|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$681.80 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$311.71
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS MAPPO |
$311.71
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$535.10
|
| Rate for Payer: BCN Medicare Advantage |
$311.71
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cofinity Commercial |
$417.69
|
| Rate for Payer: Cofinity Commercial |
$448.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.71
|
| Rate for Payer: Healthscope Commercial |
$374.05
|
| Rate for Payer: Healthscope Whirlpool |
$374.05
|
| Rate for Payer: Meridian Medicaid |
$214.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.30
|
| Rate for Payer: PACE SWMI |
$311.71
|
| Rate for Payer: PHP Medicare Advantage |
$311.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.23
|
| Rate for Payer: Priority Health Medicare |
$311.71
|
| Rate for Payer: Priority Health Narrow Network |
$450.23
|
| Rate for Payer: UHC Medicare Advantage |
$321.06
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$2,773.00
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$2,791.69 |
| Rate for Payer: Aetna Commercial |
$2,117.62
|
| Rate for Payer: Aetna Medicare |
$1,580.31
|
| Rate for Payer: BCBS Complete |
$1,068.83
|
| Rate for Payer: BCBS MAPPO |
$1,580.31
|
| Rate for Payer: BCBS Trust/PPO |
$537.81
|
| Rate for Payer: BCN Commercial |
$2,320.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.31
|
| Rate for Payer: Cash Price |
$2,218.40
|
| Rate for Payer: Cash Price |
$2,218.40
|
| Rate for Payer: Cofinity Commercial |
$2,275.65
|
| Rate for Payer: Cofinity Commercial |
$2,117.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.31
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,896.37
|
| Rate for Payer: Meridian Medicaid |
$1,068.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,659.33
|
| Rate for Payer: PACE SWMI |
$1,580.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,941.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,791.69
|
| Rate for Payer: Priority Health Medicare |
$1,580.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,791.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,627.72
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$1,199.77 |
| Rate for Payer: Aetna Commercial |
$218.53
|
| Rate for Payer: Aetna Medicare |
$163.08
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS MAPPO |
$163.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.77
|
| Rate for Payer: BCN Commercial |
$336.70
|
| Rate for Payer: BCN Medicare Advantage |
$163.08
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cofinity Commercial |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$218.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.08
|
| Rate for Payer: Healthscope Commercial |
$195.70
|
| Rate for Payer: Healthscope Whirlpool |
$195.70
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.23
|
| Rate for Payer: PACE SWMI |
$163.08
|
| Rate for Payer: PHP Medicare Advantage |
$163.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.10
|
| Rate for Payer: Priority Health Medicare |
$163.08
|
| Rate for Payer: Priority Health Narrow Network |
$269.10
|
| Rate for Payer: UHC Medicare Advantage |
$167.97
|
|
|
PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
|
Professional
|
Both
|
$2,180.00
|
|
|
Service Code
|
HCPCS 49040
|
| Min. Negotiated Rate |
$640.83 |
| Max. Negotiated Rate |
$1,763.34 |
| Rate for Payer: Aetna Commercial |
$1,335.77
|
| Rate for Payer: Aetna Medicare |
$996.84
|
| Rate for Payer: BCBS Complete |
$673.41
|
| Rate for Payer: BCBS MAPPO |
$996.84
|
| Rate for Payer: BCBS Trust/PPO |
$640.83
|
| Rate for Payer: BCN Commercial |
$1,465.54
|
| Rate for Payer: BCN Medicare Advantage |
$996.84
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cofinity Commercial |
$1,335.77
|
| Rate for Payer: Cofinity Commercial |
$1,435.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.84
|
| Rate for Payer: Healthscope Commercial |
$1,196.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,196.21
|
| Rate for Payer: Meridian Medicaid |
$673.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,046.68
|
| Rate for Payer: PACE SWMI |
$996.84
|
| Rate for Payer: PHP Medicare Advantage |
$996.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,526.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,763.34
|
| Rate for Payer: Priority Health Medicare |
$996.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,763.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.75
|
|
|
PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26020
|
| Min. Negotiated Rate |
$362.31 |
| Max. Negotiated Rate |
$860.45 |
| Rate for Payer: Aetna Commercial |
$734.28
|
| Rate for Payer: Aetna Medicare |
$547.97
|
| Rate for Payer: BCBS Complete |
$380.43
|
| Rate for Payer: BCBS MAPPO |
$547.97
|
| Rate for Payer: BCBS Trust/PPO |
$663.49
|
| Rate for Payer: BCN Commercial |
$823.43
|
| Rate for Payer: BCN Medicare Advantage |
$547.97
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$789.08
|
| Rate for Payer: Cofinity Commercial |
$734.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.97
|
| Rate for Payer: Healthscope Commercial |
$657.56
|
| Rate for Payer: Healthscope Whirlpool |
$657.56
|
| Rate for Payer: Meridian Medicaid |
$380.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$575.37
|
| Rate for Payer: PACE SWMI |
$547.97
|
| Rate for Payer: PHP Medicare Advantage |
$547.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$860.45
|
| Rate for Payer: Priority Health Medicare |
$547.97
|
| Rate for Payer: Priority Health Narrow Network |
$860.45
|
| Rate for Payer: UHC Medicare Advantage |
$564.41
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$61.43
|
| Rate for Payer: Aetna Medicare |
$45.84
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS MAPPO |
$45.84
|
| Rate for Payer: BCBS Trust/PPO |
$450.00
|
| Rate for Payer: BCN Commercial |
$66.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.84
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$66.01
|
| Rate for Payer: Cofinity Commercial |
$61.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$55.01
|
| Rate for Payer: Healthscope Whirlpool |
$55.01
|
| Rate for Payer: Meridian Medicaid |
$29.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.13
|
| Rate for Payer: PACE SWMI |
$45.84
|
| Rate for Payer: PHP Medicare Advantage |
$45.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.32
|
| Rate for Payer: Priority Health Medicare |
$45.84
|
| Rate for Payer: Priority Health Narrow Network |
$56.32
|
| Rate for Payer: UHC Medicare Advantage |
$47.22
|
|
|
PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$2,059.31 |
| Rate for Payer: Aetna Commercial |
$197.90
|
| Rate for Payer: Aetna Medicare |
$147.69
|
| Rate for Payer: BCBS Complete |
$104.22
|
| Rate for Payer: BCBS MAPPO |
$147.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.31
|
| Rate for Payer: BCN Commercial |
$429.55
|
| Rate for Payer: BCN Medicare Advantage |
$147.69
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$212.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.69
|
| Rate for Payer: Healthscope Commercial |
$177.23
|
| Rate for Payer: Healthscope Whirlpool |
$177.23
|
| Rate for Payer: Meridian Medicaid |
$104.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$155.07
|
| Rate for Payer: PACE SWMI |
$147.69
|
| Rate for Payer: PHP Medicare Advantage |
$147.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.65
|
| Rate for Payer: Priority Health Medicare |
$147.69
|
| Rate for Payer: Priority Health Narrow Network |
$271.65
|
| Rate for Payer: UHC Medicare Advantage |
$152.12
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 40801
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$1,779.31 |
| Rate for Payer: Aetna Commercial |
$256.23
|
| Rate for Payer: Aetna Medicare |
$191.22
|
| Rate for Payer: BCBS Complete |
$133.74
|
| Rate for Payer: BCBS MAPPO |
$191.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,779.31
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: BCN Medicare Advantage |
$191.22
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cofinity Commercial |
$275.36
|
| Rate for Payer: Cofinity Commercial |
$256.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.22
|
| Rate for Payer: Healthscope Commercial |
$229.46
|
| Rate for Payer: Healthscope Whirlpool |
$229.46
|
| Rate for Payer: Meridian Medicaid |
$133.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.78
|
| Rate for Payer: PACE SWMI |
$191.22
|
| Rate for Payer: PHP Medicare Advantage |
$191.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.32
|
| Rate for Payer: Priority Health Medicare |
$191.22
|
| Rate for Payer: Priority Health Narrow Network |
$346.32
|
| Rate for Payer: UHC Medicare Advantage |
$196.96
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$1,074.93 |
| Rate for Payer: Aetna Commercial |
$653.40
|
| Rate for Payer: Aetna Medicare |
$487.61
|
| Rate for Payer: BCBS Complete |
$335.48
|
| Rate for Payer: BCBS MAPPO |
$487.61
|
| Rate for Payer: BCBS Trust/PPO |
$565.81
|
| Rate for Payer: BCN Commercial |
$725.20
|
| Rate for Payer: BCN Medicare Advantage |
$487.61
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cofinity Commercial |
$653.40
|
| Rate for Payer: Cofinity Commercial |
$702.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.61
|
| Rate for Payer: Healthscope Commercial |
$585.13
|
| Rate for Payer: Healthscope Whirlpool |
$585.13
|
| Rate for Payer: Meridian Medicaid |
$335.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$511.99
|
| Rate for Payer: PACE SWMI |
$487.61
|
| Rate for Payer: PHP Medicare Advantage |
$487.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,074.93
|
| Rate for Payer: Priority Health Medicare |
$487.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,074.93
|
| Rate for Payer: UHC Medicare Advantage |
$502.24
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$135.47 |
| Max. Negotiated Rate |
$604.38 |
| Rate for Payer: Aetna Commercial |
$273.75
|
| Rate for Payer: Aetna Medicare |
$204.29
|
| Rate for Payer: BCBS Complete |
$142.24
|
| Rate for Payer: BCBS MAPPO |
$204.29
|
| Rate for Payer: BCBS Trust/PPO |
$604.38
|
| Rate for Payer: BCN Commercial |
$498.94
|
| Rate for Payer: BCN Medicare Advantage |
$204.29
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$273.75
|
| Rate for Payer: Cofinity Commercial |
$294.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.29
|
| Rate for Payer: Healthscope Commercial |
$245.15
|
| Rate for Payer: Healthscope Whirlpool |
$245.15
|
| Rate for Payer: Meridian Medicaid |
$142.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.50
|
| Rate for Payer: PACE SWMI |
$204.29
|
| Rate for Payer: PHP Medicare Advantage |
$204.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.88
|
| Rate for Payer: Priority Health Medicare |
$204.29
|
| Rate for Payer: Priority Health Narrow Network |
$454.88
|
| Rate for Payer: UHC Medicare Advantage |
$210.42
|
|
|
PR DRG OF SKENE'S GLAND ABSCESS OR CYST
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 53060
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$163.97
|
| Rate for Payer: BCBS Complete |
$111.82
|
| Rate for Payer: BCBS MAPPO |
$163.97
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$277.56
|
| Rate for Payer: BCN Medicare Advantage |
$163.97
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$219.72
|
| Rate for Payer: Cofinity Commercial |
$236.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$196.76
|
| Rate for Payer: Healthscope Whirlpool |
$196.76
|
| Rate for Payer: Meridian Medicaid |
$111.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$172.17
|
| Rate for Payer: PACE SWMI |
$163.97
|
| Rate for Payer: PHP Medicare Advantage |
$163.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.56
|
| Rate for Payer: Priority Health Medicare |
$163.97
|
| Rate for Payer: Priority Health Narrow Network |
$268.56
|
| Rate for Payer: UHC Medicare Advantage |
$168.89
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$569.29 |
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Aetna Medicare |
$129.22
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$129.22
|
| Rate for Payer: BCBS Trust/PPO |
$569.29
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$129.22
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$173.15
|
| Rate for Payer: Cofinity Commercial |
$186.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.22
|
| Rate for Payer: Healthscope Commercial |
$155.06
|
| Rate for Payer: Healthscope Whirlpool |
$155.06
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.68
|
| Rate for Payer: PACE SWMI |
$129.22
|
| Rate for Payer: PHP Medicare Advantage |
$129.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.72
|
| Rate for Payer: Priority Health Medicare |
$129.22
|
| Rate for Payer: Priority Health Narrow Network |
$160.72
|
| Rate for Payer: UHC Medicare Advantage |
$133.10
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 16025
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Aetna Commercial |
$144.75
|
| Rate for Payer: Aetna Medicare |
$108.02
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS MAPPO |
$108.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,369.57
|
| Rate for Payer: BCN Commercial |
$228.70
|
| Rate for Payer: BCN Medicare Advantage |
$108.02
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$155.55
|
| Rate for Payer: Cofinity Commercial |
$144.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.02
|
| Rate for Payer: Healthscope Commercial |
$129.62
|
| Rate for Payer: Healthscope Whirlpool |
$129.62
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.42
|
| Rate for Payer: PACE SWMI |
$108.02
|
| Rate for Payer: PHP Medicare Advantage |
$108.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.82
|
| Rate for Payer: Priority Health Medicare |
$108.02
|
| Rate for Payer: Priority Health Narrow Network |
$134.82
|
| Rate for Payer: UHC Medicare Advantage |
$111.26
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 16020
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$3,995.58 |
| Rate for Payer: Aetna Commercial |
$72.02
|
| Rate for Payer: Aetna Medicare |
$53.75
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS MAPPO |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,995.58
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: BCN Medicare Advantage |
$53.75
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$64.50
|
| Rate for Payer: Healthscope Whirlpool |
$64.50
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.44
|
| Rate for Payer: PACE SWMI |
$53.75
|
| Rate for Payer: PHP Medicare Advantage |
$53.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.82
|
| Rate for Payer: Priority Health Medicare |
$53.75
|
| Rate for Payer: Priority Health Narrow Network |
$67.82
|
| Rate for Payer: UHC Medicare Advantage |
$55.36
|
|
|
PR DRUG-ELUTING STENTS, SINGLE
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS G0290
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: BCBS Complete |
$990.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.50
|
|
|
PR DRUG SCREEN MULTI DRUG CLASS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS G0434
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
|
|
PR DRUG SCREEN MULTIP CLASS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS G0431
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$42.70 |
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
|
|
PR DRUG SCREEN PANEL 10 WITH BATH SALTS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 00124
|
|
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 DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS
|
Professional
|
Both
|
$2,386.00
|
|
|
Service Code
|
HCPCS 36838
|
| Min. Negotiated Rate |
$711.42 |
| Max. Negotiated Rate |
$1,774.08 |
| Rate for Payer: Aetna Commercial |
$1,506.75
|
| Rate for Payer: Aetna Medicare |
$1,124.44
|
| Rate for Payer: BCBS Complete |
$746.99
|
| Rate for Payer: BCBS MAPPO |
$1,124.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.13
|
| Rate for Payer: BCN Commercial |
$1,629.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,124.44
|
| Rate for Payer: Cash Price |
$1,908.80
|
| Rate for Payer: Cash Price |
$1,908.80
|
| Rate for Payer: Cofinity Commercial |
$1,619.19
|
| Rate for Payer: Cofinity Commercial |
$1,506.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,124.44
|
| Rate for Payer: Healthscope Commercial |
$1,349.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,349.33
|
| Rate for Payer: Meridian Medicaid |
$746.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,180.66
|
| Rate for Payer: PACE SWMI |
$1,124.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,124.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,774.08
|
| Rate for Payer: Priority Health Medicare |
$1,124.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,774.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,158.17
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 17107
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Aetna Commercial |
$379.73
|
| Rate for Payer: BCBS Complete |
$241.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,712.50
|
| Rate for Payer: BCN Commercial |
$523.42
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Meridian Medicaid |
$241.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.76
|
| Rate for Payer: Priority Health Narrow Network |
$437.76
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
HCPCS 17108
|
| Min. Negotiated Rate |
$337.82 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$684.19
|
| Rate for Payer: Aetna Medicare |
$510.59
|
| Rate for Payer: BCBS Complete |
$354.71
|
| Rate for Payer: BCBS MAPPO |
$510.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,400.00
|
| Rate for Payer: BCN Commercial |
$742.53
|
| Rate for Payer: BCN Medicare Advantage |
$510.59
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cash Price |
$917.60
|
| Rate for Payer: Cofinity Commercial |
$684.19
|
| Rate for Payer: Cofinity Commercial |
$735.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.59
|
| Rate for Payer: Healthscope Commercial |
$612.71
|
| Rate for Payer: Healthscope Whirlpool |
$612.71
|
| Rate for Payer: Meridian Medicaid |
$354.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$536.12
|
| Rate for Payer: PACE SWMI |
$510.59
|
| Rate for Payer: PHP Medicare Advantage |
$510.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.46
|
| Rate for Payer: Priority Health Medicare |
$510.59
|
| Rate for Payer: Priority Health Narrow Network |
$642.46
|
| Rate for Payer: UHC Medicare Advantage |
$525.91
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
46924
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$3,119.72 |
| Rate for Payer: Aetna Commercial |
$763.20
|
| Rate for Payer: Aetna Medicare |
$2,495.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: ASR ASR |
$822.56
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$657.45
|
| Rate for Payer: BCN Commercial |
$657.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$797.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Healthscope Commercial |
$848.00
|
| Rate for Payer: Healthscope Whirlpool |
$822.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,495.78
|
| Rate for Payer: Mclaren Commercial |
$763.20
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$720.80
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Commercial |
$2,745.36
|
| Rate for Payer: PHP Medicaid |
$1,365.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$771.68
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$602.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$746.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: VA VA |
$2,495.78
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 46924
|
| Hospital Charge Code |
46924
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$1,253.66 |
| Rate for Payer: Aetna Commercial |
$237.56
|
| Rate for Payer: Aetna Medicare |
$177.28
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: BCBS MAPPO |
$177.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.66
|
| Rate for Payer: BCN Commercial |
$809.25
|
| Rate for Payer: BCN Medicare Advantage |
$177.28
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$255.28
|
| Rate for Payer: Cofinity Commercial |
$237.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.28
|
| Rate for Payer: Healthscope Commercial |
$212.74
|
| Rate for Payer: Healthscope Whirlpool |
$212.74
|
| Rate for Payer: Meridian Medicaid |
$122.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.14
|
| Rate for Payer: PACE SWMI |
$177.28
|
| Rate for Payer: PHP Medicare Advantage |
$177.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.91
|
| Rate for Payer: Priority Health Medicare |
$177.28
|
| Rate for Payer: Priority Health Narrow Network |
$316.91
|
| Rate for Payer: UHC Medicare Advantage |
$182.60
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 46924
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$1,253.66 |
| Rate for Payer: Aetna Commercial |
$237.56
|
| Rate for Payer: Aetna Medicare |
$177.28
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: BCBS MAPPO |
$177.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.66
|
| Rate for Payer: BCN Commercial |
$809.25
|
| Rate for Payer: BCN Medicare Advantage |
$177.28
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$255.28
|
| Rate for Payer: Cofinity Commercial |
$237.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.28
|
| Rate for Payer: Healthscope Commercial |
$212.74
|
| Rate for Payer: Healthscope Whirlpool |
$212.74
|
| Rate for Payer: Meridian Medicaid |
$122.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.14
|
| Rate for Payer: PACE SWMI |
$177.28
|
| Rate for Payer: PHP Medicare Advantage |
$177.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.91
|
| Rate for Payer: Priority Health Medicare |
$177.28
|
| Rate for Payer: Priority Health Narrow Network |
$316.91
|
| Rate for Payer: UHC Medicare Advantage |
$182.60
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
46924
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$763.20
|
| Rate for Payer: ASR ASR |
$822.56
|
| Rate for Payer: BCBS Trust/PPO |
$657.45
|
| Rate for Payer: BCN Commercial |
$657.45
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$797.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.40
|
| Rate for Payer: Healthscope Commercial |
$848.00
|
| Rate for Payer: Healthscope Whirlpool |
$822.56
|
| Rate for Payer: Mclaren Commercial |
$763.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$746.24
|
|
