
Professional
|
Both
|
$261.87
|
|
|
Service Code
|
HCPCS 0054T
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$183.31 |
| Rate for Payer: Aetna Commercial |
$179.20
|
| Rate for Payer: BCBS Complete |
$96.34
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Meridian Medicaid |
$96.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.31
|
|
|
PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 20985
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$219.57 |
| Rate for Payer: Aetna Commercial |
$191.81
|
| Rate for Payer: Aetna Medicare |
$143.14
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$143.14
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$143.14
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$206.12
|
| Rate for Payer: Cofinity Commercial |
$191.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.14
|
| Rate for Payer: Healthscope Commercial |
$171.77
|
| Rate for Payer: Healthscope Whirlpool |
$171.77
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.30
|
| Rate for Payer: PACE SWMI |
$143.14
|
| Rate for Payer: PHP Medicare Advantage |
$143.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.57
|
| Rate for Payer: Priority Health Medicare |
$143.14
|
| Rate for Payer: Priority Health Narrow Network |
$219.57
|
| Rate for Payer: UHC Medicare Advantage |
$147.43
|
|
