|
PR AORTOPLASTY SUPRAVALVULAR STENOSIS
|
Professional
|
Both
|
$9,378.00
|
|
|
Service Code
|
HCPCS 33417
|
| Min. Negotiated Rate |
$918.19 |
| Max. Negotiated Rate |
$6,095.70 |
| Rate for Payer: Aetna Commercial |
$2,236.97
|
| Rate for Payer: Aetna Medicare |
$4,689.00
|
| Rate for Payer: BCBS Complete |
$1,106.62
|
| Rate for Payer: BCBS Trust/PPO |
$918.19
|
| Rate for Payer: BCN Commercial |
$2,397.45
|
| Rate for Payer: Cash Price |
$7,502.40
|
| Rate for Payer: Cash Price |
$7,502.40
|
| Rate for Payer: Meridian Medicaid |
$1,106.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,053.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,095.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,623.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,623.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,189.00
|
| Rate for Payer: UHC Exchange |
$2,189.00
|
| Rate for Payer: UHCCP Medicaid |
$1,053.92
|
|
|
PR APNEALINK
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$562.25 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$778.50
|
| Rate for Payer: ASR ASR |
$839.05
|
| Rate for Payer: ASR Commercial |
$839.05
|
| Rate for Payer: BCBS Trust/PPO |
$704.89
|
| Rate for Payer: BCN Commercial |
$670.63
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$813.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$865.00
|
| Rate for Payer: Healthscope Whirlpool |
$839.05
|
| Rate for Payer: Mclaren Commercial |
$778.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: Nomi Health Commercial |
$709.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$761.20
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$566.34 |
| Rate for Payer: Aetna Commercial |
$112.58
|
| Rate for Payer: Aetna Medicare |
$432.50
|
| Rate for Payer: BCBS Complete |
$55.69
|
| Rate for Payer: BCBS Trust/PPO |
$566.34
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Meridian Medicaid |
$55.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.95
|
| Rate for Payer: Priority Health Narrow Network |
$147.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.18
|
| Rate for Payer: UHC Exchange |
$104.18
|
| Rate for Payer: UHCCP Medicaid |
$53.04
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$778.50
|
| Rate for Payer: Aetna Medicare |
$432.50
|
| Rate for Payer: ASR ASR |
$839.05
|
| Rate for Payer: ASR Commercial |
$839.05
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS Trust/PPO |
$708.35
|
| Rate for Payer: BCN Commercial |
$670.63
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$813.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$865.00
|
| Rate for Payer: Healthscope Whirlpool |
$839.05
|
| Rate for Payer: Mclaren Commercial |
$778.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: Nomi Health Commercial |
$709.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$757.91
|
| Rate for Payer: Priority Health Narrow Network |
$606.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$761.20
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$566.34 |
| Rate for Payer: Aetna Commercial |
$112.58
|
| Rate for Payer: Aetna Medicare |
$432.50
|
| Rate for Payer: BCBS Complete |
$55.69
|
| Rate for Payer: BCBS Trust/PPO |
$566.34
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Meridian Medicaid |
$55.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.95
|
| Rate for Payer: Priority Health Narrow Network |
$147.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.18
|
| Rate for Payer: UHC Exchange |
$104.18
|
| Rate for Payer: UHCCP Medicaid |
$53.04
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$2,137.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$564.45 |
| Max. Negotiated Rate |
$1,572.03 |
| Rate for Payer: Aetna Commercial |
$1,185.47
|
| Rate for Payer: Aetna Medicare |
$1,068.50
|
| Rate for Payer: BCBS Complete |
$592.67
|
| Rate for Payer: BCBS Trust/PPO |
$857.96
|
| Rate for Payer: BCN Commercial |
$1,281.31
|
| Rate for Payer: Cash Price |
$1,709.60
|
| Rate for Payer: Cash Price |
$1,709.60
|
| Rate for Payer: Meridian Medicaid |
$592.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$564.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,572.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,572.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.16
|
| Rate for Payer: UHC Exchange |
$1,051.16
|
| Rate for Payer: UHCCP Medicaid |
$564.45
|
|
|
PR APPENDECTOMY
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$1,129.70 |
| Max. Negotiated Rate |
$1,738.00 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: ASR ASR |
$1,685.86
|
| Rate for Payer: ASR Commercial |
$1,685.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,416.30
|
| Rate for Payer: BCN Commercial |
$1,347.47
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,633.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.40
|
| Rate for Payer: Healthscope Commercial |
$1,738.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,685.86
|
| Rate for Payer: Mclaren Commercial |
$1,564.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.30
|
| Rate for Payer: Nomi Health Commercial |
$1,425.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,529.44
|
|
|
PR APPENDECTOMY
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$1,129.70 |
| Max. Negotiated Rate |
$9,476.05 |
| Rate for Payer: Aetna Commercial |
$1,564.20
|
| Rate for Payer: Aetna Medicare |
$6,113.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,641.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,641.98
|
| Rate for Payer: ASR ASR |
$1,685.86
|
| Rate for Payer: ASR Commercial |
$1,685.86
|
| Rate for Payer: BCBS Complete |
$3,440.72
|
| Rate for Payer: BCBS MAPPO |
$6,113.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,423.25
|
| Rate for Payer: BCN Commercial |
$1,347.47
|
| Rate for Payer: BCN Medicare Advantage |
$6,113.58
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,633.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,113.58
|
| Rate for Payer: Healthscope Commercial |
$1,738.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,685.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,113.58
|
| Rate for Payer: Mclaren Commercial |
$1,564.20
|
| Rate for Payer: Mclaren Medicaid |
$3,276.88
|
| Rate for Payer: Mclaren Medicare |
$6,113.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,419.26
|
| Rate for Payer: Meridian Medicaid |
$3,440.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,030.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.30
|
| Rate for Payer: Nomi Health Commercial |
$1,425.16
|
| Rate for Payer: PACE Medicare |
$5,807.90
|
| Rate for Payer: PACE SWMI |
$6,113.58
|
| Rate for Payer: PHP Commercial |
$6,724.94
|
| Rate for Payer: PHP Medicaid |
$3,276.88
|
| Rate for Payer: PHP Medicare Advantage |
$6,113.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,276.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.84
|
| Rate for Payer: Priority Health Medicare |
$6,113.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,218.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,113.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,113.58
|
| Rate for Payer: UHC Exchange |
$9,476.05
|
| Rate for Payer: UHC Medicare Advantage |
$6,113.58
|
| Rate for Payer: UHCCP DNSP |
$6,113.58
|
| Rate for Payer: UHCCP Medicaid |
$3,276.88
|
| Rate for Payer: VA VA |
$6,113.58
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$413.13 |
| Max. Negotiated Rate |
$1,152.61 |
| Rate for Payer: Aetna Commercial |
$868.66
|
| Rate for Payer: Aetna Medicare |
$869.00
|
| Rate for Payer: BCBS Complete |
$434.33
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: BCN Commercial |
$938.75
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Meridian Medicaid |
$434.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,152.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,152.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.39
|
| Rate for Payer: UHC Exchange |
$774.39
|
| Rate for Payer: UHCCP Medicaid |
$413.65
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$413.13 |
| Max. Negotiated Rate |
$1,152.61 |
| Rate for Payer: Aetna Commercial |
$868.66
|
| Rate for Payer: Aetna Medicare |
$869.00
|
| Rate for Payer: BCBS Complete |
$434.33
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: BCN Commercial |
$938.75
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Meridian Medicaid |
$434.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,152.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,152.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$774.39
|
| Rate for Payer: UHC Exchange |
$774.39
|
| Rate for Payer: UHCCP Medicaid |
$413.65
|
|
|
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 20660
|
| Min. Negotiated Rate |
$154.85 |
| Max. Negotiated Rate |
$6,925.56 |
| Rate for Payer: Aetna Commercial |
$326.16
|
| Rate for Payer: Aetna Medicare |
$432.00
|
| Rate for Payer: BCBS Complete |
$162.59
|
| Rate for Payer: BCBS Trust/PPO |
$6,925.56
|
| Rate for Payer: BCN Commercial |
$352.82
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Meridian Medicaid |
$162.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.38
|
| Rate for Payer: Priority Health Narrow Network |
$366.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.74
|
| Rate for Payer: UHC Exchange |
$287.74
|
| Rate for Payer: UHCCP Medicaid |
$154.85
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$1,154.34 |
| Rate for Payer: Aetna Commercial |
$232.63
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.34
|
| Rate for Payer: BCN Commercial |
$402.67
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.24
|
| Rate for Payer: Priority Health Narrow Network |
$272.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.47
|
| Rate for Payer: UHC Exchange |
$201.47
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$1,010.64 |
| Rate for Payer: Aetna Commercial |
$81.81
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.64
|
| Rate for Payer: BCN Commercial |
$104.05
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.17
|
| Rate for Payer: Priority Health Narrow Network |
$96.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.08
|
| Rate for Payer: UHC Exchange |
$69.08
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR APPLICATION CAST FIGURE-OF-8
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 29049
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$822.03 |
| Rate for Payer: Aetna Commercial |
$90.96
|
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$822.03
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.37
|
| Rate for Payer: Priority Health Narrow Network |
$107.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.43
|
| Rate for Payer: UHC Exchange |
$72.43
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR APPLICATION CAST FINGER
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 29086
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$1,122.64 |
| Rate for Payer: Aetna Commercial |
$62.87
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$33.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.64
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$33.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.82
|
| Rate for Payer: Priority Health Narrow Network |
$75.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.43
|
| Rate for Payer: UHC Exchange |
$55.43
|
| Rate for Payer: UHCCP Medicaid |
$31.95
|
|
|
PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 29085
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$87.81
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$113.88
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.81
|
| Rate for Payer: Priority Health Narrow Network |
$103.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.36
|
| Rate for Payer: UHC Exchange |
$74.36
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
PR APPLICATION CAST SHOULDER HAND LONG ARM
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 29065
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$1,191.32 |
| Rate for Payer: Aetna Commercial |
$89.13
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.32
|
| Rate for Payer: BCN Commercial |
$114.65
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.82
|
| Rate for Payer: Priority Health Narrow Network |
$104.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.60
|
| Rate for Payer: UHC Exchange |
$76.60
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
PR APPLICATION CYLINDER CAST THIGH ANKLE
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 29365
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$701.58 |
| Rate for Payer: Aetna Commercial |
$114.22
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: BCBS Complete |
$59.49
|
| Rate for Payer: BCBS Trust/PPO |
$701.58
|
| Rate for Payer: BCN Commercial |
$182.28
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Meridian Medicaid |
$59.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.85
|
| Rate for Payer: Priority Health Narrow Network |
$134.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.37
|
| Rate for Payer: UHC Exchange |
$100.37
|
| Rate for Payer: UHCCP Medicaid |
$56.66
|
|
|
PR APPLICATION FINGER SPLINT DYNAMIC
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 29131
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$2,121.65 |
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.65
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.92
|
| Rate for Payer: Priority Health Narrow Network |
$52.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.70
|
| Rate for Payer: UHC Exchange |
$38.70
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
|
|
PR APPLICATION FINGER SPLINT STATIC
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 29130
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$2,436.52 |
| Rate for Payer: Aetna Commercial |
$38.86
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,436.52
|
| Rate for Payer: BCN Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Meridian Medicaid |
$19.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.27
|
| Rate for Payer: Priority Health Narrow Network |
$44.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.46
|
| Rate for Payer: UHC Exchange |
$33.46
|
| Rate for Payer: UHCCP Medicaid |
$18.53
|
|
|
PR APPLICATION HALO CRANIAL INCLUDING REMOVAL
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 20661
|
| Min. Negotiated Rate |
$339.10 |
| Max. Negotiated Rate |
$32,076.33 |
| Rate for Payer: Aetna Commercial |
$671.47
|
| Rate for Payer: Aetna Medicare |
$549.50
|
| Rate for Payer: BCBS Complete |
$356.06
|
| Rate for Payer: BCBS Trust/PPO |
$32,076.33
|
| Rate for Payer: BCN Commercial |
$841.55
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Meridian Medicaid |
$356.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.23
|
| Rate for Payer: Priority Health Narrow Network |
$817.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$544.42
|
| Rate for Payer: UHC Exchange |
$544.42
|
| Rate for Payer: UHCCP Medicaid |
$339.10
|
|
|
PR APPLICATION HIP SPICA CAST 1 LEG
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 29305
|
| Min. Negotiated Rate |
$103.52 |
| Max. Negotiated Rate |
$1,986.41 |
| Rate for Payer: Aetna Commercial |
$208.12
|
| Rate for Payer: Aetna Medicare |
$245.00
|
| Rate for Payer: BCBS Complete |
$108.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.41
|
| Rate for Payer: BCN Commercial |
$365.04
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Meridian Medicaid |
$108.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.23
|
| Rate for Payer: Priority Health Narrow Network |
$243.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.63
|
| Rate for Payer: UHC Exchange |
$178.63
|
| Rate for Payer: UHCCP Medicaid |
$103.52
|
|
|
PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 22851
|
| Min. Negotiated Rate |
$833.20 |
| Max. Negotiated Rate |
$1,353.95 |
| Rate for Payer: Aetna Medicare |
$1,041.50
|
| Rate for Payer: BCBS Complete |
$833.20
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.95
|
|
|
PR APPLICATION LONG ARM SPLINT SHOULDER HAND
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 29105
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$950.41 |
| Rate for Payer: Aetna Commercial |
$57.05
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$950.41
|
| Rate for Payer: BCN Commercial |
$122.17
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.61
|
| Rate for Payer: Priority Health Narrow Network |
$63.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.55
|
| Rate for Payer: UHC Exchange |
$67.55
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
|
