|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$1,039.69 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.69
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.59
|
| Rate for Payer: UHC Exchange |
$25.59
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$10.52
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.00
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.04
|
| Rate for Payer: UHC Exchange |
$12.04
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$578.50 |
| Max. Negotiated Rate |
$2,702.06 |
| Rate for Payer: Aetna Commercial |
$2,627.28
|
| Rate for Payer: Aetna Medicare |
$1,947.50
|
| Rate for Payer: BCBS Complete |
$1,558.00
|
| Rate for Payer: BCBS Trust/PPO |
$578.50
|
| Rate for Payer: BCN Commercial |
$2,682.84
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,702.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,702.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.74
|
| Rate for Payer: UHC Exchange |
$1,487.74
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$121.19 |
| Rate for Payer: Aetna Commercial |
$49.31
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.60
|
| Rate for Payer: Priority Health Narrow Network |
$59.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.45
|
| Rate for Payer: UHC Exchange |
$52.45
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$121.19 |
| Rate for Payer: Aetna Commercial |
$49.31
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$121.19
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.60
|
| Rate for Payer: Priority Health Narrow Network |
$59.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.45
|
| Rate for Payer: UHC Exchange |
$52.45
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: ASR ASR |
$597.52
|
| Rate for Payer: ASR Commercial |
$597.52
|
| Rate for Payer: BCBS Trust/PPO |
$501.98
|
| Rate for Payer: BCN Commercial |
$477.58
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$579.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Healthscope Commercial |
$616.00
|
| Rate for Payer: Healthscope Whirlpool |
$597.52
|
| Rate for Payer: Mclaren Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: Nomi Health Commercial |
$505.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.08
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$123.33 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$216.78
|
| Rate for Payer: Aetna Medicare |
$308.00
|
| Rate for Payer: BCBS Complete |
$129.50
|
| Rate for Payer: BCBS Trust/PPO |
$383.40
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Meridian Medicaid |
$129.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.88
|
| Rate for Payer: Priority Health Narrow Network |
$261.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.40
|
| Rate for Payer: UHC Exchange |
$248.40
|
| Rate for Payer: UHCCP Medicaid |
$123.33
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$123.33 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$216.78
|
| Rate for Payer: Aetna Medicare |
$308.00
|
| Rate for Payer: BCBS Complete |
$129.50
|
| Rate for Payer: BCBS Trust/PPO |
$383.40
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Meridian Medicaid |
$129.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.88
|
| Rate for Payer: Priority Health Narrow Network |
$261.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.40
|
| Rate for Payer: UHC Exchange |
$248.40
|
| Rate for Payer: UHCCP Medicaid |
$123.33
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,559.77 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Medicare |
$3,586.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: ASR ASR |
$597.52
|
| Rate for Payer: ASR Commercial |
$597.52
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$504.44
|
| Rate for Payer: BCN Commercial |
$477.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$579.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Healthscope Commercial |
$616.00
|
| Rate for Payer: Healthscope Whirlpool |
$597.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,586.95
|
| Rate for Payer: Mclaren Commercial |
$554.40
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: Nomi Health Commercial |
$505.12
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$3,945.64
|
| Rate for Payer: PHP Medicaid |
$1,922.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.74
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$431.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$5,559.77
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP DNSP |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.88
|
| Rate for Payer: Priority Health Narrow Network |
$112.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.20
|
| Rate for Payer: UHC Exchange |
$104.20
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$227.65
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$261.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.58
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$194.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Trust/PPO |
$226.54
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$261.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,661.55 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.55
|
| Rate for Payer: BCN Commercial |
$224.79
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.88
|
| Rate for Payer: Priority Health Narrow Network |
$112.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.20
|
| Rate for Payer: UHC Exchange |
$104.20
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.57
|
| Rate for Payer: Priority Health Narrow Network |
$22.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.60
|
| Rate for Payer: UHC Exchange |
$20.60
|
| Rate for Payer: UHCCP Medicaid |
$10.65
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$434.31 |
| Max. Negotiated Rate |
$1,103.70 |
| Rate for Payer: Aetna Commercial |
$885.07
|
| Rate for Payer: Aetna Medicare |
$849.00
|
| Rate for Payer: BCBS Complete |
$456.03
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Commercial |
$978.82
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Meridian Medicaid |
$456.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.98
|
| Rate for Payer: UHC Exchange |
$751.98
|
| Rate for Payer: UHCCP Medicaid |
$434.31
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
HCPCS 27732
|
| Min. Negotiated Rate |
$299.69 |
| Max. Negotiated Rate |
$989.30 |
| Rate for Payer: Aetna Commercial |
$602.74
|
| Rate for Payer: Aetna Medicare |
$761.00
|
| Rate for Payer: BCBS Complete |
$314.67
|
| Rate for Payer: BCBS Trust/PPO |
$512.98
|
| Rate for Payer: BCN Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Cash Price |
$1,217.60
|
| Rate for Payer: Meridian Medicaid |
$314.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$989.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$709.36
|
| Rate for Payer: Priority Health Narrow Network |
$709.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.70
|
| Rate for Payer: UHC Exchange |
$472.70
|
| Rate for Payer: UHCCP Medicaid |
$299.69
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 27730
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$929.50 |
| Rate for Payer: Aetna Commercial |
$784.73
|
| Rate for Payer: Aetna Medicare |
$715.00
|
| Rate for Payer: BCBS Complete |
$405.48
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: BCN Commercial |
$869.36
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Meridian Medicaid |
$405.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.93
|
| Rate for Payer: Priority Health Narrow Network |
$914.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$661.26
|
| Rate for Payer: UHC Exchange |
$661.26
|
| Rate for Payer: UHCCP Medicaid |
$386.17
|
|
|
PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA
|
Professional
|
Both
|
$2,957.00
|
|
|
Service Code
|
HCPCS 27734
|
| Min. Negotiated Rate |
$237.21 |
| Max. Negotiated Rate |
$1,922.05 |
| Rate for Payer: Aetna Commercial |
$878.18
|
| Rate for Payer: Aetna Medicare |
$1,478.50
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$971.00
|
| Rate for Payer: Cash Price |
$2,365.60
|
| Rate for Payer: Cash Price |
$2,365.60
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,922.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$643.88
|
| Rate for Payer: UHC Exchange |
$643.88
|
| Rate for Payer: UHCCP Medicaid |
$431.11
|
|
|
PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 27742
|
| Min. Negotiated Rate |
$507.79 |
| Max. Negotiated Rate |
$2,852.82 |
| Rate for Payer: Aetna Commercial |
$1,037.50
|
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: BCBS Complete |
$533.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.82
|
| Rate for Payer: BCN Commercial |
$1,144.48
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Meridian Medicaid |
$533.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$507.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,202.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,202.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$826.31
|
| Rate for Payer: UHC Exchange |
$826.31
|
| Rate for Payer: UHCCP Medicaid |
$507.79
|
|
|
PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB
|
Professional
|
Both
|
$3,099.00
|
|
|
Service Code
|
HCPCS 27479
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$2,014.35 |
| Rate for Payer: Aetna Commercial |
$1,228.23
|
| Rate for Payer: Aetna Medicare |
$1,549.50
|
| Rate for Payer: BCBS Complete |
$627.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.73
|
| Rate for Payer: BCN Commercial |
$1,348.75
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Cash Price |
$2,479.20
|
| Rate for Payer: Meridian Medicaid |
$627.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,014.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,415.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,415.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$972.01
|
| Rate for Payer: UHC Exchange |
$972.01
|
| Rate for Payer: UHCCP Medicaid |
$597.25
|
|
|
PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 36600
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$789.28 |
| Rate for Payer: Aetna Commercial |
$21.21
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$789.28
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.41
|
| Rate for Payer: Priority Health Narrow Network |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC Exchange |
$19.30
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
|
|
PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 36821
|
| Min. Negotiated Rate |
$413.43 |
| Max. Negotiated Rate |
$1,454.70 |
| Rate for Payer: Aetna Commercial |
$889.36
|
| Rate for Payer: Aetna Medicare |
$1,119.00
|
| Rate for Payer: BCBS Complete |
$434.10
|
| Rate for Payer: BCBS Trust/PPO |
$869.05
|
| Rate for Payer: BCN Commercial |
$946.08
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Meridian Medicaid |
$434.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,031.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,031.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.61
|
| Rate for Payer: UHC Exchange |
$891.61
|
| Rate for Payer: UHCCP Medicaid |
$413.43
|
|
|
PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 33987
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$322.28 |
| Rate for Payer: Aetna Commercial |
$281.69
|
| Rate for Payer: Aetna Medicare |
$221.00
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$295.65
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.28
|
| Rate for Payer: Priority Health Narrow Network |
$322.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.74
|
| Rate for Payer: UHC Exchange |
$282.74
|
| Rate for Payer: UHCCP Medicaid |
$129.08
|
|
