|
PR FRAC NECK
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00102
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR FRAC SCARS PER INCH
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00104
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR FRAC THGH/ABD/BACK
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 00103
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$790.87 |
| Rate for Payer: Aetna Commercial |
$153.58
|
| Rate for Payer: Aetna Medicare |
$114.61
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$114.61
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: BCN Medicare Advantage |
$114.61
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$165.04
|
| Rate for Payer: Cofinity Commercial |
$153.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.61
|
| Rate for Payer: Healthscope Commercial |
$137.53
|
| Rate for Payer: Healthscope Whirlpool |
$137.53
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.34
|
| Rate for Payer: PACE SWMI |
$114.61
|
| Rate for Payer: PHP Medicare Advantage |
$114.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.38
|
| Rate for Payer: Priority Health Medicare |
$114.61
|
| Rate for Payer: Priority Health Narrow Network |
$164.38
|
| Rate for Payer: UHC Medicare Advantage |
$118.05
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00101
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$162.09 |
| Max. Negotiated Rate |
$653.51 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$244.47
|
| Rate for Payer: BCBS Complete |
$170.19
|
| Rate for Payer: BCBS MAPPO |
$244.47
|
| Rate for Payer: BCBS Trust/PPO |
$653.51
|
| Rate for Payer: BCN Commercial |
$541.46
|
| Rate for Payer: BCN Medicare Advantage |
$244.47
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$352.04
|
| Rate for Payer: Cofinity Commercial |
$327.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.47
|
| Rate for Payer: Healthscope Commercial |
$293.36
|
| Rate for Payer: Healthscope Whirlpool |
$293.36
|
| Rate for Payer: Meridian Medicaid |
$170.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.69
|
| Rate for Payer: PACE SWMI |
$244.47
|
| Rate for Payer: PHP Medicare Advantage |
$244.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.10
|
| Rate for Payer: Priority Health Medicare |
$244.47
|
| Rate for Payer: Priority Health Narrow Network |
$445.10
|
| Rate for Payer: UHC Medicare Advantage |
$251.80
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$1,012.75 |
| Rate for Payer: Aetna Commercial |
$251.81
|
| Rate for Payer: Aetna Medicare |
$187.92
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$187.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.75
|
| Rate for Payer: BCN Commercial |
$280.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.92
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$251.81
|
| Rate for Payer: Cofinity Commercial |
$270.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.92
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Healthscope Whirlpool |
$225.50
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.32
|
| Rate for Payer: PACE SWMI |
$187.92
|
| Rate for Payer: PHP Medicare Advantage |
$187.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.70
|
| Rate for Payer: Priority Health Medicare |
$187.92
|
| Rate for Payer: Priority Health Narrow Network |
$310.70
|
| Rate for Payer: UHC Medicare Advantage |
$193.56
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,331.65 |
| Rate for Payer: Aetna Commercial |
$959.00
|
| Rate for Payer: Aetna Medicare |
$715.67
|
| Rate for Payer: BCBS Complete |
$489.79
|
| Rate for Payer: BCBS MAPPO |
$715.67
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| Rate for Payer: BCN Medicare Advantage |
$715.67
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$959.00
|
| Rate for Payer: Cofinity Commercial |
$1,030.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.67
|
| Rate for Payer: Healthscope Commercial |
$858.80
|
| Rate for Payer: Healthscope Whirlpool |
$858.80
|
| Rate for Payer: Meridian Medicaid |
$489.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$751.45
|
| Rate for Payer: PACE SWMI |
$715.67
|
| Rate for Payer: PHP Medicare Advantage |
$715.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,031.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.30
|
| Rate for Payer: Priority Health Medicare |
$715.67
|
| Rate for Payer: Priority Health Narrow Network |
$897.30
|
| Rate for Payer: UHC Medicare Advantage |
$737.14
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$413.65 |
| Max. Negotiated Rate |
$4,106.40 |
| Rate for Payer: Aetna Commercial |
$844.66
|
| Rate for Payer: Aetna Medicare |
$630.34
|
| Rate for Payer: BCBS Complete |
$434.33
|
| Rate for Payer: BCBS MAPPO |
$630.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.40
|
| Rate for Payer: BCN Commercial |
$1,142.53
|
| Rate for Payer: BCN Medicare Advantage |
$630.34
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$907.69
|
| Rate for Payer: Cofinity Commercial |
$844.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.34
|
| Rate for Payer: Healthscope Commercial |
$756.41
|
| Rate for Payer: Healthscope Whirlpool |
$756.41
|
| Rate for Payer: Meridian Medicaid |
$434.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$661.86
|
| Rate for Payer: PACE SWMI |
$630.34
|
| Rate for Payer: PHP Medicare Advantage |
$630.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.30
|
| Rate for Payer: Priority Health Medicare |
$630.34
|
| Rate for Payer: Priority Health Narrow Network |
$793.30
|
| Rate for Payer: UHC Medicare Advantage |
$649.25
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,535.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Aetna Commercial |
$963.61
|
| Rate for Payer: Aetna Medicare |
$719.11
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCBS MAPPO |
$719.11
|
| Rate for Payer: BCBS Trust/PPO |
$6,341.25
|
| Rate for Payer: BCN Commercial |
$1,290.60
|
| Rate for Payer: BCN Medicare Advantage |
$719.11
|
| Rate for Payer: Cash Price |
$1,228.00
|
| Rate for Payer: Cash Price |
$1,228.00
|
| Rate for Payer: Cofinity Commercial |
$963.61
|
| Rate for Payer: Cofinity Commercial |
$1,035.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.11
|
| Rate for Payer: Healthscope Commercial |
$862.93
|
| Rate for Payer: Healthscope Whirlpool |
$862.93
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$755.07
|
| Rate for Payer: PACE SWMI |
$719.11
|
| Rate for Payer: PHP Medicare Advantage |
$719.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$903.87
|
| Rate for Payer: Priority Health Medicare |
$719.11
|
| Rate for Payer: Priority Health Narrow Network |
$903.87
|
| Rate for Payer: UHC Medicare Advantage |
$740.68
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$962.00
|
| Rate for Payer: Aetna Medicare |
$717.91
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS MAPPO |
$717.91
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,283.75
|
| Rate for Payer: BCN Medicare Advantage |
$717.91
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Commercial |
$962.00
|
| Rate for Payer: Cofinity Commercial |
$1,033.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.91
|
| Rate for Payer: Healthscope Commercial |
$861.49
|
| Rate for Payer: Healthscope Whirlpool |
$861.49
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$753.81
|
| Rate for Payer: PACE SWMI |
$717.91
|
| Rate for Payer: PHP Medicare Advantage |
$717.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$901.00
|
| Rate for Payer: Priority Health Medicare |
$717.91
|
| Rate for Payer: Priority Health Narrow Network |
$901.00
|
| Rate for Payer: UHC Medicare Advantage |
$739.45
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,026.22 |
| Rate for Payer: Aetna Commercial |
$1,234.80
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$1,330.84
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.71
|
| Rate for Payer: BCN Commercial |
$1,063.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,289.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$1,372.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,330.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$1,234.80
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.20
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,248.52
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$974.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,207.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$960.40 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna Commercial |
$1,234.80
|
| Rate for Payer: ASR ASR |
$1,330.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.71
|
| Rate for Payer: BCN Commercial |
$1,063.71
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,289.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,372.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,330.84
|
| Rate for Payer: Mclaren Commercial |
$1,234.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,207.36
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$1,458.22 |
| Rate for Payer: Aetna Commercial |
$1,095.83
|
| Rate for Payer: Aetna Medicare |
$817.78
|
| Rate for Payer: BCBS Complete |
$566.96
|
| Rate for Payer: BCBS MAPPO |
$817.78
|
| Rate for Payer: BCBS Trust/PPO |
$35.25
|
| Rate for Payer: BCN Commercial |
$1,458.22
|
| Rate for Payer: BCN Medicare Advantage |
$817.78
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,095.83
|
| Rate for Payer: Cofinity Commercial |
$1,177.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$817.78
|
| Rate for Payer: Healthscope Commercial |
$981.34
|
| Rate for Payer: Healthscope Whirlpool |
$981.34
|
| Rate for Payer: Meridian Medicaid |
$566.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$858.67
|
| Rate for Payer: PACE SWMI |
$817.78
|
| Rate for Payer: PHP Medicare Advantage |
$817.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.12
|
| Rate for Payer: Priority Health Medicare |
$817.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,032.12
|
| Rate for Payer: UHC Medicare Advantage |
$842.31
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<
|
Professional
|
Both
|
$1,656.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$390.64 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$791.56
|
| Rate for Payer: Aetna Medicare |
$590.72
|
| Rate for Payer: BCBS Complete |
$410.17
|
| Rate for Payer: BCBS MAPPO |
$590.72
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,125.42
|
| Rate for Payer: BCN Medicare Advantage |
$590.72
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cofinity Commercial |
$850.64
|
| Rate for Payer: Cofinity Commercial |
$791.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.72
|
| Rate for Payer: Healthscope Commercial |
$708.86
|
| Rate for Payer: Healthscope Whirlpool |
$708.86
|
| Rate for Payer: Meridian Medicaid |
$410.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$620.26
|
| Rate for Payer: PACE SWMI |
$590.72
|
| Rate for Payer: PHP Medicare Advantage |
$590.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.62
|
| Rate for Payer: Priority Health Medicare |
$590.72
|
| Rate for Payer: Priority Health Narrow Network |
$745.62
|
| Rate for Payer: UHC Medicare Advantage |
$608.44
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,227.56 |
| Rate for Payer: Aetna Commercial |
$878.05
|
| Rate for Payer: Aetna Medicare |
$655.26
|
| Rate for Payer: BCBS Complete |
$452.90
|
| Rate for Payer: BCBS MAPPO |
$655.26
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$655.26
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$943.57
|
| Rate for Payer: Cofinity Commercial |
$878.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.26
|
| Rate for Payer: Healthscope Commercial |
$786.31
|
| Rate for Payer: Healthscope Whirlpool |
$786.31
|
| Rate for Payer: Meridian Medicaid |
$452.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$688.02
|
| Rate for Payer: PACE SWMI |
$655.26
|
| Rate for Payer: PHP Medicare Advantage |
$655.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$823.72
|
| Rate for Payer: Priority Health Medicare |
$655.26
|
| Rate for Payer: Priority Health Narrow Network |
$823.72
|
| Rate for Payer: UHC Medicare Advantage |
$674.92
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$509.50 |
| Max. Negotiated Rate |
$1,357.55 |
| Rate for Payer: Aetna Commercial |
$1,030.75
|
| Rate for Payer: Aetna Medicare |
$769.22
|
| Rate for Payer: BCBS Complete |
$534.98
|
| Rate for Payer: BCBS MAPPO |
$769.22
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$1,357.55
|
| Rate for Payer: BCN Medicare Advantage |
$769.22
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,107.68
|
| Rate for Payer: Cofinity Commercial |
$1,030.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.22
|
| Rate for Payer: Healthscope Commercial |
$923.06
|
| Rate for Payer: Healthscope Whirlpool |
$923.06
|
| Rate for Payer: Meridian Medicaid |
$534.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$807.68
|
| Rate for Payer: PACE SWMI |
$769.22
|
| Rate for Payer: PHP Medicare Advantage |
$769.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$972.10
|
| Rate for Payer: Priority Health Medicare |
$769.22
|
| Rate for Payer: Priority Health Narrow Network |
$972.10
|
| Rate for Payer: UHC Medicare Advantage |
$792.30
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$194.60 |
| Rate for Payer: Aetna Commercial |
$90.69
|
| Rate for Payer: Aetna Medicare |
$67.68
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS MAPPO |
$67.68
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$190.59
|
| Rate for Payer: BCN Medicare Advantage |
$67.68
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$90.69
|
| Rate for Payer: Cofinity Commercial |
$97.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Healthscope Whirlpool |
$81.22
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.06
|
| Rate for Payer: PACE SWMI |
$67.68
|
| Rate for Payer: PHP Medicare Advantage |
$67.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$67.68
|
| Rate for Payer: Priority Health Narrow Network |
$83.85
|
| Rate for Payer: UHC Medicare Advantage |
$69.71
|
|
|
PR FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$138.76
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS MAPPO |
$103.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$253.63
|
| Rate for Payer: BCN Medicare Advantage |
$103.55
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$138.76
|
| Rate for Payer: Cofinity Commercial |
$149.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.55
|
| Rate for Payer: Healthscope Commercial |
$124.26
|
| Rate for Payer: Healthscope Whirlpool |
$124.26
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.73
|
| Rate for Payer: PACE SWMI |
$103.55
|
| Rate for Payer: PHP Medicare Advantage |
$103.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.25
|
| Rate for Payer: Priority Health Medicare |
$103.55
|
| Rate for Payer: Priority Health Narrow Network |
$128.25
|
| Rate for Payer: UHC Medicare Advantage |
$106.66
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$324.23 |
| Rate for Payer: Aetna Commercial |
$189.20
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCN Commercial |
$324.23
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$399.87
|
| Rate for Payer: Aetna Medicare |
$298.41
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS MAPPO |
$298.41
|
| Rate for Payer: BCBS Trust/PPO |
$173.28
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: BCN Medicare Advantage |
$298.41
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$429.71
|
| Rate for Payer: Cofinity Commercial |
$399.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.41
|
| Rate for Payer: Healthscope Commercial |
$358.09
|
| Rate for Payer: Healthscope Whirlpool |
$358.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$313.33
|
| Rate for Payer: PACE SWMI |
$298.41
|
| Rate for Payer: PHP Medicare Advantage |
$298.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.60
|
| Rate for Payer: Priority Health Medicare |
$298.41
|
| Rate for Payer: Priority Health Narrow Network |
$418.60
|
| Rate for Payer: UHC Medicare Advantage |
$307.36
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$1,952.60 |
| Rate for Payer: Aetna Commercial |
$47.69
|
| Rate for Payer: Aetna Medicare |
$35.59
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$35.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,952.60
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Medicare Advantage |
$35.59
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$51.25
|
| Rate for Payer: Cofinity Commercial |
$47.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$42.71
|
| Rate for Payer: Healthscope Whirlpool |
$42.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.37
|
| Rate for Payer: PACE SWMI |
$35.59
|
| Rate for Payer: PHP Medicare Advantage |
$35.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$35.59
|
| Rate for Payer: Priority Health Narrow Network |
$44.56
|
| Rate for Payer: UHC Medicare Advantage |
$36.66
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$799.32 |
| Rate for Payer: Aetna Commercial |
$195.84
|
| Rate for Payer: Aetna Medicare |
$146.15
|
| Rate for Payer: BCBS Complete |
$128.40
|
| Rate for Payer: BCBS MAPPO |
$146.15
|
| Rate for Payer: BCBS Trust/PPO |
$799.32
|
| Rate for Payer: BCN Commercial |
$227.24
|
| Rate for Payer: BCN Medicare Advantage |
$146.15
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$210.46
|
| Rate for Payer: Cofinity Commercial |
$195.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.15
|
| Rate for Payer: Healthscope Commercial |
$175.38
|
| Rate for Payer: Healthscope Whirlpool |
$175.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.46
|
| Rate for Payer: PACE SWMI |
$146.15
|
| Rate for Payer: PHP Medicare Advantage |
$146.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.89
|
| Rate for Payer: Priority Health Medicare |
$146.15
|
| Rate for Payer: Priority Health Narrow Network |
$219.89
|
| Rate for Payer: UHC Medicare Advantage |
$150.53
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Cofinity Commercial |
$0.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$0.59
|
| Rate for Payer: Healthscope Whirlpool |
$0.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.51
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Aetna Medicare |
$2.99
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: BCN Commercial |
$0.68
|
| Rate for Payer: BCN Medicare Advantage |
$2.99
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Healthscope Whirlpool |
$3.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.14
|
| Rate for Payer: PACE SWMI |
$2.99
|
| Rate for Payer: PHP Medicare Advantage |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: UHC Medicare Advantage |
$3.08
|
|
