|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$6,743.00
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$1,000.46 |
| Max. Negotiated Rate |
$4,720.10 |
| Rate for Payer: Aetna Commercial |
$2,076.40
|
| Rate for Payer: Aetna Medicare |
$1,549.55
|
| Rate for Payer: BCBS Complete |
$1,050.48
|
| Rate for Payer: BCBS MAPPO |
$1,549.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,117.43
|
| Rate for Payer: BCN Commercial |
$3,154.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,549.55
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Cash Price |
$5,394.40
|
| Rate for Payer: Cofinity Commercial |
$2,231.35
|
| Rate for Payer: Cofinity Commercial |
$2,076.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,549.55
|
| Rate for Payer: Healthscope Commercial |
$1,859.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,859.46
|
| Rate for Payer: Meridian Medicaid |
$1,050.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,627.03
|
| Rate for Payer: PACE SWMI |
$1,549.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,549.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,720.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,634.64
|
| Rate for Payer: Priority Health Medicare |
$1,549.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,634.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,596.04
|
|
|
PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
|
|
PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$52,614.47
|
|
|
Service Code
|
MS-DRG 791
|
| Min. Negotiated Rate |
$34,555.01 |
| Max. Negotiated Rate |
$52,614.47 |
| Rate for Payer: Aetna Medicare |
$36,373.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,467.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,467.11
|
| Rate for Payer: BCBS MAPPO |
$36,373.69
|
| Rate for Payer: BCN Medicare Advantage |
$36,373.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,373.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$36,373.69
|
| Rate for Payer: Mclaren Medicare |
$36,373.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38,192.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,829.74
|
| Rate for Payer: PACE Medicare |
$34,555.01
|
| Rate for Payer: PACE SWMI |
$36,373.69
|
| Rate for Payer: PHP Commercial |
$40,011.06
|
| Rate for Payer: PHP Medicare Advantage |
$36,373.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,614.47
|
| Rate for Payer: Priority Health Medicare |
$36,373.69
|
| Rate for Payer: Priority Health Narrow Network |
$42,091.58
|
| Rate for Payer: Railroad Medicare Medicare |
$36,373.69
|
| Rate for Payer: UHC Medicare Advantage |
$37,464.90
|
| Rate for Payer: VA VA |
$36,373.69
|
|
|
PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$31,746.90
|
|
|
Service Code
|
MS-DRG 792
|
| Min. Negotiated Rate |
$21,483.40 |
| Max. Negotiated Rate |
$31,746.90 |
| Rate for Payer: Aetna Medicare |
$22,614.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,267.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,267.62
|
| Rate for Payer: BCBS MAPPO |
$22,614.10
|
| Rate for Payer: BCN Medicare Advantage |
$22,614.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,614.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,614.10
|
| Rate for Payer: Mclaren Medicare |
$22,614.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,744.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,006.22
|
| Rate for Payer: PACE Medicare |
$21,483.40
|
| Rate for Payer: PACE SWMI |
$22,614.10
|
| Rate for Payer: PHP Commercial |
$24,875.51
|
| Rate for Payer: PHP Medicare Advantage |
$22,614.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,746.90
|
| Rate for Payer: Priority Health Medicare |
$22,614.10
|
| Rate for Payer: Priority Health Narrow Network |
$25,397.52
|
| Rate for Payer: Railroad Medicare Medicare |
$22,614.10
|
| Rate for Payer: UHC Medicare Advantage |
$23,292.52
|
| Rate for Payer: VA VA |
$22,614.10
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,291.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,746.03 |
| Rate for Payer: Aetna Commercial |
$787.54
|
| Rate for Payer: Aetna Medicare |
$587.72
|
| Rate for Payer: BCBS Complete |
$391.39
|
| Rate for Payer: BCBS MAPPO |
$587.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,746.03
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$587.72
|
| Rate for Payer: Cash Price |
$1,832.80
|
| Rate for Payer: Cash Price |
$1,832.80
|
| Rate for Payer: Cofinity Commercial |
$787.54
|
| Rate for Payer: Cofinity Commercial |
$846.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.72
|
| Rate for Payer: Healthscope Commercial |
$705.26
|
| Rate for Payer: Healthscope Whirlpool |
$705.26
|
| Rate for Payer: Meridian Medicaid |
$391.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$617.11
|
| Rate for Payer: PACE SWMI |
$587.72
|
| Rate for Payer: PHP Medicare Advantage |
$587.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,603.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.40
|
| Rate for Payer: Priority Health Medicare |
$587.72
|
| Rate for Payer: Priority Health Narrow Network |
$930.40
|
| Rate for Payer: UHC Medicare Advantage |
$605.35
|
|
|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$571.48 |
| Max. Negotiated Rate |
$1,434.86 |
| Rate for Payer: Aetna Commercial |
$1,209.63
|
| Rate for Payer: Aetna Medicare |
$902.71
|
| Rate for Payer: BCBS Complete |
$600.05
|
| Rate for Payer: BCBS MAPPO |
$902.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.86
|
| Rate for Payer: BCN Commercial |
$1,305.26
|
| Rate for Payer: BCN Medicare Advantage |
$902.71
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cofinity Commercial |
$1,299.90
|
| Rate for Payer: Cofinity Commercial |
$1,209.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.71
|
| Rate for Payer: Healthscope Commercial |
$1,083.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,083.25
|
| Rate for Payer: Meridian Medicaid |
$600.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$947.85
|
| Rate for Payer: PACE SWMI |
$902.71
|
| Rate for Payer: PHP Medicare Advantage |
$902.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,420.86
|
| Rate for Payer: Priority Health Medicare |
$902.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,420.86
|
| Rate for Payer: UHC Medicare Advantage |
$929.79
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$637.51 |
| Max. Negotiated Rate |
$2,634.63 |
| Rate for Payer: Aetna Commercial |
$1,348.01
|
| Rate for Payer: Aetna Medicare |
$1,005.98
|
| Rate for Payer: BCBS Complete |
$669.39
|
| Rate for Payer: BCBS MAPPO |
$1,005.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,634.63
|
| Rate for Payer: BCN Commercial |
$1,457.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.98
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cofinity Commercial |
$1,448.61
|
| Rate for Payer: Cofinity Commercial |
$1,348.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.98
|
| Rate for Payer: Healthscope Commercial |
$1,207.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.18
|
| Rate for Payer: Meridian Medicaid |
$669.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,056.28
|
| Rate for Payer: PACE SWMI |
$1,005.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.84
|
| Rate for Payer: Priority Health Medicare |
$1,005.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,036.16
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$624.09 |
| Max. Negotiated Rate |
$2,053.50 |
| Rate for Payer: Aetna Commercial |
$1,305.55
|
| Rate for Payer: Aetna Medicare |
$974.29
|
| Rate for Payer: BCBS Complete |
$655.29
|
| Rate for Payer: BCBS MAPPO |
$974.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,053.50
|
| Rate for Payer: BCN Commercial |
$1,427.42
|
| Rate for Payer: BCN Medicare Advantage |
$974.29
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cofinity Commercial |
$1,305.55
|
| Rate for Payer: Cofinity Commercial |
$1,402.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.29
|
| Rate for Payer: Healthscope Commercial |
$1,169.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,169.15
|
| Rate for Payer: Meridian Medicaid |
$655.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,023.00
|
| Rate for Payer: PACE SWMI |
$974.29
|
| Rate for Payer: PHP Medicare Advantage |
$974.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,379.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,553.86
|
| Rate for Payer: Priority Health Medicare |
$974.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,553.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.52
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$592.35 |
| Max. Negotiated Rate |
$3,301.73 |
| Rate for Payer: Aetna Commercial |
$1,250.01
|
| Rate for Payer: Aetna Medicare |
$932.84
|
| Rate for Payer: BCBS Complete |
$621.97
|
| Rate for Payer: BCBS MAPPO |
$932.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.73
|
| Rate for Payer: BCN Commercial |
$1,353.15
|
| Rate for Payer: BCN Medicare Advantage |
$932.84
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,343.29
|
| Rate for Payer: Cofinity Commercial |
$1,250.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$932.84
|
| Rate for Payer: Healthscope Commercial |
$1,119.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,119.41
|
| Rate for Payer: Meridian Medicaid |
$621.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$979.48
|
| Rate for Payer: PACE SWMI |
$932.84
|
| Rate for Payer: PHP Medicare Advantage |
$932.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,473.00
|
| Rate for Payer: Priority Health Medicare |
$932.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,473.00
|
| Rate for Payer: UHC Medicare Advantage |
$960.83
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,676.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$868.40 |
| Max. Negotiated Rate |
$2,233.15 |
| Rate for Payer: Aetna Commercial |
$1,837.43
|
| Rate for Payer: Aetna Medicare |
$1,371.22
|
| Rate for Payer: BCBS Complete |
$911.82
|
| Rate for Payer: BCBS MAPPO |
$1,371.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.15
|
| Rate for Payer: BCN Commercial |
$1,987.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,371.22
|
| Rate for Payer: Cash Price |
$2,140.80
|
| Rate for Payer: Cash Price |
$2,140.80
|
| Rate for Payer: Cofinity Commercial |
$1,837.43
|
| Rate for Payer: Cofinity Commercial |
$1,974.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,371.22
|
| Rate for Payer: Healthscope Commercial |
$1,645.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,645.46
|
| Rate for Payer: Meridian Medicaid |
$911.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,439.78
|
| Rate for Payer: PACE SWMI |
$1,371.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,371.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$868.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,873.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,164.00
|
| Rate for Payer: Priority Health Medicare |
$1,371.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,164.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,412.36
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,233.34
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$372.32 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$789.88
|
| Rate for Payer: Aetna Medicare |
$589.46
|
| Rate for Payer: BCBS Complete |
$390.94
|
| Rate for Payer: BCBS MAPPO |
$589.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$857.63
|
| Rate for Payer: BCN Medicare Advantage |
$589.46
|
| Rate for Payer: Cash Price |
$986.67
|
| Rate for Payer: Cash Price |
$986.67
|
| Rate for Payer: Cofinity Commercial |
$848.82
|
| Rate for Payer: Cofinity Commercial |
$789.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.46
|
| Rate for Payer: Healthscope Commercial |
$707.35
|
| Rate for Payer: Healthscope Whirlpool |
$707.35
|
| Rate for Payer: Meridian Medicaid |
$390.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$618.93
|
| Rate for Payer: PACE SWMI |
$589.46
|
| Rate for Payer: PHP Medicare Advantage |
$589.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$933.58
|
| Rate for Payer: Priority Health Medicare |
$589.46
|
| Rate for Payer: Priority Health Narrow Network |
$933.58
|
| Rate for Payer: UHC Medicare Advantage |
$607.14
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$234.84
|
| Rate for Payer: Aetna Medicare |
$175.25
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS MAPPO |
$175.25
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: BCN Commercial |
$254.60
|
| Rate for Payer: BCN Medicare Advantage |
$175.25
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$252.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.25
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Healthscope Whirlpool |
$192.78
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.01
|
| Rate for Payer: PACE SWMI |
$175.25
|
| Rate for Payer: PHP Medicare Advantage |
$175.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.90
|
| Rate for Payer: Priority Health Medicare |
$175.25
|
| Rate for Payer: Priority Health Narrow Network |
$284.90
|
| Rate for Payer: UHC Medicare Advantage |
$180.51
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna Commercial |
$95.93
|
| Rate for Payer: Aetna Medicare |
$71.59
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS MAPPO |
$71.59
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$104.09
|
| Rate for Payer: BCN Medicare Advantage |
$71.59
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$95.93
|
| Rate for Payer: Cofinity Commercial |
$103.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.59
|
| Rate for Payer: Healthscope Commercial |
$78.75
|
| Rate for Payer: Healthscope Whirlpool |
$78.75
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.17
|
| Rate for Payer: PACE SWMI |
$71.59
|
| Rate for Payer: PHP Medicare Advantage |
$71.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.57
|
| Rate for Payer: Priority Health Medicare |
$71.59
|
| Rate for Payer: Priority Health Narrow Network |
$108.57
|
| Rate for Payer: UHC Medicare Advantage |
$73.74
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$11.78
|
| Rate for Payer: BCBS Trust/PPO |
$171.07
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Medicare Advantage |
$11.78
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.78
|
| Rate for Payer: Healthscope Commercial |
$12.96
|
| Rate for Payer: Healthscope Whirlpool |
$12.96
|
| Rate for Payer: Meridian Medicaid |
$7.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.37
|
| Rate for Payer: PACE SWMI |
$11.78
|
| Rate for Payer: PHP Medicare Advantage |
$11.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.13
|
| Rate for Payer: Priority Health Medicare |
$11.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.13
|
| Rate for Payer: UHC Medicare Advantage |
$12.13
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$193.43 |
| Rate for Payer: Aetna Commercial |
$161.19
|
| Rate for Payer: Aetna Medicare |
$120.29
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$120.29
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$120.29
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$173.22
|
| Rate for Payer: Cofinity Commercial |
$161.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.29
|
| Rate for Payer: Healthscope Commercial |
$132.32
|
| Rate for Payer: Healthscope Whirlpool |
$132.32
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.30
|
| Rate for Payer: PACE SWMI |
$120.29
|
| Rate for Payer: PHP Medicare Advantage |
$120.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.43
|
| Rate for Payer: Priority Health Medicare |
$120.29
|
| Rate for Payer: Priority Health Narrow Network |
$193.43
|
| Rate for Payer: UHC Medicare Advantage |
$123.90
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$338.11 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Medicare |
$41.64
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$41.64
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: BCN Medicare Advantage |
$41.64
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$59.96
|
| Rate for Payer: Cofinity Commercial |
$55.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.64
|
| Rate for Payer: Healthscope Commercial |
$45.80
|
| Rate for Payer: Healthscope Whirlpool |
$45.80
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.72
|
| Rate for Payer: PACE SWMI |
$41.64
|
| Rate for Payer: PHP Medicare Advantage |
$41.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.39
|
| Rate for Payer: Priority Health Medicare |
$41.64
|
| Rate for Payer: Priority Health Narrow Network |
$68.39
|
| Rate for Payer: UHC Medicare Advantage |
$42.89
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$61.67 |
| Max. Negotiated Rate |
$3,642.10 |
| Rate for Payer: Aetna Commercial |
$82.64
|
| Rate for Payer: Aetna Medicare |
$61.67
|
| Rate for Payer: BCBS Complete |
$154.00
|
| Rate for Payer: BCBS MAPPO |
$61.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,642.10
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$61.67
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cofinity Commercial |
$82.64
|
| Rate for Payer: Cofinity Commercial |
$88.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.67
|
| Rate for Payer: Healthscope Commercial |
$74.00
|
| Rate for Payer: Healthscope Whirlpool |
$74.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.75
|
| Rate for Payer: PACE SWMI |
$61.67
|
| Rate for Payer: PHP Medicare Advantage |
$61.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.20
|
| Rate for Payer: Priority Health Medicare |
$61.67
|
| Rate for Payer: Priority Health Narrow Network |
$103.20
|
| Rate for Payer: UHC Medicare Advantage |
$63.52
|
|
|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| Rate for Payer: Aetna Medicare |
$106.22
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$106.22
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$184.16
|
| Rate for Payer: BCN Medicare Advantage |
$106.22
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$152.96
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.22
|
| Rate for Payer: Healthscope Commercial |
$127.46
|
| Rate for Payer: Healthscope Whirlpool |
$127.46
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.53
|
| Rate for Payer: PACE SWMI |
$106.22
|
| Rate for Payer: PHP Medicare Advantage |
$106.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.76
|
| Rate for Payer: Priority Health Medicare |
$106.22
|
| Rate for Payer: Priority Health Narrow Network |
$155.76
|
| Rate for Payer: UHC Medicare Advantage |
$109.41
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$206.57 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$28.73
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.64
|
| Rate for Payer: Priority Health Narrow Network |
$47.64
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: BCBS Complete |
$120.40
|
| Rate for Payer: BCBS Trust/PPO |
$230.34
|
| Rate for Payer: BCN Commercial |
$233.10
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.03
|
| Rate for Payer: Priority Health Narrow Network |
$226.03
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 92978
|
| Min. Negotiated Rate |
$154.26 |
| Max. Negotiated Rate |
$386.06 |
| Rate for Payer: Aetna Commercial |
$348.91
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$386.06
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.09
|
| Rate for Payer: Priority Health Narrow Network |
$373.09
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$1,402.10 |
| Rate for Payer: Aetna Commercial |
$306.89
|
| Rate for Payer: Aetna Medicare |
$229.02
|
| Rate for Payer: BCBS Complete |
$155.88
|
| Rate for Payer: BCBS MAPPO |
$229.02
|
| Rate for Payer: BCBS Trust/PPO |
$572.15
|
| Rate for Payer: BCN Commercial |
$1,387.35
|
| Rate for Payer: BCN Medicare Advantage |
$229.02
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cofinity Commercial |
$306.89
|
| Rate for Payer: Cofinity Commercial |
$329.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.02
|
| Rate for Payer: Healthscope Commercial |
$274.82
|
| Rate for Payer: Healthscope Whirlpool |
$274.82
|
| Rate for Payer: Meridian Medicaid |
$155.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$240.47
|
| Rate for Payer: PACE SWMI |
$229.02
|
| Rate for Payer: PHP Medicare Advantage |
$229.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,402.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.50
|
| Rate for Payer: Priority Health Medicare |
$229.02
|
| Rate for Payer: Priority Health Narrow Network |
$329.50
|
| Rate for Payer: UHC Medicare Advantage |
$235.89
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$1,845.88 |
| Rate for Payer: Aetna Commercial |
$53.24
|
| Rate for Payer: Aetna Medicare |
$39.73
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS MAPPO |
$39.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.88
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: BCN Medicare Advantage |
$39.73
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$57.21
|
| Rate for Payer: Cofinity Commercial |
$53.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.73
|
| Rate for Payer: Healthscope Commercial |
$47.68
|
| Rate for Payer: Healthscope Whirlpool |
$47.68
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.72
|
| Rate for Payer: PACE SWMI |
$39.73
|
| Rate for Payer: PHP Medicare Advantage |
$39.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.34
|
| Rate for Payer: Priority Health Medicare |
$39.73
|
| Rate for Payer: Priority Health Narrow Network |
$56.34
|
| Rate for Payer: UHC Medicare Advantage |
$40.92
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,579.09 |
| Rate for Payer: Aetna Commercial |
$84.08
|
| Rate for Payer: Aetna Medicare |
$62.75
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$62.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.09
|
| Rate for Payer: BCN Commercial |
$120.16
|
| Rate for Payer: BCN Medicare Advantage |
$62.75
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cofinity Commercial |
$90.36
|
| Rate for Payer: Cofinity Commercial |
$84.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$75.30
|
| Rate for Payer: Healthscope Whirlpool |
$75.30
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.89
|
| Rate for Payer: PACE SWMI |
$62.75
|
| Rate for Payer: PHP Medicare Advantage |
$62.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.01
|
| Rate for Payer: Priority Health Medicare |
$62.75
|
| Rate for Payer: Priority Health Narrow Network |
$89.01
|
| Rate for Payer: UHC Medicare Advantage |
$64.63
|
|
