|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$961.20
|
| 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 |
$1,035.96
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$828.02
|
| Rate for Payer: BCN Commercial |
$828.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cofinity Commercial |
$1,003.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$1,068.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$961.20
|
| 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 |
$907.80
|
| 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 |
$747.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.88
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$758.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$1,152.90 |
| Rate for Payer: Aetna Commercial |
$693.85
|
| Rate for Payer: Aetna Medicare |
$517.80
|
| Rate for Payer: BCBS Complete |
$358.96
|
| Rate for Payer: BCBS MAPPO |
$517.80
|
| Rate for Payer: BCBS Trust/PPO |
$149.00
|
| Rate for Payer: BCN Commercial |
$776.51
|
| Rate for Payer: BCN Medicare Advantage |
$517.80
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$745.63
|
| Rate for Payer: Cofinity Commercial |
$693.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.80
|
| Rate for Payer: Healthscope Commercial |
$621.36
|
| Rate for Payer: Healthscope Whirlpool |
$621.36
|
| Rate for Payer: Meridian Medicaid |
$358.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$543.69
|
| Rate for Payer: PACE SWMI |
$517.80
|
| Rate for Payer: PHP Medicare Advantage |
$517.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.43
|
| Rate for Payer: Priority Health Medicare |
$517.80
|
| Rate for Payer: Priority Health Narrow Network |
$811.43
|
| Rate for Payer: UHC Medicare Advantage |
$533.33
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$5,428.00
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$406.62 |
| Max. Negotiated Rate |
$3,799.60 |
| Rate for Payer: Aetna Commercial |
$833.84
|
| Rate for Payer: Aetna Medicare |
$622.27
|
| Rate for Payer: BCBS Complete |
$426.95
|
| Rate for Payer: BCBS MAPPO |
$622.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,025.57
|
| Rate for Payer: BCN Commercial |
$920.67
|
| Rate for Payer: BCN Medicare Advantage |
$622.27
|
| Rate for Payer: Cash Price |
$4,342.40
|
| Rate for Payer: Cash Price |
$4,342.40
|
| Rate for Payer: Cofinity Commercial |
$896.07
|
| Rate for Payer: Cofinity Commercial |
$833.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.27
|
| Rate for Payer: Healthscope Commercial |
$746.72
|
| Rate for Payer: Healthscope Whirlpool |
$746.72
|
| Rate for Payer: Meridian Medicaid |
$426.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$653.38
|
| Rate for Payer: PACE SWMI |
$622.27
|
| Rate for Payer: PHP Medicare Advantage |
$622.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,799.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.03
|
| Rate for Payer: Priority Health Medicare |
$622.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.03
|
| Rate for Payer: UHC Medicare Advantage |
$640.94
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,126.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$975.34 |
| Rate for Payer: Aetna Commercial |
$799.07
|
| Rate for Payer: Aetna Medicare |
$596.32
|
| Rate for Payer: BCBS Complete |
$409.28
|
| Rate for Payer: BCBS MAPPO |
$596.32
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: BCN Commercial |
$882.06
|
| Rate for Payer: BCN Medicare Advantage |
$596.32
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cofinity Commercial |
$799.07
|
| Rate for Payer: Cofinity Commercial |
$858.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$596.32
|
| Rate for Payer: Healthscope Commercial |
$715.58
|
| Rate for Payer: Healthscope Whirlpool |
$715.58
|
| Rate for Payer: Meridian Medicaid |
$409.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$626.14
|
| Rate for Payer: PACE SWMI |
$596.32
|
| Rate for Payer: PHP Medicare Advantage |
$596.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.34
|
| Rate for Payer: Priority Health Medicare |
$596.32
|
| Rate for Payer: Priority Health Narrow Network |
$975.34
|
| Rate for Payer: UHC Medicare Advantage |
$614.21
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$1,511.99 |
| Rate for Payer: Aetna Commercial |
$563.27
|
| Rate for Payer: Aetna Medicare |
$420.35
|
| Rate for Payer: BCBS Complete |
$289.63
|
| Rate for Payer: BCBS MAPPO |
$420.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,511.99
|
| Rate for Payer: BCN Commercial |
$623.55
|
| Rate for Payer: BCN Medicare Advantage |
$420.35
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cofinity Commercial |
$563.27
|
| Rate for Payer: Cofinity Commercial |
$605.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.35
|
| Rate for Payer: Healthscope Commercial |
$504.42
|
| Rate for Payer: Healthscope Whirlpool |
$504.42
|
| Rate for Payer: Meridian Medicaid |
$289.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.37
|
| Rate for Payer: PACE SWMI |
$420.35
|
| Rate for Payer: PHP Medicare Advantage |
$420.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,470.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.50
|
| Rate for Payer: Priority Health Medicare |
$420.35
|
| Rate for Payer: Priority Health Narrow Network |
$689.50
|
| Rate for Payer: UHC Medicare Advantage |
$432.96
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$225.99 |
| Max. Negotiated Rate |
$1,577.50 |
| Rate for Payer: Aetna Commercial |
$460.85
|
| Rate for Payer: Aetna Medicare |
$343.92
|
| Rate for Payer: BCBS Complete |
$237.29
|
| Rate for Payer: BCBS MAPPO |
$343.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.50
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$343.92
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$460.85
|
| Rate for Payer: Cofinity Commercial |
$495.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.92
|
| Rate for Payer: Healthscope Commercial |
$412.70
|
| Rate for Payer: Healthscope Whirlpool |
$412.70
|
| Rate for Payer: Meridian Medicaid |
$237.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$361.12
|
| Rate for Payer: PACE SWMI |
$343.92
|
| Rate for Payer: PHP Medicare Advantage |
$343.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$564.67
|
| Rate for Payer: Priority Health Medicare |
$343.92
|
| Rate for Payer: Priority Health Narrow Network |
$564.67
|
| Rate for Payer: UHC Medicare Advantage |
$354.24
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$357.63 |
| Max. Negotiated Rate |
$1,332.37 |
| Rate for Payer: Aetna Commercial |
$738.31
|
| Rate for Payer: Aetna Medicare |
$550.98
|
| Rate for Payer: BCBS Complete |
$375.51
|
| Rate for Payer: BCBS MAPPO |
$550.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.37
|
| Rate for Payer: BCN Commercial |
$814.14
|
| Rate for Payer: BCN Medicare Advantage |
$550.98
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$793.41
|
| Rate for Payer: Cofinity Commercial |
$738.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.98
|
| Rate for Payer: Healthscope Commercial |
$661.18
|
| Rate for Payer: Healthscope Whirlpool |
$661.18
|
| Rate for Payer: Meridian Medicaid |
$375.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$578.53
|
| Rate for Payer: PACE SWMI |
$550.98
|
| Rate for Payer: PHP Medicare Advantage |
$550.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.24
|
| Rate for Payer: Priority Health Medicare |
$550.98
|
| Rate for Payer: Priority Health Narrow Network |
$900.24
|
| Rate for Payer: UHC Medicare Advantage |
$567.51
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$343.57 |
| Max. Negotiated Rate |
$1,954.18 |
| Rate for Payer: Aetna Commercial |
$703.50
|
| Rate for Payer: Aetna Medicare |
$525.00
|
| Rate for Payer: BCBS Complete |
$360.75
|
| Rate for Payer: BCBS MAPPO |
$525.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,954.18
|
| Rate for Payer: BCN Commercial |
$776.51
|
| Rate for Payer: BCN Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cofinity Commercial |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$703.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$525.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Healthscope Whirlpool |
$630.00
|
| Rate for Payer: Meridian Medicaid |
$360.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$551.25
|
| Rate for Payer: PACE SWMI |
$525.00
|
| Rate for Payer: PHP Medicare Advantage |
$525.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$858.63
|
| Rate for Payer: Priority Health Medicare |
$525.00
|
| Rate for Payer: Priority Health Narrow Network |
$858.63
|
| Rate for Payer: UHC Medicare Advantage |
$540.75
|
|
|
PR EXERCISE EQUIPMENT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A9300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$752.00
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$235.37 |
| Max. Negotiated Rate |
$696.86 |
| Rate for Payer: Aetna Commercial |
$478.96
|
| Rate for Payer: Aetna Medicare |
$357.43
|
| Rate for Payer: BCBS Complete |
$247.14
|
| Rate for Payer: BCBS MAPPO |
$357.43
|
| Rate for Payer: BCBS Trust/PPO |
$563.70
|
| Rate for Payer: BCN Commercial |
$696.86
|
| Rate for Payer: BCN Medicare Advantage |
$357.43
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cofinity Commercial |
$478.96
|
| Rate for Payer: Cofinity Commercial |
$514.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.43
|
| Rate for Payer: Healthscope Commercial |
$428.92
|
| Rate for Payer: Healthscope Whirlpool |
$428.92
|
| Rate for Payer: Meridian Medicaid |
$247.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$375.30
|
| Rate for Payer: PACE SWMI |
$357.43
|
| Rate for Payer: PHP Medicare Advantage |
$357.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$526.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$646.18
|
| Rate for Payer: Priority Health Medicare |
$357.43
|
| Rate for Payer: Priority Health Narrow Network |
$646.18
|
| Rate for Payer: UHC Medicare Advantage |
$368.15
|
|
|
PR EXPL CONGENITAL ATRESIA BILE DUCTS
|
Professional
|
Both
|
$2,845.00
|
|
|
Service Code
|
HCPCS 47700
|
| Min. Negotiated Rate |
$678.34 |
| Max. Negotiated Rate |
$1,991.50 |
| Rate for Payer: Aetna Commercial |
$1,410.22
|
| Rate for Payer: Aetna Medicare |
$1,052.40
|
| Rate for Payer: BCBS Complete |
$712.99
|
| Rate for Payer: BCBS MAPPO |
$1,052.40
|
| Rate for Payer: BCBS Trust/PPO |
$678.34
|
| Rate for Payer: BCN Commercial |
$1,550.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,052.40
|
| Rate for Payer: Cash Price |
$2,276.00
|
| Rate for Payer: Cash Price |
$2,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,515.46
|
| Rate for Payer: Cofinity Commercial |
$1,410.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,052.40
|
| Rate for Payer: Healthscope Commercial |
$1,262.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,262.88
|
| Rate for Payer: Meridian Medicaid |
$712.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,105.02
|
| Rate for Payer: PACE SWMI |
$1,052.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,052.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,991.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,865.64
|
| Rate for Payer: Priority Health Medicare |
$1,052.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,865.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.97
|
|
|
PR EXPLORATION EPIDIDYMIS W/WO BIOPSY
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 54865
|
| Min. Negotiated Rate |
$231.32 |
| Max. Negotiated Rate |
$1,488.22 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Medicare |
$351.27
|
| Rate for Payer: BCBS Complete |
$242.89
|
| Rate for Payer: BCBS MAPPO |
$351.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.22
|
| Rate for Payer: BCN Commercial |
$522.39
|
| Rate for Payer: BCN Medicare Advantage |
$351.27
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$505.83
|
| Rate for Payer: Cofinity Commercial |
$470.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.27
|
| Rate for Payer: Healthscope Commercial |
$421.52
|
| Rate for Payer: Healthscope Whirlpool |
$421.52
|
| Rate for Payer: Meridian Medicaid |
$242.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$368.83
|
| Rate for Payer: PACE SWMI |
$351.27
|
| Rate for Payer: PHP Medicare Advantage |
$351.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.64
|
| Rate for Payer: Priority Health Medicare |
$351.27
|
| Rate for Payer: Priority Health Narrow Network |
$577.64
|
| Rate for Payer: UHC Medicare Advantage |
$361.81
|
|
|
PR EXPLORATION, FEMORAL ARTERY
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
HCPCS 35721
|
| Min. Negotiated Rate |
$612.80 |
| Max. Negotiated Rate |
$1,072.40 |
| Rate for Payer: BCBS Complete |
$612.80
|
| Rate for Payer: Cash Price |
$1,225.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.40
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$2,000.67 |
| Rate for Payer: Aetna Commercial |
$549.68
|
| Rate for Payer: Aetna Medicare |
$410.21
|
| Rate for Payer: BCBS Complete |
$273.75
|
| Rate for Payer: BCBS MAPPO |
$410.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.67
|
| Rate for Payer: BCN Commercial |
$598.14
|
| Rate for Payer: BCN Medicare Advantage |
$410.21
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cofinity Commercial |
$590.70
|
| Rate for Payer: Cofinity Commercial |
$549.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.21
|
| Rate for Payer: Healthscope Commercial |
$492.25
|
| Rate for Payer: Healthscope Whirlpool |
$492.25
|
| Rate for Payer: Meridian Medicaid |
$273.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$430.72
|
| Rate for Payer: PACE SWMI |
$410.21
|
| Rate for Payer: PHP Medicare Advantage |
$410.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$651.12
|
| Rate for Payer: Priority Health Medicare |
$410.21
|
| Rate for Payer: Priority Health Narrow Network |
$651.12
|
| Rate for Payer: UHC Medicare Advantage |
$422.52
|
|
|
PR EXPLORATION N/FLWD SURG NECK ARTERY
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 35701
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$2,119.54 |
| Rate for Payer: Aetna Commercial |
$580.17
|
| Rate for Payer: Aetna Medicare |
$432.96
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS MAPPO |
$432.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.54
|
| Rate for Payer: BCN Commercial |
$638.21
|
| Rate for Payer: BCN Medicare Advantage |
$432.96
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cofinity Commercial |
$623.46
|
| Rate for Payer: Cofinity Commercial |
$580.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.96
|
| Rate for Payer: Healthscope Commercial |
$519.55
|
| Rate for Payer: Healthscope Whirlpool |
$519.55
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$454.61
|
| Rate for Payer: PACE SWMI |
$432.96
|
| Rate for Payer: PHP Medicare Advantage |
$432.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$694.74
|
| Rate for Payer: Priority Health Medicare |
$432.96
|
| Rate for Payer: Priority Health Narrow Network |
$694.74
|
| Rate for Payer: UHC Medicare Advantage |
$445.95
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$257.73 |
| Max. Negotiated Rate |
$1,869.13 |
| Rate for Payer: Aetna Commercial |
$542.14
|
| Rate for Payer: Aetna Medicare |
$404.58
|
| Rate for Payer: BCBS Complete |
$270.62
|
| Rate for Payer: BCBS MAPPO |
$404.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.13
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: BCN Medicare Advantage |
$404.58
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cofinity Commercial |
$582.60
|
| Rate for Payer: Cofinity Commercial |
$542.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.58
|
| Rate for Payer: Healthscope Commercial |
$485.50
|
| Rate for Payer: Healthscope Whirlpool |
$485.50
|
| Rate for Payer: Meridian Medicaid |
$270.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$424.81
|
| Rate for Payer: PACE SWMI |
$404.58
|
| Rate for Payer: PHP Medicare Advantage |
$404.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.73
|
| Rate for Payer: Priority Health Medicare |
$404.58
|
| Rate for Payer: Priority Health Narrow Network |
$644.73
|
| Rate for Payer: UHC Medicare Advantage |
$416.72
|
|
|
PR EXPLORATION OF ARTERY/VEIN
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 35761
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$897.40 |
| Rate for Payer: BCBS Complete |
$512.80
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.40
|
|
|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$5,215.40 |
| Rate for Payer: Aetna Commercial |
$278.43
|
| Rate for Payer: Aetna Medicare |
$207.78
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS MAPPO |
$207.78
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$857.63
|
| Rate for Payer: BCN Medicare Advantage |
$207.78
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cofinity Commercial |
$299.20
|
| Rate for Payer: Cofinity Commercial |
$278.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.78
|
| Rate for Payer: Healthscope Commercial |
$249.34
|
| Rate for Payer: Healthscope Whirlpool |
$249.34
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.17
|
| Rate for Payer: PACE SWMI |
$207.78
|
| Rate for Payer: PHP Medicare Advantage |
$207.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.17
|
| Rate for Payer: Priority Health Medicare |
$207.78
|
| Rate for Payer: Priority Health Narrow Network |
$320.17
|
| Rate for Payer: UHC Medicare Advantage |
$214.01
|
|
|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,781.00
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$221.09 |
| Max. Negotiated Rate |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$455.01
|
| Rate for Payer: Aetna Medicare |
$339.56
|
| Rate for Payer: BCBS Complete |
$232.14
|
| Rate for Payer: BCBS MAPPO |
$339.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,940.00
|
| Rate for Payer: BCN Commercial |
$828.31
|
| Rate for Payer: BCN Medicare Advantage |
$339.56
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cofinity Commercial |
$488.97
|
| Rate for Payer: Cofinity Commercial |
$455.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.56
|
| Rate for Payer: Healthscope Commercial |
$407.47
|
| Rate for Payer: Healthscope Whirlpool |
$407.47
|
| Rate for Payer: Meridian Medicaid |
$232.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.54
|
| Rate for Payer: PACE SWMI |
$339.56
|
| Rate for Payer: PHP Medicare Advantage |
$339.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.97
|
| Rate for Payer: Priority Health Medicare |
$339.56
|
| Rate for Payer: Priority Health Narrow Network |
$525.97
|
| Rate for Payer: UHC Medicare Advantage |
$349.75
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$1,901.00
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$383.19 |
| Max. Negotiated Rate |
$5,215.40 |
| Rate for Payer: Aetna Commercial |
$796.51
|
| Rate for Payer: Aetna Medicare |
$594.41
|
| Rate for Payer: BCBS Complete |
$402.35
|
| Rate for Payer: BCBS MAPPO |
$594.41
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$872.77
|
| Rate for Payer: BCN Medicare Advantage |
$594.41
|
| Rate for Payer: Cash Price |
$1,520.80
|
| Rate for Payer: Cash Price |
$1,520.80
|
| Rate for Payer: Cofinity Commercial |
$796.51
|
| Rate for Payer: Cofinity Commercial |
$855.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.41
|
| Rate for Payer: Healthscope Commercial |
$713.29
|
| Rate for Payer: Healthscope Whirlpool |
$713.29
|
| Rate for Payer: Meridian Medicaid |
$402.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$624.13
|
| Rate for Payer: PACE SWMI |
$594.41
|
| Rate for Payer: PHP Medicare Advantage |
$594.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$912.03
|
| Rate for Payer: Priority Health Medicare |
$594.41
|
| Rate for Payer: Priority Health Narrow Network |
$912.03
|
| Rate for Payer: UHC Medicare Advantage |
$612.24
|
|
|
PR EXPLORATION POPLITEAL ARTERY
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 35741
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$740.60 |
| Rate for Payer: BCBS Complete |
$423.20
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.60
|
|
|
PR EXPLORATION SPINAL FUSION
|
Professional
|
Both
|
$5,074.00
|
|
|
Service Code
|
HCPCS 22830
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$3,551.80 |
| Rate for Payer: Aetna Commercial |
$1,094.10
|
| Rate for Payer: Aetna Medicare |
$816.49
|
| Rate for Payer: BCBS Complete |
$559.58
|
| Rate for Payer: BCBS MAPPO |
$816.49
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,209.96
|
| Rate for Payer: BCN Medicare Advantage |
$816.49
|
| Rate for Payer: Cash Price |
$4,059.20
|
| Rate for Payer: Cash Price |
$4,059.20
|
| Rate for Payer: Cofinity Commercial |
$1,175.75
|
| Rate for Payer: Cofinity Commercial |
$1,094.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.49
|
| Rate for Payer: Healthscope Commercial |
$979.79
|
| Rate for Payer: Healthscope Whirlpool |
$979.79
|
| Rate for Payer: Meridian Medicaid |
$559.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$857.31
|
| Rate for Payer: PACE SWMI |
$816.49
|
| Rate for Payer: PHP Medicare Advantage |
$816.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,551.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.37
|
| Rate for Payer: Priority Health Medicare |
$816.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.37
|
| Rate for Payer: UHC Medicare Advantage |
$840.98
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$492.03 |
| Max. Negotiated Rate |
$1,614.90 |
| Rate for Payer: Aetna Commercial |
$1,022.13
|
| Rate for Payer: Aetna Medicare |
$762.78
|
| Rate for Payer: BCBS Complete |
$516.63
|
| Rate for Payer: BCBS MAPPO |
$762.78
|
| Rate for Payer: BCBS Trust/PPO |
$576.90
|
| Rate for Payer: BCN Commercial |
$1,122.01
|
| Rate for Payer: BCN Medicare Advantage |
$762.78
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cofinity Commercial |
$1,022.13
|
| Rate for Payer: Cofinity Commercial |
$1,098.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.78
|
| Rate for Payer: Healthscope Commercial |
$915.34
|
| Rate for Payer: Healthscope Whirlpool |
$915.34
|
| Rate for Payer: Meridian Medicaid |
$516.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$800.92
|
| Rate for Payer: PACE SWMI |
$762.78
|
| Rate for Payer: PHP Medicare Advantage |
$762.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,614.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,349.99
|
| Rate for Payer: Priority Health Medicare |
$762.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.99
|
| Rate for Payer: UHC Medicare Advantage |
$785.66
|
|
|
PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 20102
|
| Min. Negotiated Rate |
$164.22 |
| Max. Negotiated Rate |
$1,395.80 |
| Rate for Payer: Aetna Commercial |
$336.39
|
| Rate for Payer: Aetna Medicare |
$251.04
|
| Rate for Payer: BCBS Complete |
$172.43
|
| Rate for Payer: BCBS MAPPO |
$251.04
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$895.26
|
| Rate for Payer: BCN Medicare Advantage |
$251.04
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cofinity Commercial |
$361.50
|
| Rate for Payer: Cofinity Commercial |
$336.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.04
|
| Rate for Payer: Healthscope Commercial |
$301.25
|
| Rate for Payer: Healthscope Whirlpool |
$301.25
|
| Rate for Payer: Meridian Medicaid |
$172.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.59
|
| Rate for Payer: PACE SWMI |
$251.04
|
| Rate for Payer: PHP Medicare Advantage |
$251.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.07
|
| Rate for Payer: Priority Health Medicare |
$251.04
|
| Rate for Payer: Priority Health Narrow Network |
$387.07
|
| Rate for Payer: UHC Medicare Advantage |
$258.57
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
HCPCS 35840
|
| Min. Negotiated Rate |
$771.06 |
| Max. Negotiated Rate |
$1,913.45 |
| Rate for Payer: Aetna Commercial |
$1,608.48
|
| Rate for Payer: Aetna Medicare |
$1,200.36
|
| Rate for Payer: BCBS Complete |
$809.61
|
| Rate for Payer: BCBS MAPPO |
$1,200.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.11
|
| Rate for Payer: BCN Commercial |
$1,757.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,200.36
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cofinity Commercial |
$1,728.52
|
| Rate for Payer: Cofinity Commercial |
$1,608.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,200.36
|
| Rate for Payer: Healthscope Commercial |
$1,440.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,440.43
|
| Rate for Payer: Meridian Medicaid |
$809.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,260.38
|
| Rate for Payer: PACE SWMI |
$1,200.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,200.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$771.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,614.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.45
|
| Rate for Payer: Priority Health Medicare |
$1,200.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,913.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,236.37
|
|
