|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$955.37 |
| Rate for Payer: Aetna Commercial |
$548.46
|
| Rate for Payer: Aetna Medicare |
$409.30
|
| Rate for Payer: BCBS Complete |
$277.33
|
| Rate for Payer: BCBS MAPPO |
$409.30
|
| Rate for Payer: BCBS Trust/PPO |
$25.40
|
| Rate for Payer: BCN Commercial |
$955.37
|
| Rate for Payer: BCN Medicare Advantage |
$409.30
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cofinity Commercial |
$548.46
|
| Rate for Payer: Cofinity Commercial |
$589.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$409.30
|
| Rate for Payer: Healthscope Commercial |
$491.16
|
| Rate for Payer: Healthscope Whirlpool |
$491.16
|
| Rate for Payer: Meridian Medicaid |
$277.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$429.76
|
| Rate for Payer: PACE SWMI |
$409.30
|
| Rate for Payer: PHP Medicare Advantage |
$409.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.64
|
| Rate for Payer: Priority Health Medicare |
$409.30
|
| Rate for Payer: Priority Health Narrow Network |
$507.64
|
| Rate for Payer: UHC Medicare Advantage |
$421.58
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$976.50 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$1,255.50
|
| Rate for Payer: ASR ASR |
$1,353.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.54
|
| Rate for Payer: BCN Commercial |
$1,081.54
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$1,311.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,116.00
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.15
|
| Rate for Payer: Mclaren Commercial |
$1,255.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,185.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,227.60
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$488.84 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,029.25
|
| Rate for Payer: Aetna Medicare |
$768.10
|
| Rate for Payer: BCBS Complete |
$513.28
|
| Rate for Payer: BCBS MAPPO |
$768.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: BCN Medicare Advantage |
$768.10
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.25
|
| Rate for Payer: Cofinity Commercial |
$1,106.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.10
|
| Rate for Payer: Healthscope Commercial |
$921.72
|
| Rate for Payer: Healthscope Whirlpool |
$921.72
|
| Rate for Payer: Meridian Medicaid |
$513.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.50
|
| Rate for Payer: PACE SWMI |
$768.10
|
| Rate for Payer: PHP Medicare Advantage |
$768.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.87
|
| Rate for Payer: Priority Health Medicare |
$768.10
|
| Rate for Payer: Priority Health Narrow Network |
$940.87
|
| Rate for Payer: UHC Medicare Advantage |
$791.14
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$488.84 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,029.25
|
| Rate for Payer: Aetna Medicare |
$768.10
|
| Rate for Payer: BCBS Complete |
$513.28
|
| Rate for Payer: BCBS MAPPO |
$768.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: BCN Medicare Advantage |
$768.10
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$1,106.06
|
| Rate for Payer: Cofinity Commercial |
$1,029.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.10
|
| Rate for Payer: Healthscope Commercial |
$921.72
|
| Rate for Payer: Healthscope Whirlpool |
$921.72
|
| Rate for Payer: Meridian Medicaid |
$513.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.50
|
| Rate for Payer: PACE SWMI |
$768.10
|
| Rate for Payer: PHP Medicare Advantage |
$768.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$940.87
|
| Rate for Payer: Priority Health Medicare |
$768.10
|
| Rate for Payer: Priority Health Narrow Network |
$940.87
|
| Rate for Payer: UHC Medicare Advantage |
$791.14
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$558.00 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$1,255.50
|
| Rate for Payer: ASR ASR |
$1,353.15
|
| Rate for Payer: BCBS Complete |
$558.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.54
|
| Rate for Payer: BCN Commercial |
$1,081.54
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$1,311.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,116.00
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.15
|
| Rate for Payer: Mclaren Commercial |
$1,255.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,185.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.45
|
| Rate for Payer: Priority Health Narrow Network |
$990.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,227.60
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$442.19 |
| Max. Negotiated Rate |
$2,187.45 |
| Rate for Payer: Aetna Commercial |
$930.19
|
| Rate for Payer: Aetna Medicare |
$694.17
|
| Rate for Payer: BCBS Complete |
$464.30
|
| Rate for Payer: BCBS MAPPO |
$694.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,187.45
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: BCN Medicare Advantage |
$694.17
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$999.60
|
| Rate for Payer: Cofinity Commercial |
$930.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.17
|
| Rate for Payer: Healthscope Commercial |
$833.00
|
| Rate for Payer: Healthscope Whirlpool |
$833.00
|
| Rate for Payer: Meridian Medicaid |
$464.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$728.88
|
| Rate for Payer: PACE SWMI |
$694.17
|
| Rate for Payer: PHP Medicare Advantage |
$694.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$851.26
|
| Rate for Payer: Priority Health Medicare |
$694.17
|
| Rate for Payer: Priority Health Narrow Network |
$851.26
|
| Rate for Payer: UHC Medicare Advantage |
$715.00
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR
|
Professional
|
Both
|
$1,046.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$358.69 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$753.91
|
| Rate for Payer: Aetna Medicare |
$562.62
|
| Rate for Payer: BCBS Complete |
$376.62
|
| Rate for Payer: BCBS MAPPO |
$562.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$820.97
|
| Rate for Payer: BCN Medicare Advantage |
$562.62
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cash Price |
$836.80
|
| Rate for Payer: Cofinity Commercial |
$810.17
|
| Rate for Payer: Cofinity Commercial |
$753.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.62
|
| Rate for Payer: Healthscope Commercial |
$675.14
|
| Rate for Payer: Healthscope Whirlpool |
$675.14
|
| Rate for Payer: Meridian Medicaid |
$376.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$590.75
|
| Rate for Payer: PACE SWMI |
$562.62
|
| Rate for Payer: PHP Medicare Advantage |
$562.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$358.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.54
|
| Rate for Payer: Priority Health Medicare |
$562.62
|
| Rate for Payer: Priority Health Narrow Network |
$690.54
|
| Rate for Payer: UHC Medicare Advantage |
$579.50
|
|
|
PR DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 11045
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$111.72 |
| Rate for Payer: Aetna Commercial |
$33.65
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$25.11
|
| Rate for Payer: BCBS Trust/PPO |
$111.72
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Medicare Advantage |
$25.11
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$36.16
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$30.13
|
| Rate for Payer: Healthscope Whirlpool |
$30.13
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.37
|
| Rate for Payer: PACE SWMI |
$25.11
|
| Rate for Payer: PHP Medicare Advantage |
$25.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.83
|
| Rate for Payer: Priority Health Medicare |
$25.11
|
| Rate for Payer: Priority Health Narrow Network |
$30.83
|
| Rate for Payer: UHC Medicare Advantage |
$25.86
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$664.60 |
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Medicare |
$270.84
|
| Rate for Payer: BCBS Complete |
$184.74
|
| Rate for Payer: BCBS MAPPO |
$270.84
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: BCN Medicare Advantage |
$270.84
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$390.01
|
| Rate for Payer: Cofinity Commercial |
$362.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.84
|
| Rate for Payer: Healthscope Commercial |
$325.01
|
| Rate for Payer: Healthscope Whirlpool |
$325.01
|
| Rate for Payer: Meridian Medicaid |
$184.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.38
|
| Rate for Payer: PACE SWMI |
$270.84
|
| Rate for Payer: PHP Medicare Advantage |
$270.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.28
|
| Rate for Payer: Priority Health Medicare |
$270.84
|
| Rate for Payer: Priority Health Narrow Network |
$338.28
|
| Rate for Payer: UHC Medicare Advantage |
$278.97
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$729.59 |
| Rate for Payer: Aetna Commercial |
$390.70
|
| Rate for Payer: Aetna Medicare |
$291.57
|
| Rate for Payer: BCBS Complete |
$198.60
|
| Rate for Payer: BCBS MAPPO |
$291.57
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$729.59
|
| Rate for Payer: BCN Medicare Advantage |
$291.57
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$390.70
|
| Rate for Payer: Cofinity Commercial |
$419.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.57
|
| Rate for Payer: Healthscope Commercial |
$349.88
|
| Rate for Payer: Healthscope Whirlpool |
$349.88
|
| Rate for Payer: Meridian Medicaid |
$198.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$306.15
|
| Rate for Payer: PACE SWMI |
$291.57
|
| Rate for Payer: PHP Medicare Advantage |
$291.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.30
|
| Rate for Payer: Priority Health Medicare |
$291.57
|
| Rate for Payer: Priority Health Narrow Network |
$361.30
|
| Rate for Payer: UHC Medicare Advantage |
$300.32
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,717.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$647.95 |
| Max. Negotiated Rate |
$4,478.93 |
| Rate for Payer: Aetna Commercial |
$1,333.69
|
| Rate for Payer: Aetna Medicare |
$995.29
|
| Rate for Payer: BCBS Complete |
$680.35
|
| Rate for Payer: BCBS MAPPO |
$995.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,478.93
|
| Rate for Payer: BCN Commercial |
$1,477.76
|
| Rate for Payer: BCN Medicare Advantage |
$995.29
|
| Rate for Payer: Cash Price |
$1,373.60
|
| Rate for Payer: Cash Price |
$1,373.60
|
| Rate for Payer: Cofinity Commercial |
$1,433.22
|
| Rate for Payer: Cofinity Commercial |
$1,333.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$995.29
|
| Rate for Payer: Healthscope Commercial |
$1,194.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,194.35
|
| Rate for Payer: Meridian Medicaid |
$680.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,045.05
|
| Rate for Payer: PACE SWMI |
$995.29
|
| Rate for Payer: PHP Medicare Advantage |
$995.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$647.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,201.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,544.21
|
| Rate for Payer: Priority Health Medicare |
$995.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.15
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$427.07 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$869.18
|
| Rate for Payer: Aetna Medicare |
$648.64
|
| Rate for Payer: BCBS Complete |
$448.42
|
| Rate for Payer: BCBS MAPPO |
$648.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$970.03
|
| Rate for Payer: BCN Medicare Advantage |
$648.64
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cofinity Commercial |
$934.04
|
| Rate for Payer: Cofinity Commercial |
$869.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$648.64
|
| Rate for Payer: Healthscope Commercial |
$778.37
|
| Rate for Payer: Healthscope Whirlpool |
$778.37
|
| Rate for Payer: Meridian Medicaid |
$448.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$681.07
|
| Rate for Payer: PACE SWMI |
$648.64
|
| Rate for Payer: PHP Medicare Advantage |
$648.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,013.64
|
| Rate for Payer: Priority Health Medicare |
$648.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.64
|
| Rate for Payer: UHC Medicare Advantage |
$668.10
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$788.95 |
| Max. Negotiated Rate |
$1,877.66 |
| Rate for Payer: Aetna Commercial |
$1,620.56
|
| Rate for Payer: Aetna Medicare |
$1,209.37
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$1,209.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: BCN Commercial |
$1,796.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,209.37
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cofinity Commercial |
$1,741.49
|
| Rate for Payer: Cofinity Commercial |
$1,620.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,209.37
|
| Rate for Payer: Healthscope Commercial |
$1,451.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,451.24
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,269.84
|
| Rate for Payer: PACE SWMI |
$1,209.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,209.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,877.66
|
| Rate for Payer: Priority Health Medicare |
$1,209.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,877.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,245.65
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$842.63 |
| Max. Negotiated Rate |
$2,015.03 |
| Rate for Payer: Aetna Commercial |
$1,709.01
|
| Rate for Payer: Aetna Medicare |
$1,275.38
|
| Rate for Payer: BCBS Complete |
$884.76
|
| Rate for Payer: BCBS MAPPO |
$1,275.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$1,928.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.38
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cofinity Commercial |
$1,709.01
|
| Rate for Payer: Cofinity Commercial |
$1,836.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.38
|
| Rate for Payer: Healthscope Commercial |
$1,530.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,530.46
|
| Rate for Payer: Meridian Medicaid |
$884.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,339.15
|
| Rate for Payer: PACE SWMI |
$1,275.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,015.03
|
| Rate for Payer: Priority Health Medicare |
$1,275.38
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,313.64
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$218.72 |
| Max. Negotiated Rate |
$1,250.90 |
| Rate for Payer: Aetna Commercial |
$1,024.03
|
| Rate for Payer: Aetna Medicare |
$764.20
|
| Rate for Payer: BCBS Complete |
$529.83
|
| Rate for Payer: BCBS MAPPO |
$764.20
|
| Rate for Payer: BCBS Trust/PPO |
$218.72
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| Rate for Payer: BCN Medicare Advantage |
$764.20
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cofinity Commercial |
$1,024.03
|
| Rate for Payer: Cofinity Commercial |
$1,100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.20
|
| Rate for Payer: Healthscope Commercial |
$917.04
|
| Rate for Payer: Healthscope Whirlpool |
$917.04
|
| Rate for Payer: Meridian Medicaid |
$529.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.41
|
| Rate for Payer: PACE SWMI |
$764.20
|
| Rate for Payer: PHP Medicare Advantage |
$764.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,190.84
|
| Rate for Payer: Priority Health Medicare |
$764.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,190.84
|
| Rate for Payer: UHC Medicare Advantage |
$787.13
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,150.50 |
| Rate for Payer: Aetna Commercial |
$964.96
|
| Rate for Payer: Aetna Medicare |
$720.12
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS MAPPO |
$720.12
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: BCN Commercial |
$1,100.99
|
| Rate for Payer: BCN Medicare Advantage |
$720.12
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cofinity Commercial |
$964.96
|
| Rate for Payer: Cofinity Commercial |
$1,036.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.12
|
| Rate for Payer: Healthscope Commercial |
$864.14
|
| Rate for Payer: Healthscope Whirlpool |
$864.14
|
| Rate for Payer: Meridian Medicaid |
$501.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$756.13
|
| Rate for Payer: PACE SWMI |
$720.12
|
| Rate for Payer: PHP Medicare Advantage |
$720.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.50
|
| Rate for Payer: Priority Health Medicare |
$720.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.50
|
| Rate for Payer: UHC Medicare Advantage |
$741.72
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$256.88 |
| Max. Negotiated Rate |
$863.24 |
| Rate for Payer: Aetna Commercial |
$531.50
|
| Rate for Payer: Aetna Medicare |
$396.64
|
| Rate for Payer: BCBS Complete |
$269.72
|
| Rate for Payer: BCBS MAPPO |
$396.64
|
| Rate for Payer: BCBS Trust/PPO |
$863.24
|
| Rate for Payer: BCN Commercial |
$588.36
|
| Rate for Payer: BCN Medicare Advantage |
$396.64
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$531.50
|
| Rate for Payer: Cofinity Commercial |
$571.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.64
|
| Rate for Payer: Healthscope Commercial |
$475.97
|
| Rate for Payer: Healthscope Whirlpool |
$475.97
|
| Rate for Payer: Meridian Medicaid |
$269.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$416.47
|
| Rate for Payer: PACE SWMI |
$396.64
|
| Rate for Payer: PHP Medicare Advantage |
$396.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.82
|
| Rate for Payer: Priority Health Medicare |
$396.64
|
| Rate for Payer: Priority Health Narrow Network |
$614.82
|
| Rate for Payer: UHC Medicare Advantage |
$408.54
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$304.16 |
| Max. Negotiated Rate |
$1,903.46 |
| Rate for Payer: Aetna Commercial |
$633.82
|
| Rate for Payer: Aetna Medicare |
$473.00
|
| Rate for Payer: BCBS Complete |
$319.37
|
| Rate for Payer: BCBS MAPPO |
$473.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.46
|
| Rate for Payer: BCN Commercial |
$695.39
|
| Rate for Payer: BCN Medicare Advantage |
$473.00
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$681.12
|
| Rate for Payer: Cofinity Commercial |
$633.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.00
|
| Rate for Payer: Healthscope Commercial |
$567.60
|
| Rate for Payer: Healthscope Whirlpool |
$567.60
|
| Rate for Payer: Meridian Medicaid |
$319.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$496.65
|
| Rate for Payer: PACE SWMI |
$473.00
|
| Rate for Payer: PHP Medicare Advantage |
$473.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.65
|
| Rate for Payer: Priority Health Medicare |
$473.00
|
| Rate for Payer: Priority Health Narrow Network |
$726.65
|
| Rate for Payer: UHC Medicare Advantage |
$487.19
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$522.06 |
| Max. Negotiated Rate |
$2,785.73 |
| Rate for Payer: Aetna Commercial |
$1,077.27
|
| Rate for Payer: Aetna Medicare |
$803.93
|
| Rate for Payer: BCBS Complete |
$548.16
|
| Rate for Payer: BCBS MAPPO |
$803.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.73
|
| Rate for Payer: BCN Commercial |
$1,189.44
|
| Rate for Payer: BCN Medicare Advantage |
$803.93
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cofinity Commercial |
$1,077.27
|
| Rate for Payer: Cofinity Commercial |
$1,157.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$803.93
|
| Rate for Payer: Healthscope Commercial |
$964.72
|
| Rate for Payer: Healthscope Whirlpool |
$964.72
|
| Rate for Payer: Meridian Medicaid |
$548.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$844.13
|
| Rate for Payer: PACE SWMI |
$803.93
|
| Rate for Payer: PHP Medicare Advantage |
$803.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,242.92
|
| Rate for Payer: Priority Health Medicare |
$803.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,242.92
|
| Rate for Payer: UHC Medicare Advantage |
$828.05
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$345.27 |
| Max. Negotiated Rate |
$2,576.52 |
| Rate for Payer: Aetna Commercial |
$708.22
|
| Rate for Payer: Aetna Medicare |
$528.52
|
| Rate for Payer: BCBS Complete |
$362.53
|
| Rate for Payer: BCBS MAPPO |
$528.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,576.52
|
| Rate for Payer: BCN Commercial |
$784.82
|
| Rate for Payer: BCN Medicare Advantage |
$528.52
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cofinity Commercial |
$761.07
|
| Rate for Payer: Cofinity Commercial |
$708.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.52
|
| Rate for Payer: Healthscope Commercial |
$634.22
|
| Rate for Payer: Healthscope Whirlpool |
$634.22
|
| Rate for Payer: Meridian Medicaid |
$362.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$554.95
|
| Rate for Payer: PACE SWMI |
$528.52
|
| Rate for Payer: PHP Medicare Advantage |
$528.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.11
|
| Rate for Payer: Priority Health Medicare |
$528.52
|
| Rate for Payer: Priority Health Narrow Network |
$820.11
|
| Rate for Payer: UHC Medicare Advantage |
$544.38
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$582.16
|
| Rate for Payer: Aetna Medicare |
$434.45
|
| Rate for Payer: BCBS Complete |
$299.91
|
| Rate for Payer: BCBS MAPPO |
$434.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: BCN Medicare Advantage |
$434.45
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cash Price |
$1,088.80
|
| Rate for Payer: Cofinity Commercial |
$625.61
|
| Rate for Payer: Cofinity Commercial |
$582.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.45
|
| Rate for Payer: Healthscope Commercial |
$521.34
|
| Rate for Payer: Healthscope Whirlpool |
$521.34
|
| Rate for Payer: Meridian Medicaid |
$299.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$456.17
|
| Rate for Payer: PACE SWMI |
$434.45
|
| Rate for Payer: PHP Medicare Advantage |
$434.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$677.63
|
| Rate for Payer: Priority Health Medicare |
$434.45
|
| Rate for Payer: Priority Health Narrow Network |
$677.63
|
| Rate for Payer: UHC Medicare Advantage |
$447.48
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$2,735.54 |
| Rate for Payer: Aetna Commercial |
$929.41
|
| Rate for Payer: Aetna Medicare |
$693.59
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCBS MAPPO |
$693.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.54
|
| Rate for Payer: BCN Commercial |
$1,036.00
|
| Rate for Payer: BCN Medicare Advantage |
$693.59
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cofinity Commercial |
$998.77
|
| Rate for Payer: Cofinity Commercial |
$929.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.59
|
| Rate for Payer: Healthscope Commercial |
$832.31
|
| Rate for Payer: Healthscope Whirlpool |
$832.31
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$728.27
|
| Rate for Payer: PACE SWMI |
$693.59
|
| Rate for Payer: PHP Medicare Advantage |
$693.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,082.58
|
| Rate for Payer: Priority Health Medicare |
$693.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,082.58
|
| Rate for Payer: UHC Medicare Advantage |
$714.40
|
|
|
PR DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$2,942.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$385.32 |
| Max. Negotiated Rate |
$2,059.40 |
| Rate for Payer: Aetna Commercial |
$737.79
|
| Rate for Payer: Aetna Medicare |
$550.59
|
| Rate for Payer: BCBS Complete |
$404.59
|
| Rate for Payer: BCBS MAPPO |
$550.59
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$820.49
|
| Rate for Payer: BCN Medicare Advantage |
$550.59
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Cofinity Commercial |
$792.85
|
| Rate for Payer: Cofinity Commercial |
$737.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.59
|
| Rate for Payer: Healthscope Commercial |
$660.71
|
| Rate for Payer: Healthscope Whirlpool |
$660.71
|
| Rate for Payer: Meridian Medicaid |
$404.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$578.12
|
| Rate for Payer: PACE SWMI |
$550.59
|
| Rate for Payer: PHP Medicare Advantage |
$550.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,059.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.70
|
| Rate for Payer: Priority Health Medicare |
$550.59
|
| Rate for Payer: Priority Health Narrow Network |
$950.70
|
| Rate for Payer: UHC Medicare Advantage |
$567.11
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$800.25
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$639.62
|
| Rate for Payer: BCN Commercial |
$639.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$775.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$825.00
|
| Rate for Payer: Healthscope Whirlpool |
$800.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$742.50
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$585.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$742.50
|
| Rate for Payer: ASR ASR |
$800.25
|
| Rate for Payer: BCBS Trust/PPO |
$639.62
|
| Rate for Payer: BCN Commercial |
$639.62
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$775.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Healthscope Commercial |
$825.00
|
| Rate for Payer: Healthscope Whirlpool |
$800.25
|
| Rate for Payer: Mclaren Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.00
|
|
