|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| 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 |
$426.80
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$341.13
|
| Rate for Payer: BCN Commercial |
$341.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$413.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$440.00
|
| Rate for Payer: Healthscope Whirlpool |
$426.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$396.00
|
| 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 |
$374.00
|
| 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 |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$312.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$115.02 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$232.26
|
| Rate for Payer: Aetna Medicare |
$173.33
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: BCBS MAPPO |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: BCN Medicare Advantage |
$173.33
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$232.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.33
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.00
|
| Rate for Payer: Meridian Medicaid |
$120.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.00
|
| Rate for Payer: PACE SWMI |
$173.33
|
| Rate for Payer: PHP Medicare Advantage |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
| Rate for Payer: Priority Health Medicare |
$173.33
|
| Rate for Payer: Priority Health Narrow Network |
$219.09
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$396.20 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| 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 |
$549.02
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$438.82
|
| Rate for Payer: BCN Commercial |
$438.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$532.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$566.00
|
| Rate for Payer: Healthscope Whirlpool |
$549.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$509.40
|
| 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 |
$481.10
|
| 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 |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.06
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$401.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$144.63 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$294.18
|
| Rate for Payer: Aetna Medicare |
$219.54
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS MAPPO |
$219.54
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: BCN Medicare Advantage |
$219.54
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$316.14
|
| Rate for Payer: Cofinity Commercial |
$294.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.54
|
| Rate for Payer: Healthscope Commercial |
$263.45
|
| Rate for Payer: Healthscope Whirlpool |
$263.45
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.52
|
| Rate for Payer: PACE SWMI |
$219.54
|
| Rate for Payer: PHP Medicare Advantage |
$219.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.22
|
| Rate for Payer: Priority Health Medicare |
$219.54
|
| Rate for Payer: Priority Health Narrow Network |
$276.22
|
| Rate for Payer: UHC Medicare Advantage |
$226.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$144.63 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$294.18
|
| Rate for Payer: Aetna Medicare |
$219.54
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS MAPPO |
$219.54
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: BCN Medicare Advantage |
$219.54
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$316.14
|
| Rate for Payer: Cofinity Commercial |
$294.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.54
|
| Rate for Payer: Healthscope Commercial |
$263.45
|
| Rate for Payer: Healthscope Whirlpool |
$263.45
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.52
|
| Rate for Payer: PACE SWMI |
$219.54
|
| Rate for Payer: PHP Medicare Advantage |
$219.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.22
|
| Rate for Payer: Priority Health Medicare |
$219.54
|
| Rate for Payer: Priority Health Narrow Network |
$276.22
|
| Rate for Payer: UHC Medicare Advantage |
$226.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$396.20 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: ASR ASR |
$549.02
|
| Rate for Payer: BCBS Trust/PPO |
$438.82
|
| Rate for Payer: BCN Commercial |
$438.82
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$532.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.80
|
| Rate for Payer: Healthscope Commercial |
$566.00
|
| Rate for Payer: Healthscope Whirlpool |
$549.02
|
| Rate for Payer: Mclaren Commercial |
$509.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$481.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.08
|
|
|
PR EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$1,879.16 |
| Rate for Payer: Aetna Commercial |
$418.03
|
| Rate for Payer: Aetna Medicare |
$311.96
|
| Rate for Payer: BCBS Complete |
$212.92
|
| Rate for Payer: BCBS MAPPO |
$311.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.16
|
| Rate for Payer: BCN Commercial |
$463.27
|
| Rate for Payer: BCN Medicare Advantage |
$311.96
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$418.03
|
| Rate for Payer: Cofinity Commercial |
$449.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.96
|
| Rate for Payer: Healthscope Commercial |
$374.35
|
| Rate for Payer: Healthscope Whirlpool |
$374.35
|
| Rate for Payer: Meridian Medicaid |
$212.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.56
|
| Rate for Payer: PACE SWMI |
$311.96
|
| Rate for Payer: PHP Medicare Advantage |
$311.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.81
|
| Rate for Payer: Priority Health Medicare |
$311.96
|
| Rate for Payer: Priority Health Narrow Network |
$448.81
|
| Rate for Payer: UHC Medicare Advantage |
$321.32
|
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$7,827.00
|
|
|
Service Code
|
HCPCS 61563
|
| Min. Negotiated Rate |
$382.49 |
| Max. Negotiated Rate |
$5,478.90 |
| Rate for Payer: Aetna Commercial |
$2,676.94
|
| Rate for Payer: Aetna Medicare |
$1,997.72
|
| Rate for Payer: BCBS Complete |
$1,350.63
|
| Rate for Payer: BCBS MAPPO |
$1,997.72
|
| Rate for Payer: BCBS Trust/PPO |
$382.49
|
| Rate for Payer: BCN Commercial |
$4,057.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.72
|
| Rate for Payer: Cash Price |
$6,261.60
|
| Rate for Payer: Cash Price |
$6,261.60
|
| Rate for Payer: Cofinity Commercial |
$2,876.72
|
| Rate for Payer: Cofinity Commercial |
$2,676.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.72
|
| Rate for Payer: Healthscope Commercial |
$2,397.26
|
| Rate for Payer: Healthscope Whirlpool |
$2,397.26
|
| Rate for Payer: Meridian Medicaid |
$1,350.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,097.61
|
| Rate for Payer: PACE SWMI |
$1,997.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,286.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,478.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,388.85
|
| Rate for Payer: Priority Health Medicare |
$1,997.72
|
| Rate for Payer: Priority Health Narrow Network |
$3,388.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,057.65
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$635.38 |
| Max. Negotiated Rate |
$3,701.02 |
| Rate for Payer: Aetna Commercial |
$1,299.97
|
| Rate for Payer: Aetna Medicare |
$970.13
|
| Rate for Payer: BCBS Complete |
$667.15
|
| Rate for Payer: BCBS MAPPO |
$970.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.02
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: BCN Medicare Advantage |
$970.13
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$1,299.97
|
| Rate for Payer: Cofinity Commercial |
$1,396.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$970.13
|
| Rate for Payer: Healthscope Commercial |
$1,164.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,164.16
|
| Rate for Payer: Meridian Medicaid |
$667.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,018.64
|
| Rate for Payer: PACE SWMI |
$970.13
|
| Rate for Payer: PHP Medicare Advantage |
$970.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$635.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,586.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.66
|
| Rate for Payer: Priority Health Medicare |
$970.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,517.66
|
| Rate for Payer: UHC Medicare Advantage |
$999.23
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$468.89
|
| Rate for Payer: Aetna Medicare |
$349.92
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS MAPPO |
$349.92
|
| Rate for Payer: BCBS Trust/PPO |
$998.90
|
| Rate for Payer: BCN Commercial |
$672.42
|
| Rate for Payer: BCN Medicare Advantage |
$349.92
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cofinity Commercial |
$503.88
|
| Rate for Payer: Cofinity Commercial |
$468.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.92
|
| Rate for Payer: Healthscope Commercial |
$419.90
|
| Rate for Payer: Healthscope Whirlpool |
$419.90
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.42
|
| Rate for Payer: PACE SWMI |
$349.92
|
| Rate for Payer: PHP Medicare Advantage |
$349.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.98
|
| Rate for Payer: Priority Health Medicare |
$349.92
|
| Rate for Payer: Priority Health Narrow Network |
$549.98
|
| Rate for Payer: UHC Medicare Advantage |
$360.42
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$1,136.10 |
| Rate for Payer: Aetna Commercial |
$712.30
|
| Rate for Payer: Aetna Medicare |
$531.57
|
| Rate for Payer: BCBS Complete |
$364.33
|
| Rate for Payer: BCBS MAPPO |
$531.57
|
| Rate for Payer: BCBS Trust/PPO |
$278.41
|
| Rate for Payer: BCN Commercial |
$796.55
|
| Rate for Payer: BCN Medicare Advantage |
$531.57
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$765.46
|
| Rate for Payer: Cofinity Commercial |
$712.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.57
|
| Rate for Payer: Healthscope Commercial |
$637.88
|
| Rate for Payer: Healthscope Whirlpool |
$637.88
|
| Rate for Payer: Meridian Medicaid |
$364.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$558.15
|
| Rate for Payer: PACE SWMI |
$531.57
|
| Rate for Payer: PHP Medicare Advantage |
$531.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.39
|
| Rate for Payer: Priority Health Medicare |
$531.57
|
| Rate for Payer: Priority Health Narrow Network |
$958.39
|
| Rate for Payer: UHC Medicare Advantage |
$547.52
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna Commercial |
$369.22
|
| Rate for Payer: Aetna Medicare |
$275.54
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS MAPPO |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$196.53
|
| Rate for Payer: BCN Commercial |
$575.66
|
| Rate for Payer: BCN Medicare Advantage |
$275.54
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$396.78
|
| Rate for Payer: Cofinity Commercial |
$369.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.54
|
| Rate for Payer: Healthscope Commercial |
$330.65
|
| Rate for Payer: Healthscope Whirlpool |
$330.65
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.32
|
| Rate for Payer: PACE SWMI |
$275.54
|
| Rate for Payer: PHP Medicare Advantage |
$275.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$500.36
|
| Rate for Payer: Priority Health Medicare |
$275.54
|
| Rate for Payer: Priority Health Narrow Network |
$500.36
|
| Rate for Payer: UHC Medicare Advantage |
$283.81
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$866.60 |
| Max. Negotiated Rate |
$1,238.00 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: ASR ASR |
$1,200.86
|
| Rate for Payer: BCBS Trust/PPO |
$959.82
|
| Rate for Payer: BCN Commercial |
$959.82
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.40
|
| Rate for Payer: Healthscope Commercial |
$1,238.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.86
|
| Rate for Payer: Mclaren Commercial |
$1,114.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.44
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$866.60 |
| Rate for Payer: Aetna Commercial |
$613.24
|
| Rate for Payer: Aetna Medicare |
$457.64
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$457.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: BCN Medicare Advantage |
$457.64
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$659.00
|
| Rate for Payer: Cofinity Commercial |
$613.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.64
|
| Rate for Payer: Healthscope Commercial |
$549.17
|
| Rate for Payer: Healthscope Whirlpool |
$549.17
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.52
|
| Rate for Payer: PACE SWMI |
$457.64
|
| Rate for Payer: PHP Medicare Advantage |
$457.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.12
|
| Rate for Payer: Priority Health Medicare |
$457.64
|
| Rate for Payer: Priority Health Narrow Network |
$570.12
|
| Rate for Payer: UHC Medicare Advantage |
$471.37
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$866.60 |
| Rate for Payer: Aetna Commercial |
$613.24
|
| Rate for Payer: Aetna Medicare |
$457.64
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$457.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: BCN Medicare Advantage |
$457.64
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$613.24
|
| Rate for Payer: Cofinity Commercial |
$659.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.64
|
| Rate for Payer: Healthscope Commercial |
$549.17
|
| Rate for Payer: Healthscope Whirlpool |
$549.17
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$480.52
|
| Rate for Payer: PACE SWMI |
$457.64
|
| Rate for Payer: PHP Medicare Advantage |
$457.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.12
|
| Rate for Payer: Priority Health Medicare |
$457.64
|
| Rate for Payer: Priority Health Narrow Network |
$570.12
|
| Rate for Payer: UHC Medicare Advantage |
$471.37
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$618.15 |
| Max. Negotiated Rate |
$4,235.21 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Medicare |
$3,388.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: ASR ASR |
$1,200.86
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$959.82
|
| Rate for Payer: BCCCP Commercial |
$618.15
|
| Rate for Payer: BCN Commercial |
$959.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$1,238.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,388.17
|
| Rate for Payer: Mclaren Commercial |
$1,114.20
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.30
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$3,726.99
|
| Rate for Payer: PHP Medicaid |
$1,853.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,126.58
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$878.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$232.12 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$159.50
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$159.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$232.12
|
| Rate for Payer: BCN Medicare Advantage |
$159.50
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$229.68
|
| Rate for Payer: Cofinity Commercial |
$213.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.50
|
| Rate for Payer: Healthscope Commercial |
$191.40
|
| Rate for Payer: Healthscope Whirlpool |
$191.40
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$167.48
|
| Rate for Payer: PACE SWMI |
$159.50
|
| Rate for Payer: PHP Medicare Advantage |
$159.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.24
|
| Rate for Payer: Priority Health Medicare |
$159.50
|
| Rate for Payer: Priority Health Narrow Network |
$195.24
|
| Rate for Payer: UHC Medicare Advantage |
$164.28
|
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$2,711.00
|
|
|
Service Code
|
HCPCS 60600
|
| Min. Negotiated Rate |
$529.36 |
| Max. Negotiated Rate |
$1,977.68 |
| Rate for Payer: Aetna Commercial |
$1,817.72
|
| Rate for Payer: Aetna Medicare |
$1,356.51
|
| Rate for Payer: BCBS Complete |
$909.14
|
| Rate for Payer: BCBS MAPPO |
$1,356.51
|
| Rate for Payer: BCBS Trust/PPO |
$529.36
|
| Rate for Payer: BCN Commercial |
$1,977.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,356.51
|
| Rate for Payer: Cash Price |
$2,168.80
|
| Rate for Payer: Cash Price |
$2,168.80
|
| Rate for Payer: Cofinity Commercial |
$1,953.37
|
| Rate for Payer: Cofinity Commercial |
$1,817.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,356.51
|
| Rate for Payer: Healthscope Commercial |
$1,627.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,627.81
|
| Rate for Payer: Meridian Medicaid |
$909.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,424.34
|
| Rate for Payer: PACE SWMI |
$1,356.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,356.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$865.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,914.80
|
| Rate for Payer: Priority Health Medicare |
$1,356.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,914.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,397.21
|
|
|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 26596
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$1,267.95 |
| Rate for Payer: Aetna Commercial |
$1,077.95
|
| Rate for Payer: Aetna Medicare |
$804.44
|
| Rate for Payer: BCBS Complete |
$556.22
|
| Rate for Payer: BCBS MAPPO |
$804.44
|
| Rate for Payer: BCBS Trust/PPO |
$72.17
|
| Rate for Payer: BCN Commercial |
$1,213.39
|
| Rate for Payer: BCN Medicare Advantage |
$804.44
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$1,158.39
|
| Rate for Payer: Cofinity Commercial |
$1,077.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.44
|
| Rate for Payer: Healthscope Commercial |
$965.33
|
| Rate for Payer: Healthscope Whirlpool |
$965.33
|
| Rate for Payer: Meridian Medicaid |
$556.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$844.66
|
| Rate for Payer: PACE SWMI |
$804.44
|
| Rate for Payer: PHP Medicare Advantage |
$804.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,267.95
|
| Rate for Payer: Priority Health Medicare |
$804.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,267.95
|
| Rate for Payer: UHC Medicare Advantage |
$828.57
|
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 57556
|
| Min. Negotiated Rate |
$378.50 |
| Max. Negotiated Rate |
$1,301.73 |
| Rate for Payer: Aetna Commercial |
$781.65
|
| Rate for Payer: Aetna Medicare |
$583.32
|
| Rate for Payer: BCBS Complete |
$397.42
|
| Rate for Payer: BCBS MAPPO |
$583.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.73
|
| Rate for Payer: BCN Commercial |
$864.96
|
| Rate for Payer: BCN Medicare Advantage |
$583.32
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cofinity Commercial |
$839.98
|
| Rate for Payer: Cofinity Commercial |
$781.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.32
|
| Rate for Payer: Healthscope Commercial |
$699.98
|
| Rate for Payer: Healthscope Whirlpool |
$699.98
|
| Rate for Payer: Meridian Medicaid |
$397.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$612.49
|
| Rate for Payer: PACE SWMI |
$583.32
|
| Rate for Payer: PHP Medicare Advantage |
$583.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$378.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.96
|
| Rate for Payer: Priority Health Medicare |
$583.32
|
| Rate for Payer: Priority Health Narrow Network |
$837.96
|
| Rate for Payer: UHC Medicare Advantage |
$600.82
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,123.00
|
|
|
Service Code
|
HCPCS 38555
|
| Min. Negotiated Rate |
$556.83 |
| Max. Negotiated Rate |
$2,886.10 |
| Rate for Payer: Aetna Commercial |
$1,363.68
|
| Rate for Payer: Aetna Medicare |
$1,017.67
|
| Rate for Payer: BCBS Complete |
$691.30
|
| Rate for Payer: BCBS MAPPO |
$1,017.67
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,501.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.67
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: Cofinity Commercial |
$1,363.68
|
| Rate for Payer: Cofinity Commercial |
$1,465.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.67
|
| Rate for Payer: Healthscope Commercial |
$1,221.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.20
|
| Rate for Payer: Meridian Medicaid |
$691.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,068.55
|
| Rate for Payer: PACE SWMI |
$1,017.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$658.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,886.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,225.89
|
| Rate for Payer: Priority Health Medicare |
$1,017.67
|
| Rate for Payer: Priority Health Narrow Network |
$2,225.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.20
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 38550
|
| Min. Negotiated Rate |
$337.18 |
| Max. Negotiated Rate |
$1,135.76 |
| Rate for Payer: Aetna Commercial |
$690.64
|
| Rate for Payer: Aetna Medicare |
$515.40
|
| Rate for Payer: BCBS Complete |
$354.04
|
| Rate for Payer: BCBS MAPPO |
$515.40
|
| Rate for Payer: BCBS Trust/PPO |
$608.07
|
| Rate for Payer: BCN Commercial |
$766.24
|
| Rate for Payer: BCN Medicare Advantage |
$515.40
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$742.18
|
| Rate for Payer: Cofinity Commercial |
$690.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.40
|
| Rate for Payer: Healthscope Commercial |
$618.48
|
| Rate for Payer: Healthscope Whirlpool |
$618.48
|
| Rate for Payer: Meridian Medicaid |
$354.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$541.17
|
| Rate for Payer: PACE SWMI |
$515.40
|
| Rate for Payer: PHP Medicare Advantage |
$515.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.76
|
| Rate for Payer: Priority Health Medicare |
$515.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,135.76
|
| Rate for Payer: UHC Medicare Advantage |
$530.86
|
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,315.00
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$1,620.50 |
| Rate for Payer: Aetna Commercial |
$801.88
|
| Rate for Payer: Aetna Medicare |
$598.42
|
| Rate for Payer: BCBS Complete |
$413.53
|
| Rate for Payer: BCBS MAPPO |
$598.42
|
| Rate for Payer: BCBS Trust/PPO |
$32.23
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: BCN Medicare Advantage |
$598.42
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cofinity Commercial |
$861.72
|
| Rate for Payer: Cofinity Commercial |
$801.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.42
|
| Rate for Payer: Healthscope Commercial |
$718.10
|
| Rate for Payer: Healthscope Whirlpool |
$718.10
|
| Rate for Payer: Meridian Medicaid |
$413.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$628.34
|
| Rate for Payer: PACE SWMI |
$598.42
|
| Rate for Payer: PHP Medicare Advantage |
$598.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$393.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.51
|
| Rate for Payer: Priority Health Medicare |
$598.42
|
| Rate for Payer: Priority Health Narrow Network |
$935.51
|
| Rate for Payer: UHC Medicare Advantage |
$616.37
|
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$1,747.00
|
|
|
Service Code
|
HCPCS 26215
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$1,222.90 |
| Rate for Payer: Aetna Commercial |
$752.41
|
| Rate for Payer: Aetna Medicare |
$561.50
|
| Rate for Payer: BCBS Complete |
$388.48
|
| Rate for Payer: BCBS MAPPO |
$561.50
|
| Rate for Payer: BCBS Trust/PPO |
$119.40
|
| Rate for Payer: BCN Commercial |
$841.01
|
| Rate for Payer: BCN Medicare Advantage |
$561.50
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Cofinity Commercial |
$752.41
|
| Rate for Payer: Cofinity Commercial |
$808.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.50
|
| Rate for Payer: Healthscope Commercial |
$673.80
|
| Rate for Payer: Healthscope Whirlpool |
$673.80
|
| Rate for Payer: Meridian Medicaid |
$388.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$589.58
|
| Rate for Payer: PACE SWMI |
$561.50
|
| Rate for Payer: PHP Medicare Advantage |
$561.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.83
|
| Rate for Payer: Priority Health Medicare |
$561.50
|
| Rate for Payer: Priority Health Narrow Network |
$878.83
|
| Rate for Payer: UHC Medicare Advantage |
$578.34
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 27637
|
| Min. Negotiated Rate |
$483.08 |
| Max. Negotiated Rate |
$1,904.70 |
| Rate for Payer: Aetna Commercial |
$978.28
|
| Rate for Payer: Aetna Medicare |
$730.06
|
| Rate for Payer: BCBS Complete |
$507.23
|
| Rate for Payer: BCBS MAPPO |
$730.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.18
|
| Rate for Payer: BCN Commercial |
$1,089.26
|
| Rate for Payer: BCN Medicare Advantage |
$730.06
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cofinity Commercial |
$1,051.29
|
| Rate for Payer: Cofinity Commercial |
$978.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$730.06
|
| Rate for Payer: Healthscope Commercial |
$876.07
|
| Rate for Payer: Healthscope Whirlpool |
$876.07
|
| Rate for Payer: Meridian Medicaid |
$507.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$766.56
|
| Rate for Payer: PACE SWMI |
$730.06
|
| Rate for Payer: PHP Medicare Advantage |
$730.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$483.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,138.25
|
| Rate for Payer: Priority Health Medicare |
$730.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,138.25
|
| Rate for Payer: UHC Medicare Advantage |
$751.96
|
|
