|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$326.84
|
| Rate for Payer: Aetna Medicare |
$243.91
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| Rate for Payer: BCN Medicare Advantage |
$243.91
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$326.84
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.91
|
| Rate for Payer: Healthscope Commercial |
$292.69
|
| Rate for Payer: Healthscope Whirlpool |
$292.69
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.11
|
| Rate for Payer: PACE SWMI |
$243.91
|
| Rate for Payer: PHP Medicare Advantage |
$243.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.02
|
| Rate for Payer: Priority Health Medicare |
$243.91
|
| Rate for Payer: Priority Health Narrow Network |
$347.02
|
| Rate for Payer: UHC Medicare Advantage |
$251.23
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
58563
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna Commercial |
$1,379.70
|
| Rate for Payer: ASR ASR |
$1,487.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.53
|
| Rate for Payer: BCN Commercial |
$1,188.53
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,441.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Healthscope Commercial |
$1,533.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.01
|
| Rate for Payer: Mclaren Commercial |
$1,379.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,349.04
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$3,149.52 |
| Rate for Payer: Aetna Commercial |
$326.84
|
| Rate for Payer: Aetna Medicare |
$243.91
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$3,149.52
|
| Rate for Payer: BCN Medicare Advantage |
$243.91
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$351.23
|
| Rate for Payer: Cofinity Commercial |
$326.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.91
|
| Rate for Payer: Healthscope Commercial |
$292.69
|
| Rate for Payer: Healthscope Whirlpool |
$292.69
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.11
|
| Rate for Payer: PACE SWMI |
$243.91
|
| Rate for Payer: PHP Medicare Advantage |
$243.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.02
|
| Rate for Payer: Priority Health Medicare |
$243.91
|
| Rate for Payer: Priority Health Narrow Network |
$347.02
|
| Rate for Payer: UHC Medicare Advantage |
$251.23
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$180.84 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Aetna Commercial |
$376.86
|
| Rate for Payer: Aetna Medicare |
$281.24
|
| Rate for Payer: BCBS Complete |
$189.88
|
| Rate for Payer: BCBS MAPPO |
$281.24
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$412.93
|
| Rate for Payer: BCN Medicare Advantage |
$281.24
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cofinity Commercial |
$404.99
|
| Rate for Payer: Cofinity Commercial |
$376.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.24
|
| Rate for Payer: Healthscope Commercial |
$337.49
|
| Rate for Payer: Healthscope Whirlpool |
$337.49
|
| Rate for Payer: Meridian Medicaid |
$189.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$295.30
|
| Rate for Payer: PACE SWMI |
$281.24
|
| Rate for Payer: PHP Medicare Advantage |
$281.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.05
|
| Rate for Payer: Priority Health Medicare |
$281.24
|
| Rate for Payer: Priority Health Narrow Network |
$400.05
|
| Rate for Payer: UHC Medicare Advantage |
$289.68
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$807.80 |
| Rate for Payer: Aetna Commercial |
$294.13
|
| Rate for Payer: Aetna Medicare |
$219.50
|
| Rate for Payer: BCBS Complete |
$148.28
|
| Rate for Payer: BCBS MAPPO |
$219.50
|
| Rate for Payer: BCBS Trust/PPO |
$13.74
|
| Rate for Payer: BCN Commercial |
$639.19
|
| Rate for Payer: BCN Medicare Advantage |
$219.50
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cofinity Commercial |
$294.13
|
| Rate for Payer: Cofinity Commercial |
$316.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.50
|
| Rate for Payer: Healthscope Commercial |
$263.40
|
| Rate for Payer: Healthscope Whirlpool |
$263.40
|
| Rate for Payer: Meridian Medicaid |
$148.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.48
|
| Rate for Payer: PACE SWMI |
$219.50
|
| Rate for Payer: PHP Medicare Advantage |
$219.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.47
|
| Rate for Payer: Priority Health Medicare |
$219.50
|
| Rate for Payer: Priority Health Narrow Network |
$312.47
|
| Rate for Payer: UHC Medicare Advantage |
$226.08
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$646.10 |
| Max. Negotiated Rate |
$5,526.50 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Medicare |
$4,421.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: ASR ASR |
$895.31
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$715.60
|
| Rate for Payer: BCN Commercial |
$715.60
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$867.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Healthscope Commercial |
$923.00
|
| Rate for Payer: Healthscope Whirlpool |
$895.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,421.20
|
| Rate for Payer: Mclaren Commercial |
$830.70
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$784.55
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Commercial |
$4,863.32
|
| Rate for Payer: PHP Medicaid |
$2,418.40
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.93
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$655.33
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$812.24
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$646.10 |
| Rate for Payer: Aetna Commercial |
$475.47
|
| Rate for Payer: Aetna Medicare |
$354.83
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$354.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.83
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$510.96
|
| Rate for Payer: Cofinity Commercial |
$475.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.83
|
| Rate for Payer: Healthscope Commercial |
$425.80
|
| Rate for Payer: Healthscope Whirlpool |
$425.80
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.57
|
| Rate for Payer: PACE SWMI |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$354.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.20
|
| Rate for Payer: Priority Health Medicare |
$354.83
|
| Rate for Payer: Priority Health Narrow Network |
$504.20
|
| Rate for Payer: UHC Medicare Advantage |
$365.47
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$646.10 |
| Max. Negotiated Rate |
$923.00 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: ASR ASR |
$895.31
|
| Rate for Payer: BCBS Trust/PPO |
$715.60
|
| Rate for Payer: BCN Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$867.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.40
|
| Rate for Payer: Healthscope Commercial |
$923.00
|
| Rate for Payer: Healthscope Whirlpool |
$895.31
|
| Rate for Payer: Mclaren Commercial |
$830.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$784.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$812.24
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$646.10 |
| Rate for Payer: Aetna Commercial |
$475.47
|
| Rate for Payer: Aetna Medicare |
$354.83
|
| Rate for Payer: BCBS Complete |
$239.31
|
| Rate for Payer: BCBS MAPPO |
$354.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.83
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$475.47
|
| Rate for Payer: Cofinity Commercial |
$510.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.83
|
| Rate for Payer: Healthscope Commercial |
$425.80
|
| Rate for Payer: Healthscope Whirlpool |
$425.80
|
| Rate for Payer: Meridian Medicaid |
$239.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.57
|
| Rate for Payer: PACE SWMI |
$354.83
|
| Rate for Payer: PHP Medicare Advantage |
$354.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.20
|
| Rate for Payer: Priority Health Medicare |
$354.83
|
| Rate for Payer: Priority Health Narrow Network |
$504.20
|
| Rate for Payer: UHC Medicare Advantage |
$365.47
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$130.49 |
| Max. Negotiated Rate |
$1,260.30 |
| Rate for Payer: Aetna Commercial |
$1,150.72
|
| Rate for Payer: Aetna Medicare |
$858.75
|
| Rate for Payer: BCBS Complete |
$580.38
|
| Rate for Payer: BCBS MAPPO |
$858.75
|
| Rate for Payer: BCBS Trust/PPO |
$130.49
|
| Rate for Payer: BCN Commercial |
$1,260.30
|
| Rate for Payer: BCN Medicare Advantage |
$858.75
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,236.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.75
|
| Rate for Payer: Healthscope Commercial |
$1,030.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,030.50
|
| Rate for Payer: Meridian Medicaid |
$580.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$901.69
|
| Rate for Payer: PACE SWMI |
$858.75
|
| Rate for Payer: PHP Medicare Advantage |
$858.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,217.73
|
| Rate for Payer: Priority Health Medicare |
$858.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,217.73
|
| Rate for Payer: UHC Medicare Advantage |
$884.51
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$187.08 |
| Rate for Payer: Aetna Commercial |
$187.08
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Trust/PPO |
$175.26
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
|
|
PR I131 IODIDE CAP, RX
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A9517
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$2,124.29 |
| Rate for Payer: Aetna Commercial |
$40.43
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,124.29
|
| Rate for Payer: BCN Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
|
|
PR ICAR CATHETER ABLATION ARRHYTHMIA ADD ON
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$190.64 |
| Max. Negotiated Rate |
$2,991.76 |
| Rate for Payer: Aetna Commercial |
$406.09
|
| Rate for Payer: Aetna Medicare |
$303.05
|
| Rate for Payer: BCBS Complete |
$200.17
|
| Rate for Payer: BCBS MAPPO |
$303.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,991.76
|
| Rate for Payer: BCN Commercial |
$442.74
|
| Rate for Payer: BCN Medicare Advantage |
$303.05
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cofinity Commercial |
$436.39
|
| Rate for Payer: Cofinity Commercial |
$406.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.05
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Healthscope Whirlpool |
$363.66
|
| Rate for Payer: Meridian Medicaid |
$200.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$318.20
|
| Rate for Payer: PACE SWMI |
$303.05
|
| Rate for Payer: PHP Medicare Advantage |
$303.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.42
|
| Rate for Payer: Priority Health Medicare |
$303.05
|
| Rate for Payer: Priority Health Narrow Network |
$428.42
|
| Rate for Payer: UHC Medicare Advantage |
$312.14
|
|
|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$2,821.65 |
| Rate for Payer: Aetna Commercial |
$769.99
|
| Rate for Payer: Aetna Medicare |
$574.62
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$574.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,821.65
|
| Rate for Payer: BCN Commercial |
$840.53
|
| Rate for Payer: BCN Medicare Advantage |
$574.62
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cofinity Commercial |
$827.45
|
| Rate for Payer: Cofinity Commercial |
$769.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$574.62
|
| Rate for Payer: Healthscope Commercial |
$689.54
|
| Rate for Payer: Healthscope Whirlpool |
$689.54
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$603.35
|
| Rate for Payer: PACE SWMI |
$574.62
|
| Rate for Payer: PHP Medicare Advantage |
$574.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.33
|
| Rate for Payer: Priority Health Medicare |
$574.62
|
| Rate for Payer: Priority Health Narrow Network |
$813.33
|
| Rate for Payer: UHC Medicare Advantage |
$591.86
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$492.38 |
| Rate for Payer: Aetna Commercial |
$177.82
|
| Rate for Payer: Aetna Medicare |
$132.70
|
| Rate for Payer: BCBS Complete |
$92.15
|
| Rate for Payer: BCBS MAPPO |
$132.70
|
| Rate for Payer: BCBS Trust/PPO |
$492.38
|
| Rate for Payer: BCN Commercial |
$284.90
|
| Rate for Payer: BCN Medicare Advantage |
$132.70
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$191.09
|
| Rate for Payer: Cofinity Commercial |
$177.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.70
|
| Rate for Payer: Healthscope Commercial |
$159.24
|
| Rate for Payer: Healthscope Whirlpool |
$159.24
|
| Rate for Payer: Meridian Medicaid |
$92.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$139.34
|
| Rate for Payer: PACE SWMI |
$132.70
|
| Rate for Payer: PHP Medicare Advantage |
$132.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.48
|
| Rate for Payer: Priority Health Medicare |
$132.70
|
| Rate for Payer: Priority Health Narrow Network |
$240.48
|
| Rate for Payer: UHC Medicare Advantage |
$136.68
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 42720
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$678.52 |
| Rate for Payer: Aetna Commercial |
$509.32
|
| Rate for Payer: Aetna Medicare |
$380.09
|
| Rate for Payer: BCBS Complete |
$259.43
|
| Rate for Payer: BCBS MAPPO |
$380.09
|
| Rate for Payer: BCBS Trust/PPO |
$613.88
|
| Rate for Payer: BCN Commercial |
$657.27
|
| Rate for Payer: BCN Medicare Advantage |
$380.09
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$547.33
|
| Rate for Payer: Cofinity Commercial |
$509.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.09
|
| Rate for Payer: Healthscope Commercial |
$456.11
|
| Rate for Payer: Healthscope Whirlpool |
$456.11
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.09
|
| Rate for Payer: PACE SWMI |
$380.09
|
| Rate for Payer: PHP Medicare Advantage |
$380.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.52
|
| Rate for Payer: Priority Health Medicare |
$380.09
|
| Rate for Payer: Priority Health Narrow Network |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$391.49
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 42725
|
| Min. Negotiated Rate |
$512.90 |
| Max. Negotiated Rate |
$1,402.91 |
| Rate for Payer: Aetna Commercial |
$1,050.59
|
| Rate for Payer: Aetna Medicare |
$784.02
|
| Rate for Payer: BCBS Complete |
$538.54
|
| Rate for Payer: BCBS MAPPO |
$784.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,312.83
|
| Rate for Payer: BCN Commercial |
$1,165.98
|
| Rate for Payer: BCN Medicare Advantage |
$784.02
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$1,128.99
|
| Rate for Payer: Cofinity Commercial |
$1,050.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$784.02
|
| Rate for Payer: Healthscope Commercial |
$940.82
|
| Rate for Payer: Healthscope Whirlpool |
$940.82
|
| Rate for Payer: Meridian Medicaid |
$538.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$823.22
|
| Rate for Payer: PACE SWMI |
$784.02
|
| Rate for Payer: PHP Medicare Advantage |
$784.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,402.91
|
| Rate for Payer: Priority Health Medicare |
$784.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.91
|
| Rate for Payer: UHC Medicare Advantage |
$807.54
|
|
|
PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28002
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$595.70 |
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna Medicare |
$137.93
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS MAPPO |
$137.93
|
| Rate for Payer: BCBS Trust/PPO |
$523.55
|
| Rate for Payer: BCN Commercial |
$359.18
|
| Rate for Payer: BCN Medicare Advantage |
$137.93
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$198.62
|
| Rate for Payer: Cofinity Commercial |
$184.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.93
|
| Rate for Payer: Healthscope Commercial |
$165.52
|
| Rate for Payer: Healthscope Whirlpool |
$165.52
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.83
|
| Rate for Payer: PACE SWMI |
$137.93
|
| Rate for Payer: PHP Medicare Advantage |
$137.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.92
|
| Rate for Payer: Priority Health Medicare |
$137.93
|
| Rate for Payer: Priority Health Narrow Network |
$211.92
|
| Rate for Payer: UHC Medicare Advantage |
$142.07
|
|
|
PR I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 28003
|
| Min. Negotiated Rate |
$164.22 |
| Max. Negotiated Rate |
$3,691.76 |
| Rate for Payer: Aetna Commercial |
$345.20
|
| Rate for Payer: Aetna Medicare |
$257.61
|
| Rate for Payer: BCBS Complete |
$172.43
|
| Rate for Payer: BCBS MAPPO |
$257.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,691.76
|
| Rate for Payer: BCN Commercial |
$554.65
|
| Rate for Payer: BCN Medicare Advantage |
$257.61
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cofinity Commercial |
$345.20
|
| Rate for Payer: Cofinity Commercial |
$370.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.61
|
| Rate for Payer: Healthscope Commercial |
$309.13
|
| Rate for Payer: Healthscope Whirlpool |
$309.13
|
| Rate for Payer: Meridian Medicaid |
$172.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.49
|
| Rate for Payer: PACE SWMI |
$257.61
|
| Rate for Payer: PHP Medicare Advantage |
$257.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.22
|
| Rate for Payer: Priority Health Medicare |
$257.61
|
| Rate for Payer: Priority Health Narrow Network |
$394.22
|
| Rate for Payer: UHC Medicare Advantage |
$265.34
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
HCPCS 27301
|
| Min. Negotiated Rate |
$329.94 |
| Max. Negotiated Rate |
$3,899.38 |
| Rate for Payer: Aetna Commercial |
$670.74
|
| Rate for Payer: Aetna Medicare |
$500.55
|
| Rate for Payer: BCBS Complete |
$346.44
|
| Rate for Payer: BCBS MAPPO |
$500.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,899.38
|
| Rate for Payer: BCN Commercial |
$993.00
|
| Rate for Payer: BCN Medicare Advantage |
$500.55
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cash Price |
$1,305.60
|
| Rate for Payer: Cofinity Commercial |
$720.79
|
| Rate for Payer: Cofinity Commercial |
$670.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.55
|
| Rate for Payer: Healthscope Commercial |
$600.66
|
| Rate for Payer: Healthscope Whirlpool |
$600.66
|
| Rate for Payer: Meridian Medicaid |
$346.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$525.58
|
| Rate for Payer: PACE SWMI |
$500.55
|
| Rate for Payer: PHP Medicare Advantage |
$500.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$781.29
|
| Rate for Payer: Priority Health Medicare |
$500.55
|
| Rate for Payer: Priority Health Narrow Network |
$781.29
|
| Rate for Payer: UHC Medicare Advantage |
$515.57
|
|
|
PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR
|
Professional
|
Both
|
$2,412.00
|
|
|
Service Code
|
HCPCS 22010
|
| Min. Negotiated Rate |
$233.52 |
| Max. Negotiated Rate |
$1,688.40 |
| Rate for Payer: Aetna Commercial |
$1,285.68
|
| Rate for Payer: Aetna Medicare |
$959.46
|
| Rate for Payer: BCBS Complete |
$660.89
|
| Rate for Payer: BCBS MAPPO |
$959.46
|
| Rate for Payer: BCBS Trust/PPO |
$233.52
|
| Rate for Payer: BCN Commercial |
$1,424.01
|
| Rate for Payer: BCN Medicare Advantage |
$959.46
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cofinity Commercial |
$1,381.62
|
| Rate for Payer: Cofinity Commercial |
$1,285.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.46
|
| Rate for Payer: Healthscope Commercial |
$1,151.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,151.35
|
| Rate for Payer: Meridian Medicaid |
$660.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,007.43
|
| Rate for Payer: PACE SWMI |
$959.46
|
| Rate for Payer: PHP Medicare Advantage |
$959.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$629.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,488.03
|
| Rate for Payer: Priority Health Medicare |
$959.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,488.03
|
| Rate for Payer: UHC Medicare Advantage |
$988.24
|
|
|
PR I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC
|
Professional
|
Both
|
$1,691.00
|
|
|
Service Code
|
HCPCS 22015
|
| Min. Negotiated Rate |
$233.52 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna Commercial |
$1,262.60
|
| Rate for Payer: Aetna Medicare |
$942.24
|
| Rate for Payer: BCBS Complete |
$644.78
|
| Rate for Payer: BCBS MAPPO |
$942.24
|
| Rate for Payer: BCBS Trust/PPO |
$233.52
|
| Rate for Payer: BCN Commercial |
$1,399.57
|
| Rate for Payer: BCN Medicare Advantage |
$942.24
|
| Rate for Payer: Cash Price |
$1,352.80
|
| Rate for Payer: Cash Price |
$1,352.80
|
| Rate for Payer: Cofinity Commercial |
$1,356.83
|
| Rate for Payer: Cofinity Commercial |
$1,262.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$942.24
|
| Rate for Payer: Healthscope Commercial |
$1,130.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,130.69
|
| Rate for Payer: Meridian Medicaid |
$644.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$989.35
|
| Rate for Payer: PACE SWMI |
$942.24
|
| Rate for Payer: PHP Medicare Advantage |
$942.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,462.50
|
| Rate for Payer: Priority Health Medicare |
$942.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,462.50
|
| Rate for Payer: UHC Medicare Advantage |
$970.51
|
|
|
PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 21501
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$801.50 |
| Rate for Payer: Aetna Commercial |
$439.40
|
| Rate for Payer: Aetna Medicare |
$327.91
|
| Rate for Payer: BCBS Complete |
$229.25
|
| Rate for Payer: BCBS MAPPO |
$327.91
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$718.85
|
| Rate for Payer: BCN Medicare Advantage |
$327.91
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$472.19
|
| Rate for Payer: Cofinity Commercial |
$439.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.91
|
| Rate for Payer: Healthscope Commercial |
$393.49
|
| Rate for Payer: Healthscope Whirlpool |
$393.49
|
| Rate for Payer: Meridian Medicaid |
$229.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.31
|
| Rate for Payer: PACE SWMI |
$327.91
|
| Rate for Payer: PHP Medicare Advantage |
$327.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.24
|
| Rate for Payer: Priority Health Medicare |
$327.91
|
| Rate for Payer: Priority Health Narrow Network |
$515.24
|
| Rate for Payer: UHC Medicare Advantage |
$337.75
|
|
|
PR I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 21502
|
| Min. Negotiated Rate |
$326.10 |
| Max. Negotiated Rate |
$776.19 |
| Rate for Payer: Aetna Commercial |
$672.85
|
| Rate for Payer: Aetna Medicare |
$502.13
|
| Rate for Payer: BCBS Complete |
$342.40
|
| Rate for Payer: BCBS MAPPO |
$502.13
|
| Rate for Payer: BCBS Trust/PPO |
$483.43
|
| Rate for Payer: BCN Commercial |
$742.79
|
| Rate for Payer: BCN Medicare Advantage |
$502.13
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$672.85
|
| Rate for Payer: Cofinity Commercial |
$723.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.13
|
| Rate for Payer: Healthscope Commercial |
$602.56
|
| Rate for Payer: Healthscope Whirlpool |
$602.56
|
| Rate for Payer: Meridian Medicaid |
$342.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$527.24
|
| Rate for Payer: PACE SWMI |
$502.13
|
| Rate for Payer: PHP Medicare Advantage |
$502.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$776.19
|
| Rate for Payer: Priority Health Medicare |
$502.13
|
| Rate for Payer: Priority Health Narrow Network |
$776.19
|
| Rate for Payer: UHC Medicare Advantage |
$517.19
|
|
|
PR I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC
|
Professional
|
Both
|
$1,605.00
|
|
|
Service Code
|
HCPCS 45020
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$1,123.50 |
| Rate for Payer: Aetna Commercial |
$759.87
|
| Rate for Payer: Aetna Medicare |
$567.07
|
| Rate for Payer: BCBS Complete |
$383.11
|
| Rate for Payer: BCBS MAPPO |
$567.07
|
| Rate for Payer: BCBS Trust/PPO |
$489.21
|
| Rate for Payer: BCN Commercial |
$841.99
|
| Rate for Payer: BCN Medicare Advantage |
$567.07
|
| Rate for Payer: Cash Price |
$1,284.00
|
| Rate for Payer: Cash Price |
$1,284.00
|
| Rate for Payer: Cofinity Commercial |
$816.58
|
| Rate for Payer: Cofinity Commercial |
$759.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.07
|
| Rate for Payer: Healthscope Commercial |
$680.48
|
| Rate for Payer: Healthscope Whirlpool |
$680.48
|
| Rate for Payer: Meridian Medicaid |
$383.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$595.42
|
| Rate for Payer: PACE SWMI |
$567.07
|
| Rate for Payer: PHP Medicare Advantage |
$567.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,013.08
|
| Rate for Payer: Priority Health Medicare |
$567.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.08
|
| Rate for Payer: UHC Medicare Advantage |
$584.08
|
|
