|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$221.86 |
| Rate for Payer: Aetna Commercial |
$136.10
|
| Rate for Payer: Aetna Medicare |
$101.57
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.57
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$221.86
|
| Rate for Payer: BCN Medicare Advantage |
$101.57
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$146.26
|
| Rate for Payer: Cofinity Commercial |
$136.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.57
|
| Rate for Payer: Healthscope Commercial |
$121.88
|
| Rate for Payer: Healthscope Whirlpool |
$121.88
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.65
|
| Rate for Payer: PACE SWMI |
$101.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Medicare |
$101.57
|
| Rate for Payer: Priority Health Narrow Network |
$129.07
|
| Rate for Payer: UHC Medicare Advantage |
$104.62
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$238.62
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$190.72
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$231.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$246.00
|
| Rate for Payer: Healthscope Whirlpool |
$238.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$221.40
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.84
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$308.67
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.48
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
PR INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$56.02 |
| Max. Negotiated Rate |
$1,093.40 |
| Rate for Payer: Aetna Commercial |
$118.20
|
| Rate for Payer: Aetna Medicare |
$88.21
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: BCBS MAPPO |
$88.21
|
| Rate for Payer: BCBS Trust/PPO |
$305.36
|
| Rate for Payer: BCN Commercial |
$177.62
|
| Rate for Payer: BCN Medicare Advantage |
$88.21
|
| Rate for Payer: Cash Price |
$1,249.60
|
| Rate for Payer: Cash Price |
$1,249.60
|
| Rate for Payer: Cofinity Commercial |
$118.20
|
| Rate for Payer: Cofinity Commercial |
$127.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.21
|
| Rate for Payer: Healthscope Commercial |
$105.85
|
| Rate for Payer: Healthscope Whirlpool |
$105.85
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.62
|
| Rate for Payer: PACE SWMI |
$88.21
|
| Rate for Payer: PHP Medicare Advantage |
$88.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,093.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.34
|
| Rate for Payer: Priority Health Medicare |
$88.21
|
| Rate for Payer: Priority Health Narrow Network |
$148.34
|
| Rate for Payer: UHC Medicare Advantage |
$90.86
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$2,366.78 |
| Rate for Payer: Aetna Commercial |
$143.98
|
| Rate for Payer: Aetna Medicare |
$107.45
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS MAPPO |
$107.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,366.78
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: BCN Medicare Advantage |
$107.45
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| 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 |
$74.48
|
| 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 |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.45
|
| Rate for Payer: Priority Health Medicare |
$107.45
|
| Rate for Payer: Priority Health Narrow Network |
$193.45
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
|
|
PR INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 99340
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$149.80 |
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.80
|
|
|
PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 59856
|
| Min. Negotiated Rate |
$321.63 |
| Max. Negotiated Rate |
$1,248.90 |
| Rate for Payer: Aetna Commercial |
$669.87
|
| Rate for Payer: Aetna Medicare |
$499.90
|
| Rate for Payer: BCBS Complete |
$337.71
|
| Rate for Payer: BCBS MAPPO |
$499.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.90
|
| Rate for Payer: BCN Commercial |
$733.51
|
| Rate for Payer: BCN Medicare Advantage |
$499.90
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$719.86
|
| Rate for Payer: Cofinity Commercial |
$669.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.90
|
| Rate for Payer: Healthscope Commercial |
$599.88
|
| Rate for Payer: Healthscope Whirlpool |
$599.88
|
| Rate for Payer: Meridian Medicaid |
$337.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$524.90
|
| Rate for Payer: PACE SWMI |
$499.90
|
| Rate for Payer: PHP Medicare Advantage |
$499.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$708.74
|
| Rate for Payer: Priority Health Medicare |
$499.90
|
| Rate for Payer: Priority Health Narrow Network |
$708.74
|
| Rate for Payer: UHC Medicare Advantage |
$514.90
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$374.24 |
| Max. Negotiated Rate |
$1,255.10 |
| Rate for Payer: Aetna Commercial |
$782.13
|
| Rate for Payer: Aetna Medicare |
$583.68
|
| Rate for Payer: BCBS Complete |
$392.95
|
| Rate for Payer: BCBS MAPPO |
$583.68
|
| Rate for Payer: BCBS Trust/PPO |
$756.53
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$583.68
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cofinity Commercial |
$782.13
|
| Rate for Payer: Cofinity Commercial |
$840.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.68
|
| Rate for Payer: Healthscope Commercial |
$700.42
|
| Rate for Payer: Healthscope Whirlpool |
$700.42
|
| Rate for Payer: Meridian Medicaid |
$392.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$612.86
|
| Rate for Payer: PACE SWMI |
$583.68
|
| Rate for Payer: PHP Medicare Advantage |
$583.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.84
|
| Rate for Payer: Priority Health Medicare |
$583.68
|
| Rate for Payer: Priority Health Narrow Network |
$825.84
|
| Rate for Payer: UHC Medicare Advantage |
$601.19
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$1,169.13 |
| Rate for Payer: Aetna Commercial |
$571.60
|
| Rate for Payer: Aetna Medicare |
$426.57
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS MAPPO |
$426.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.13
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: BCN Medicare Advantage |
$426.57
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$614.26
|
| Rate for Payer: Cofinity Commercial |
$571.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.57
|
| Rate for Payer: Healthscope Commercial |
$511.88
|
| Rate for Payer: Healthscope Whirlpool |
$511.88
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$447.90
|
| Rate for Payer: PACE SWMI |
$426.57
|
| Rate for Payer: PHP Medicare Advantage |
$426.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.27
|
| Rate for Payer: Priority Health Medicare |
$426.57
|
| Rate for Payer: Priority Health Narrow Network |
$606.27
|
| Rate for Payer: UHC Medicare Advantage |
$439.37
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$1,030.71 |
| Rate for Payer: Aetna Commercial |
$296.49
|
| Rate for Payer: Aetna Medicare |
$221.26
|
| Rate for Payer: BCBS Complete |
$151.19
|
| Rate for Payer: BCBS MAPPO |
$221.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: BCN Medicare Advantage |
$221.26
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Cofinity Commercial |
$318.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.26
|
| Rate for Payer: Healthscope Commercial |
$265.51
|
| Rate for Payer: Healthscope Whirlpool |
$265.51
|
| Rate for Payer: Meridian Medicaid |
$151.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.32
|
| Rate for Payer: PACE SWMI |
$221.26
|
| Rate for Payer: PHP Medicare Advantage |
$221.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.82
|
| Rate for Payer: Priority Health Medicare |
$221.26
|
| Rate for Payer: Priority Health Narrow Network |
$316.82
|
| Rate for Payer: UHC Medicare Advantage |
$227.90
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$499.90
|
| Rate for Payer: Aetna Medicare |
$373.06
|
| Rate for Payer: BCBS Complete |
$252.94
|
| Rate for Payer: BCBS MAPPO |
$373.06
|
| Rate for Payer: BCBS Trust/PPO |
$953.58
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: BCN Medicare Advantage |
$373.06
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cofinity Commercial |
$537.21
|
| Rate for Payer: Cofinity Commercial |
$499.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.06
|
| Rate for Payer: Healthscope Commercial |
$447.67
|
| Rate for Payer: Healthscope Whirlpool |
$447.67
|
| Rate for Payer: Meridian Medicaid |
$252.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$391.71
|
| Rate for Payer: PACE SWMI |
$373.06
|
| Rate for Payer: PHP Medicare Advantage |
$373.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.25
|
| Rate for Payer: Priority Health Medicare |
$373.06
|
| Rate for Payer: Priority Health Narrow Network |
$530.25
|
| Rate for Payer: UHC Medicare Advantage |
$384.25
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCN Commercial |
$29.71
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$10,750.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$7,525.00 |
| Rate for Payer: Aetna Commercial |
$4,084.74
|
| Rate for Payer: Aetna Medicare |
$3,048.31
|
| Rate for Payer: BCBS Complete |
$2,065.85
|
| Rate for Payer: BCBS MAPPO |
$3,048.31
|
| Rate for Payer: BCBS Trust/PPO |
$366.64
|
| Rate for Payer: BCN Commercial |
$4,510.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,048.31
|
| Rate for Payer: Cash Price |
$8,600.00
|
| Rate for Payer: Cash Price |
$8,600.00
|
| Rate for Payer: Cofinity Commercial |
$4,389.57
|
| Rate for Payer: Cofinity Commercial |
$4,084.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,048.31
|
| Rate for Payer: Healthscope Commercial |
$3,657.97
|
| Rate for Payer: Healthscope Whirlpool |
$3,657.97
|
| Rate for Payer: Meridian Medicaid |
$2,065.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,200.73
|
| Rate for Payer: PACE SWMI |
$3,048.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,048.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,967.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,226.25
|
| Rate for Payer: Priority Health Medicare |
$3,048.31
|
| Rate for Payer: Priority Health Narrow Network |
$5,226.25
|
| Rate for Payer: UHC Medicare Advantage |
$3,139.76
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,443.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$514.56 |
| Max. Negotiated Rate |
$5,139.04 |
| Rate for Payer: Aetna Commercial |
$4,012.12
|
| Rate for Payer: Aetna Medicare |
$2,994.12
|
| Rate for Payer: BCBS Complete |
$2,029.18
|
| Rate for Payer: BCBS MAPPO |
$2,994.12
|
| Rate for Payer: BCBS Trust/PPO |
$514.56
|
| Rate for Payer: BCN Commercial |
$4,435.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,994.12
|
| Rate for Payer: Cash Price |
$5,154.40
|
| Rate for Payer: Cash Price |
$5,154.40
|
| Rate for Payer: Cofinity Commercial |
$4,311.53
|
| Rate for Payer: Cofinity Commercial |
$4,012.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,994.12
|
| Rate for Payer: Healthscope Commercial |
$3,592.94
|
| Rate for Payer: Healthscope Whirlpool |
$3,592.94
|
| Rate for Payer: Meridian Medicaid |
$2,029.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,143.83
|
| Rate for Payer: PACE SWMI |
$2,994.12
|
| Rate for Payer: PHP Medicare Advantage |
$2,994.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,932.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,510.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,139.04
|
| Rate for Payer: Priority Health Medicare |
$2,994.12
|
| Rate for Payer: Priority Health Narrow Network |
$5,139.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.94
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$376.15 |
| Rate for Payer: Aetna Commercial |
$88.76
|
| Rate for Payer: Aetna Medicare |
$66.24
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS MAPPO |
$66.24
|
| Rate for Payer: BCBS Trust/PPO |
$376.15
|
| Rate for Payer: BCN Commercial |
$122.66
|
| Rate for Payer: BCN Medicare Advantage |
$66.24
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$88.76
|
| Rate for Payer: Cofinity Commercial |
$95.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$79.49
|
| Rate for Payer: Healthscope Whirlpool |
$79.49
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.55
|
| Rate for Payer: PACE SWMI |
$66.24
|
| Rate for Payer: PHP Medicare Advantage |
$66.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.60
|
| Rate for Payer: Priority Health Medicare |
$66.24
|
| Rate for Payer: Priority Health Narrow Network |
$83.60
|
| Rate for Payer: UHC Medicare Advantage |
$68.23
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$262.04 |
| Rate for Payer: Aetna Commercial |
$96.28
|
| Rate for Payer: Aetna Medicare |
$71.85
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCBS MAPPO |
$71.85
|
| Rate for Payer: BCBS Trust/PPO |
$262.04
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$71.85
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.85
|
| Rate for Payer: Healthscope Commercial |
$86.22
|
| Rate for Payer: Healthscope Whirlpool |
$86.22
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.44
|
| Rate for Payer: PACE SWMI |
$71.85
|
| Rate for Payer: PHP Medicare Advantage |
$71.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.72
|
| Rate for Payer: Priority Health Medicare |
$71.85
|
| Rate for Payer: Priority Health Narrow Network |
$90.72
|
| Rate for Payer: UHC Medicare Advantage |
$74.01
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$536.12 |
| Max. Negotiated Rate |
$1,810.85 |
| Rate for Payer: Aetna Commercial |
$1,110.43
|
| Rate for Payer: Aetna Medicare |
$828.68
|
| Rate for Payer: BCBS Complete |
$562.93
|
| Rate for Payer: BCBS MAPPO |
$828.68
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$1,221.69
|
| Rate for Payer: BCN Medicare Advantage |
$828.68
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,110.43
|
| Rate for Payer: Cofinity Commercial |
$1,193.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.68
|
| Rate for Payer: Healthscope Commercial |
$994.42
|
| Rate for Payer: Healthscope Whirlpool |
$994.42
|
| Rate for Payer: Meridian Medicaid |
$562.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$870.11
|
| Rate for Payer: PACE SWMI |
$828.68
|
| Rate for Payer: PHP Medicare Advantage |
$828.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$536.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,810.85
|
| Rate for Payer: Priority Health Medicare |
$828.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,810.85
|
| Rate for Payer: UHC Medicare Advantage |
$853.54
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$2,653.64
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$524.60 |
| Max. Negotiated Rate |
$2,830.72 |
| Rate for Payer: Aetna Commercial |
$1,739.43
|
| Rate for Payer: Aetna Medicare |
$1,298.08
|
| Rate for Payer: BCBS Complete |
$877.83
|
| Rate for Payer: BCBS MAPPO |
$1,298.08
|
| Rate for Payer: BCBS Trust/PPO |
$524.60
|
| Rate for Payer: BCN Commercial |
$1,909.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,298.08
|
| Rate for Payer: Cash Price |
$2,122.91
|
| Rate for Payer: Cash Price |
$2,122.91
|
| Rate for Payer: Cofinity Commercial |
$1,739.43
|
| Rate for Payer: Cofinity Commercial |
$1,869.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,298.08
|
| Rate for Payer: Healthscope Commercial |
$1,557.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,557.70
|
| Rate for Payer: Meridian Medicaid |
$877.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,362.98
|
| Rate for Payer: PACE SWMI |
$1,298.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,298.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,857.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,830.72
|
| Rate for Payer: Priority Health Medicare |
$1,298.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,830.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,337.02
|
|
|
PR INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 95070
|
| Min. Negotiated Rate |
$31.91 |
| Max. Negotiated Rate |
$302.19 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna Medicare |
$31.91
|
| Rate for Payer: BCBS Complete |
$97.60
|
| Rate for Payer: BCBS MAPPO |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: BCN Medicare Advantage |
$31.91
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$45.95
|
| Rate for Payer: Cofinity Commercial |
$42.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.91
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Healthscope Whirlpool |
$38.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.51
|
| Rate for Payer: PACE SWMI |
$31.91
|
| Rate for Payer: PHP Medicare Advantage |
$31.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.05
|
| Rate for Payer: Priority Health Medicare |
$31.91
|
| Rate for Payer: Priority Health Narrow Network |
$43.05
|
| Rate for Payer: UHC Medicare Advantage |
$32.87
|
|
|
PR INITIAL FOOT EXAM PT LOPS
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS G0245
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$52.26
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS MAPPO |
$39.00
|
| Rate for Payer: BCBS Trust/PPO |
$90.34
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: BCN Medicare Advantage |
$39.00
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Cofinity Commercial |
$56.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.00
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Healthscope Whirlpool |
$46.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.95
|
| Rate for Payer: PACE SWMI |
$39.00
|
| Rate for Payer: PHP Medicare Advantage |
$39.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.72
|
| Rate for Payer: Priority Health Medicare |
$39.00
|
| Rate for Payer: Priority Health Narrow Network |
$40.72
|
| Rate for Payer: UHC Medicare Advantage |
$40.17
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$1,044.00
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$177.51 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Aetna Commercial |
$445.82
|
| Rate for Payer: Aetna Medicare |
$332.70
|
| Rate for Payer: BCBS Complete |
$333.80
|
| Rate for Payer: BCBS MAPPO |
$332.70
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: BCN Medicare Advantage |
$332.70
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cofinity Commercial |
$479.09
|
| Rate for Payer: Cofinity Commercial |
$445.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.70
|
| Rate for Payer: Healthscope Commercial |
$365.97
|
| Rate for Payer: Healthscope Whirlpool |
$365.97
|
| Rate for Payer: Meridian Medicaid |
$333.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$349.34
|
| Rate for Payer: PACE SWMI |
$332.70
|
| Rate for Payer: PHP Medicare Advantage |
$332.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.75
|
| Rate for Payer: Priority Health Medicare |
$332.70
|
| Rate for Payer: Priority Health Narrow Network |
$428.75
|
| Rate for Payer: UHC Medicare Advantage |
$342.68
|
|
|
PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 99251
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 45 MINUTES
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$156.18 |
| Max. Negotiated Rate |
$2,045.58 |
| Rate for Payer: Aetna Commercial |
$238.35
|
| Rate for Payer: Aetna Medicare |
$177.87
|
| Rate for Payer: BCBS Complete |
$163.99
|
| Rate for Payer: BCBS MAPPO |
$177.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.58
|
| Rate for Payer: BCN Commercial |
$262.91
|
| Rate for Payer: BCN Medicare Advantage |
$177.87
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Cofinity Commercial |
$238.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.87
|
| Rate for Payer: Healthscope Commercial |
$195.66
|
| Rate for Payer: Healthscope Whirlpool |
$195.66
|
| Rate for Payer: Meridian Medicaid |
$163.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.76
|
| Rate for Payer: PACE SWMI |
$177.87
|
| Rate for Payer: PHP Medicare Advantage |
$177.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.43
|
| Rate for Payer: Priority Health Medicare |
$177.87
|
| Rate for Payer: Priority Health Narrow Network |
$230.43
|
| Rate for Payer: UHC Medicare Advantage |
$183.21
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$1,949.96 |
| Rate for Payer: Aetna Commercial |
$174.44
|
| Rate for Payer: Aetna Medicare |
$130.18
|
| Rate for Payer: BCBS Complete |
$120.12
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.96
|
| Rate for Payer: BCN Commercial |
$192.54
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cofinity Commercial |
$174.44
|
| Rate for Payer: Cofinity Commercial |
$187.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Healthscope Commercial |
$143.20
|
| Rate for Payer: Healthscope Whirlpool |
$143.20
|
| Rate for Payer: Meridian Medicaid |
$120.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.76
|
| Rate for Payer: Priority Health Medicare |
$130.18
|
| Rate for Payer: Priority Health Narrow Network |
$168.76
|
| Rate for Payer: UHC Medicare Advantage |
$134.09
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$2,272.22 |
| Rate for Payer: Aetna Commercial |
$105.34
|
| Rate for Payer: Aetna Medicare |
$78.61
|
| Rate for Payer: BCBS Complete |
$72.31
|
| Rate for Payer: BCBS MAPPO |
$78.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.22
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: BCN Medicare Advantage |
$78.61
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$113.20
|
| Rate for Payer: Cofinity Commercial |
$105.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.61
|
| Rate for Payer: Healthscope Commercial |
$86.47
|
| Rate for Payer: Healthscope Whirlpool |
$86.47
|
| Rate for Payer: Meridian Medicaid |
$72.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.54
|
| Rate for Payer: PACE SWMI |
$78.61
|
| Rate for Payer: PHP Medicare Advantage |
$78.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.94
|
| Rate for Payer: Priority Health Medicare |
$78.61
|
| Rate for Payer: Priority Health Narrow Network |
$101.94
|
| Rate for Payer: UHC Medicare Advantage |
$80.97
|
|
|
PR INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99218
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$103.60 |
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
|
