|
PR FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 97156
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$1,096.22 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCN Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.73
|
| Rate for Payer: Priority Health Narrow Network |
$31.73
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$346.04 |
| Rate for Payer: Aetna Commercial |
$126.47
|
| Rate for Payer: Aetna Medicare |
$94.38
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$94.38
|
| Rate for Payer: BCBS Trust/PPO |
$346.04
|
| Rate for Payer: BCN Commercial |
$137.81
|
| Rate for Payer: BCN Medicare Advantage |
$94.38
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$135.91
|
| Rate for Payer: Cofinity Commercial |
$126.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.38
|
| Rate for Payer: Healthscope Commercial |
$113.26
|
| Rate for Payer: Healthscope Whirlpool |
$113.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.10
|
| Rate for Payer: PACE SWMI |
$94.38
|
| Rate for Payer: PHP Medicare Advantage |
$94.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.43
|
| Rate for Payer: Priority Health Medicare |
$94.38
|
| Rate for Payer: Priority Health Narrow Network |
$107.43
|
| Rate for Payer: UHC Medicare Advantage |
$97.21
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$141.67 |
| Rate for Payer: Aetna Commercial |
$131.83
|
| Rate for Payer: Aetna Medicare |
$98.38
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCBS MAPPO |
$98.38
|
| Rate for Payer: BCBS Trust/PPO |
$109.89
|
| Rate for Payer: BCN Commercial |
$115.44
|
| Rate for Payer: BCN Medicare Advantage |
$98.38
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$141.67
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.38
|
| Rate for Payer: Healthscope Commercial |
$118.06
|
| Rate for Payer: Healthscope Whirlpool |
$118.06
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$103.30
|
| Rate for Payer: PACE SWMI |
$98.38
|
| Rate for Payer: PHP Medicare Advantage |
$98.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.88
|
| Rate for Payer: Priority Health Medicare |
$98.38
|
| Rate for Payer: Priority Health Narrow Network |
$127.88
|
| Rate for Payer: UHC Medicare Advantage |
$101.33
|
|
|
PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20922
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$55,000.50 |
| Rate for Payer: Aetna Commercial |
$651.00
|
| Rate for Payer: Aetna Medicare |
$485.82
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$485.82
|
| Rate for Payer: BCBS Trust/PPO |
$55,000.50
|
| Rate for Payer: BCN Commercial |
$892.81
|
| Rate for Payer: BCN Medicare Advantage |
$485.82
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$699.58
|
| Rate for Payer: Cofinity Commercial |
$651.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.82
|
| Rate for Payer: Healthscope Commercial |
$582.98
|
| Rate for Payer: Healthscope Whirlpool |
$582.98
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$510.11
|
| Rate for Payer: PACE SWMI |
$485.82
|
| Rate for Payer: PHP Medicare Advantage |
$485.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.25
|
| Rate for Payer: Priority Health Medicare |
$485.82
|
| Rate for Payer: Priority Health Narrow Network |
$755.25
|
| Rate for Payer: UHC Medicare Advantage |
$500.39
|
|
|
PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28060
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$2,093.12 |
| Rate for Payer: Aetna Commercial |
$469.07
|
| Rate for Payer: Aetna Medicare |
$350.05
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS MAPPO |
$350.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCN Commercial |
$752.07
|
| Rate for Payer: BCN Medicare Advantage |
$350.05
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$504.07
|
| Rate for Payer: Cofinity Commercial |
$469.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.05
|
| Rate for Payer: Healthscope Commercial |
$420.06
|
| Rate for Payer: Healthscope Whirlpool |
$420.06
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.55
|
| Rate for Payer: PACE SWMI |
$350.05
|
| Rate for Payer: PHP Medicare Advantage |
$350.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.90
|
| Rate for Payer: Priority Health Medicare |
$350.05
|
| Rate for Payer: Priority Health Narrow Network |
$546.90
|
| Rate for Payer: UHC Medicare Advantage |
$360.55
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: ASR ASR |
$683.85
|
| Rate for Payer: BCBS Trust/PPO |
$546.59
|
| Rate for Payer: BCN Commercial |
$546.59
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$662.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.00
|
| Rate for Payer: Healthscope Commercial |
$705.00
|
| Rate for Payer: Healthscope Whirlpool |
$683.85
|
| Rate for Payer: Mclaren Commercial |
$634.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.40
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$3,596.44 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Medicare |
$2,877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: ASR ASR |
$683.85
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$546.59
|
| Rate for Payer: BCN Commercial |
$546.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$662.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$705.00
|
| Rate for Payer: Healthscope Whirlpool |
$683.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,877.15
|
| Rate for Payer: Mclaren Commercial |
$634.50
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.25
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$3,164.86
|
| Rate for Payer: PHP Medicaid |
$1,573.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.55
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$500.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 28008
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$3,296.59 |
| Rate for Payer: Aetna Commercial |
$384.83
|
| Rate for Payer: Aetna Medicare |
$287.19
|
| Rate for Payer: BCBS Complete |
$199.27
|
| Rate for Payer: BCBS MAPPO |
$287.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,296.59
|
| Rate for Payer: BCN Commercial |
$623.06
|
| Rate for Payer: BCN Medicare Advantage |
$287.19
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$384.83
|
| Rate for Payer: Cofinity Commercial |
$413.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.19
|
| Rate for Payer: Healthscope Commercial |
$344.63
|
| Rate for Payer: Healthscope Whirlpool |
$344.63
|
| Rate for Payer: Meridian Medicaid |
$199.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$301.55
|
| Rate for Payer: PACE SWMI |
$287.19
|
| Rate for Payer: PHP Medicare Advantage |
$287.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.35
|
| Rate for Payer: Priority Health Medicare |
$287.19
|
| Rate for Payer: Priority Health Narrow Network |
$448.35
|
| Rate for Payer: UHC Medicare Advantage |
$295.81
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$3,296.59 |
| Rate for Payer: Aetna Commercial |
$384.83
|
| Rate for Payer: Aetna Medicare |
$287.19
|
| Rate for Payer: BCBS Complete |
$199.27
|
| Rate for Payer: BCBS MAPPO |
$287.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,296.59
|
| Rate for Payer: BCN Commercial |
$623.06
|
| Rate for Payer: BCN Medicare Advantage |
$287.19
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$413.55
|
| Rate for Payer: Cofinity Commercial |
$384.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.19
|
| Rate for Payer: Healthscope Commercial |
$344.63
|
| Rate for Payer: Healthscope Whirlpool |
$344.63
|
| Rate for Payer: Meridian Medicaid |
$199.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$301.55
|
| Rate for Payer: PACE SWMI |
$287.19
|
| Rate for Payer: PHP Medicare Advantage |
$287.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.35
|
| Rate for Payer: Priority Health Medicare |
$287.19
|
| Rate for Payer: Priority Health Narrow Network |
$448.35
|
| Rate for Payer: UHC Medicare Advantage |
$295.81
|
|
|
PR FASCIOTOMY HIP/THIGH ANY TYPE
|
Professional
|
Both
|
$3,417.00
|
|
|
Service Code
|
HCPCS 27025
|
| Min. Negotiated Rate |
$191.38 |
| Max. Negotiated Rate |
$2,391.90 |
| Rate for Payer: Aetna Commercial |
$1,216.33
|
| Rate for Payer: Aetna Medicare |
$907.71
|
| Rate for Payer: BCBS Complete |
$628.91
|
| Rate for Payer: BCBS MAPPO |
$907.71
|
| Rate for Payer: BCBS Trust/PPO |
$191.38
|
| Rate for Payer: BCN Commercial |
$1,352.66
|
| Rate for Payer: BCN Medicare Advantage |
$907.71
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cofinity Commercial |
$1,307.10
|
| Rate for Payer: Cofinity Commercial |
$1,216.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.71
|
| Rate for Payer: Healthscope Commercial |
$1,089.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.25
|
| Rate for Payer: Meridian Medicaid |
$628.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$953.10
|
| Rate for Payer: PACE SWMI |
$907.71
|
| Rate for Payer: PHP Medicare Advantage |
$907.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$598.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,391.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.48
|
| Rate for Payer: Priority Health Medicare |
$907.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.48
|
| Rate for Payer: UHC Medicare Advantage |
$934.94
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$314.81 |
| Max. Negotiated Rate |
$1,940.97 |
| Rate for Payer: Aetna Commercial |
$640.08
|
| Rate for Payer: Aetna Medicare |
$477.67
|
| Rate for Payer: BCBS Complete |
$330.55
|
| Rate for Payer: BCBS MAPPO |
$477.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.97
|
| Rate for Payer: BCN Commercial |
$715.91
|
| Rate for Payer: BCN Medicare Advantage |
$477.67
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$640.08
|
| Rate for Payer: Cofinity Commercial |
$687.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.67
|
| Rate for Payer: Healthscope Commercial |
$573.20
|
| Rate for Payer: Healthscope Whirlpool |
$573.20
|
| Rate for Payer: Meridian Medicaid |
$330.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$501.55
|
| Rate for Payer: PACE SWMI |
$477.67
|
| Rate for Payer: PHP Medicare Advantage |
$477.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$314.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.11
|
| Rate for Payer: Priority Health Medicare |
$477.67
|
| Rate for Payer: Priority Health Narrow Network |
$748.11
|
| Rate for Payer: UHC Medicare Advantage |
$492.00
|
|
|
PR FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$1,341.00
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$153.67 |
| Max. Negotiated Rate |
$938.70 |
| Rate for Payer: Aetna Commercial |
$625.10
|
| Rate for Payer: Aetna Medicare |
$466.49
|
| Rate for Payer: BCBS Complete |
$324.51
|
| Rate for Payer: BCBS MAPPO |
$466.49
|
| Rate for Payer: BCBS Trust/PPO |
$153.67
|
| Rate for Payer: BCN Commercial |
$701.25
|
| Rate for Payer: BCN Medicare Advantage |
$466.49
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Cash Price |
$1,072.80
|
| Rate for Payer: Cofinity Commercial |
$671.75
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.49
|
| Rate for Payer: Healthscope Commercial |
$559.79
|
| Rate for Payer: Healthscope Whirlpool |
$559.79
|
| Rate for Payer: Meridian Medicaid |
$324.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.81
|
| Rate for Payer: PACE SWMI |
$466.49
|
| Rate for Payer: PHP Medicare Advantage |
$466.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.78
|
| Rate for Payer: Priority Health Medicare |
$466.49
|
| Rate for Payer: Priority Health Narrow Network |
$732.78
|
| Rate for Payer: UHC Medicare Advantage |
$480.48
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$638.40 |
| Rate for Payer: Aetna Commercial |
$417.56
|
| Rate for Payer: Aetna Medicare |
$311.61
|
| Rate for Payer: BCBS Complete |
$218.28
|
| Rate for Payer: BCBS MAPPO |
$311.61
|
| Rate for Payer: BCBS Trust/PPO |
$139.24
|
| Rate for Payer: BCN Commercial |
$471.08
|
| Rate for Payer: BCN Medicare Advantage |
$311.61
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cofinity Commercial |
$417.56
|
| Rate for Payer: Cofinity Commercial |
$448.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.61
|
| Rate for Payer: Healthscope Commercial |
$373.93
|
| Rate for Payer: Healthscope Whirlpool |
$373.93
|
| Rate for Payer: Meridian Medicaid |
$218.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$327.19
|
| Rate for Payer: PACE SWMI |
$311.61
|
| Rate for Payer: PHP Medicare Advantage |
$311.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.26
|
| Rate for Payer: Priority Health Medicare |
$311.61
|
| Rate for Payer: Priority Health Narrow Network |
$492.26
|
| Rate for Payer: UHC Medicare Advantage |
$320.96
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$2,315.00
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$250.03 |
| Max. Negotiated Rate |
$1,620.50 |
| Rate for Payer: Aetna Commercial |
$793.33
|
| Rate for Payer: Aetna Medicare |
$592.04
|
| Rate for Payer: BCBS Complete |
$409.95
|
| Rate for Payer: BCBS MAPPO |
$592.04
|
| Rate for Payer: BCBS Trust/PPO |
$250.03
|
| Rate for Payer: BCN Commercial |
$887.44
|
| Rate for Payer: BCN Medicare Advantage |
$592.04
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cofinity Commercial |
$852.54
|
| Rate for Payer: Cofinity Commercial |
$793.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.04
|
| Rate for Payer: Healthscope Commercial |
$710.45
|
| Rate for Payer: Healthscope Whirlpool |
$710.45
|
| Rate for Payer: Meridian Medicaid |
$409.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$621.64
|
| Rate for Payer: PACE SWMI |
$592.04
|
| Rate for Payer: PHP Medicare Advantage |
$592.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$927.34
|
| Rate for Payer: Priority Health Medicare |
$592.04
|
| Rate for Payer: Priority Health Narrow Network |
$927.34
|
| Rate for Payer: UHC Medicare Advantage |
$609.80
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$2,894.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$2,025.80 |
| Rate for Payer: Aetna Commercial |
$1,105.22
|
| Rate for Payer: Aetna Medicare |
$824.79
|
| Rate for Payer: BCBS Complete |
$571.20
|
| Rate for Payer: BCBS MAPPO |
$824.79
|
| Rate for Payer: BCBS Trust/PPO |
$337.48
|
| Rate for Payer: BCN Commercial |
$1,235.86
|
| Rate for Payer: BCN Medicare Advantage |
$824.79
|
| Rate for Payer: Cash Price |
$2,315.20
|
| Rate for Payer: Cash Price |
$2,315.20
|
| Rate for Payer: Cofinity Commercial |
$1,105.22
|
| Rate for Payer: Cofinity Commercial |
$1,187.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$824.79
|
| Rate for Payer: Healthscope Commercial |
$989.75
|
| Rate for Payer: Healthscope Whirlpool |
$989.75
|
| Rate for Payer: Meridian Medicaid |
$571.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$866.03
|
| Rate for Payer: PACE SWMI |
$824.79
|
| Rate for Payer: PHP Medicare Advantage |
$824.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,025.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,291.44
|
| Rate for Payer: Priority Health Medicare |
$824.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,291.44
|
| Rate for Payer: UHC Medicare Advantage |
$849.53
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$607.60 |
| Rate for Payer: Aetna Commercial |
$354.99
|
| Rate for Payer: Aetna Medicare |
$264.92
|
| Rate for Payer: BCBS Complete |
$178.92
|
| Rate for Payer: BCBS MAPPO |
$264.92
|
| Rate for Payer: BCBS Trust/PPO |
$555.24
|
| Rate for Payer: BCN Commercial |
$389.96
|
| Rate for Payer: BCN Medicare Advantage |
$264.92
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cofinity Commercial |
$381.48
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$264.92
|
| Rate for Payer: Healthscope Commercial |
$317.90
|
| Rate for Payer: Healthscope Whirlpool |
$317.90
|
| Rate for Payer: Meridian Medicaid |
$178.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$278.17
|
| Rate for Payer: PACE SWMI |
$264.92
|
| Rate for Payer: PHP Medicare Advantage |
$264.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.50
|
| Rate for Payer: Priority Health Medicare |
$264.92
|
| Rate for Payer: Priority Health Narrow Network |
$407.50
|
| Rate for Payer: UHC Medicare Advantage |
$272.87
|
|
|
PR FECAL BLOOD SCRN IMMUNOASSAY
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS G0328
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$1,270.03 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.03
|
| Rate for Payer: BCN Commercial |
$18.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$21.66
|
| Rate for Payer: Healthscope Whirlpool |
$21.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.63
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow Network |
$18.63
|
| Rate for Payer: UHC Medicare Advantage |
$18.59
|
|
|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$1,923.54 |
| Rate for Payer: Aetna Commercial |
$93.97
|
| Rate for Payer: Aetna Medicare |
$70.13
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$70.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,923.54
|
| Rate for Payer: BCN Commercial |
$190.10
|
| Rate for Payer: BCN Medicare Advantage |
$70.13
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$93.97
|
| Rate for Payer: Cofinity Commercial |
$100.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.13
|
| Rate for Payer: Healthscope Commercial |
$84.16
|
| Rate for Payer: Healthscope Whirlpool |
$84.16
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.64
|
| Rate for Payer: PACE SWMI |
$70.13
|
| Rate for Payer: PHP Medicare Advantage |
$70.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.06
|
| Rate for Payer: Priority Health Medicare |
$70.13
|
| Rate for Payer: Priority Health Narrow Network |
$124.06
|
| Rate for Payer: UHC Medicare Advantage |
$72.23
|
|
|
PR FERN TEST
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Healthscope Commercial |
$11.69
|
| Rate for Payer: Healthscope Whirlpool |
$11.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.23
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: UHC Medicare Advantage |
$10.03
|
|
|
PR FETAL CONTRACTION STRESS TEST
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 59020
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: Aetna Medicare |
$68.19
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$68.19
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$103.11
|
| Rate for Payer: BCN Medicare Advantage |
$68.19
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$98.19
|
| Rate for Payer: Cofinity Commercial |
$91.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.19
|
| Rate for Payer: Healthscope Commercial |
$81.83
|
| Rate for Payer: Healthscope Whirlpool |
$81.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.60
|
| Rate for Payer: PACE SWMI |
$68.19
|
| Rate for Payer: PHP Medicare Advantage |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.63
|
| Rate for Payer: Priority Health Medicare |
$68.19
|
| Rate for Payer: Priority Health Narrow Network |
$99.63
|
| Rate for Payer: UHC Medicare Advantage |
$70.24
|
|
|
PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 59074
|
| Min. Negotiated Rate |
$197.24 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$413.86
|
| Rate for Payer: Aetna Medicare |
$308.85
|
| Rate for Payer: BCBS Complete |
$207.10
|
| Rate for Payer: BCBS MAPPO |
$308.85
|
| Rate for Payer: BCBS Trust/PPO |
$488.15
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$308.85
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$413.86
|
| Rate for Payer: Cofinity Commercial |
$444.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.85
|
| Rate for Payer: Healthscope Commercial |
$370.62
|
| Rate for Payer: Healthscope Whirlpool |
$370.62
|
| Rate for Payer: Meridian Medicaid |
$207.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$324.29
|
| Rate for Payer: PACE SWMI |
$308.85
|
| Rate for Payer: PHP Medicare Advantage |
$308.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.87
|
| Rate for Payer: Priority Health Medicare |
$308.85
|
| Rate for Payer: Priority Health Narrow Network |
$434.87
|
| Rate for Payer: UHC Medicare Advantage |
$318.12
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$522.49 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna Medicare |
$47.40
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$47.40
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$71.35
|
| Rate for Payer: BCN Medicare Advantage |
$47.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$68.26
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.40
|
| Rate for Payer: Healthscope Commercial |
$56.88
|
| Rate for Payer: Healthscope Whirlpool |
$56.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.77
|
| Rate for Payer: PACE SWMI |
$47.40
|
| Rate for Payer: PHP Medicare Advantage |
$47.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.94
|
| Rate for Payer: Priority Health Medicare |
$47.40
|
| Rate for Payer: Priority Health Narrow Network |
$68.94
|
| Rate for Payer: UHC Medicare Advantage |
$48.82
|
|
|
PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$1,045.00
|
|
|
Service Code
|
HCPCS 59076
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$759.41 |
| Rate for Payer: Aetna Commercial |
$699.33
|
| Rate for Payer: Aetna Medicare |
$521.89
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS MAPPO |
$521.89
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: BCN Commercial |
$759.41
|
| Rate for Payer: BCN Medicare Advantage |
$521.89
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cofinity Commercial |
$751.52
|
| Rate for Payer: Cofinity Commercial |
$699.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.89
|
| Rate for Payer: Healthscope Commercial |
$626.27
|
| Rate for Payer: Healthscope Whirlpool |
$626.27
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$547.98
|
| Rate for Payer: PACE SWMI |
$521.89
|
| Rate for Payer: PHP Medicare Advantage |
$521.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.76
|
| Rate for Payer: Priority Health Medicare |
$521.89
|
| Rate for Payer: Priority Health Narrow Network |
$733.76
|
| Rate for Payer: UHC Medicare Advantage |
$537.55
|
|
|
PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 14350
|
| Min. Negotiated Rate |
$432.18 |
| Max. Negotiated Rate |
$5,240.72 |
| Rate for Payer: Aetna Commercial |
$884.45
|
| Rate for Payer: Aetna Medicare |
$660.04
|
| Rate for Payer: BCBS Complete |
$453.79
|
| Rate for Payer: BCBS MAPPO |
$660.04
|
| Rate for Payer: BCBS Trust/PPO |
$5,240.72
|
| Rate for Payer: BCN Commercial |
$982.24
|
| Rate for Payer: BCN Medicare Advantage |
$660.04
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Cofinity Commercial |
$950.46
|
| Rate for Payer: Cofinity Commercial |
$884.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$660.04
|
| Rate for Payer: Healthscope Commercial |
$792.05
|
| Rate for Payer: Healthscope Whirlpool |
$792.05
|
| Rate for Payer: Meridian Medicaid |
$453.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$693.04
|
| Rate for Payer: PACE SWMI |
$660.04
|
| Rate for Payer: PHP Medicare Advantage |
$660.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.18
|
| Rate for Payer: Priority Health Medicare |
$660.04
|
| Rate for Payer: Priority Health Narrow Network |
$826.18
|
| Rate for Payer: UHC Medicare Advantage |
$679.84
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$513.21 |
| Rate for Payer: Aetna Commercial |
$143.98
|
| Rate for Payer: Aetna Medicare |
$107.45
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$107.45
|
| Rate for Payer: BCBS Trust/PPO |
$405.74
|
| Rate for Payer: BCN Commercial |
$513.21
|
| Rate for Payer: BCN Medicare Advantage |
$107.45
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Cofinity Commercial |
$143.98
|
| Rate for Payer: Cofinity Commercial |
$154.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.45
|
| Rate for Payer: Healthscope Commercial |
$128.94
|
| Rate for Payer: Healthscope Whirlpool |
$128.94
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.82
|
| Rate for Payer: PACE SWMI |
$107.45
|
| Rate for Payer: PHP Medicare Advantage |
$107.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.36
|
| Rate for Payer: Priority Health Medicare |
$107.45
|
| Rate for Payer: Priority Health Narrow Network |
$132.36
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
|
