|
PR INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 99219
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$140.70 |
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
|
|
PR INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 99220
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,438.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$288.45 |
| Max. Negotiated Rate |
$1,116.63 |
| Rate for Payer: Aetna Commercial |
$1,017.77
|
| Rate for Payer: Aetna Medicare |
$759.53
|
| Rate for Payer: BCBS Complete |
$763.68
|
| Rate for Payer: BCBS MAPPO |
$759.53
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$1,116.63
|
| Rate for Payer: BCN Medicare Advantage |
$759.53
|
| Rate for Payer: Cash Price |
$1,150.40
|
| Rate for Payer: Cash Price |
$1,150.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.72
|
| Rate for Payer: Cofinity Commercial |
$1,017.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$759.53
|
| Rate for Payer: Healthscope Commercial |
$835.48
|
| Rate for Payer: Healthscope Whirlpool |
$835.48
|
| Rate for Payer: Meridian Medicaid |
$763.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$797.51
|
| Rate for Payer: PACE SWMI |
$759.53
|
| Rate for Payer: PHP Medicare Advantage |
$759.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$727.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$978.71
|
| Rate for Payer: Priority Health Medicare |
$759.53
|
| Rate for Payer: Priority Health Narrow Network |
$978.71
|
| Rate for Payer: UHC Medicare Advantage |
$782.32
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$853.30 |
| Rate for Payer: Aetna Commercial |
$733.53
|
| Rate for Payer: Aetna Medicare |
$547.41
|
| Rate for Payer: BCBS Complete |
$550.97
|
| Rate for Payer: BCBS MAPPO |
$547.41
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$804.85
|
| Rate for Payer: BCN Medicare Advantage |
$547.41
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cofinity Commercial |
$788.27
|
| Rate for Payer: Cofinity Commercial |
$733.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.41
|
| Rate for Payer: Healthscope Commercial |
$602.15
|
| Rate for Payer: Healthscope Whirlpool |
$602.15
|
| Rate for Payer: Meridian Medicaid |
$550.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$574.78
|
| Rate for Payer: PACE SWMI |
$547.41
|
| Rate for Payer: PHP Medicare Advantage |
$547.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$524.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$705.44
|
| Rate for Payer: Priority Health Medicare |
$547.41
|
| Rate for Payer: Priority Health Narrow Network |
$705.44
|
| Rate for Payer: UHC Medicare Advantage |
$563.83
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$1,427.47 |
| Rate for Payer: Aetna Commercial |
$172.36
|
| Rate for Payer: Aetna Medicare |
$128.63
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS MAPPO |
$128.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,427.47
|
| Rate for Payer: BCN Commercial |
$240.43
|
| Rate for Payer: BCN Medicare Advantage |
$128.63
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cofinity Commercial |
$185.23
|
| Rate for Payer: Cofinity Commercial |
$172.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.63
|
| Rate for Payer: Healthscope Commercial |
$154.36
|
| Rate for Payer: Healthscope Whirlpool |
$154.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.06
|
| Rate for Payer: PACE SWMI |
$128.63
|
| Rate for Payer: PHP Medicare Advantage |
$128.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$128.63
|
| Rate for Payer: Priority Health Narrow Network |
$169.49
|
| Rate for Payer: UHC Medicare Advantage |
$132.49
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$275.77 |
| Rate for Payer: Aetna Commercial |
$78.23
|
| Rate for Payer: BCBS Complete |
$70.02
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$157.84
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$70.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.18
|
| Rate for Payer: Priority Health Narrow Network |
$155.18
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$157.99 |
| Rate for Payer: Aetna Commercial |
$121.06
|
| Rate for Payer: BCBS Complete |
$109.68
|
| Rate for Payer: BCBS Trust/PPO |
$72.38
|
| Rate for Payer: BCN Commercial |
$157.99
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Meridian Medicaid |
$109.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.21
|
| Rate for Payer: Priority Health Narrow Network |
$147.21
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$171.96 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: BCBS Complete |
$117.67
|
| Rate for Payer: BCBS Trust/PPO |
$75.55
|
| Rate for Payer: BCN Commercial |
$171.96
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Meridian Medicaid |
$117.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.57
|
| Rate for Payer: Priority Health Narrow Network |
$158.57
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$445.89 |
| Rate for Payer: Aetna Commercial |
$103.72
|
| Rate for Payer: BCBS Complete |
$94.33
|
| Rate for Payer: BCBS Trust/PPO |
$445.89
|
| Rate for Payer: BCN Commercial |
$141.16
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Meridian Medicaid |
$94.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.24
|
| Rate for Payer: Priority Health Narrow Network |
$126.24
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$71.26 |
| Max. Negotiated Rate |
$299.02 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: BCBS Complete |
$74.82
|
| Rate for Payer: BCBS Trust/PPO |
$299.02
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Meridian Medicaid |
$74.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.62
|
| Rate for Payer: Priority Health Narrow Network |
$162.62
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$99.47
|
| Rate for Payer: BCBS Complete |
$90.49
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$137.21
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Meridian Medicaid |
$90.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.44
|
| Rate for Payer: Priority Health Narrow Network |
$121.44
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: BCBS Complete |
$79.30
|
| Rate for Payer: BCBS Trust/PPO |
$40.68
|
| Rate for Payer: BCN Commercial |
$125.39
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$79.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.46
|
| Rate for Payer: Priority Health Narrow Network |
$107.46
|
|
|
PR INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 16000
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$569.29 |
| Rate for Payer: Aetna Commercial |
$60.90
|
| Rate for Payer: Aetna Medicare |
$45.45
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS MAPPO |
$45.45
|
| Rate for Payer: BCBS Trust/PPO |
$569.29
|
| Rate for Payer: BCN Commercial |
$92.28
|
| Rate for Payer: BCN Medicare Advantage |
$45.45
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Cofinity Commercial |
$60.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.45
|
| Rate for Payer: Healthscope Commercial |
$54.54
|
| Rate for Payer: Healthscope Whirlpool |
$54.54
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.72
|
| Rate for Payer: PACE SWMI |
$45.45
|
| Rate for Payer: PHP Medicare Advantage |
$45.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.91
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow Network |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$46.81
|
|
|
PR INIT/SUB PSYCH CARE M 1ST 30
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS G2214
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna Medicare |
$37.12
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS MAPPO |
$37.12
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$81.69
|
| Rate for Payer: BCN Medicare Advantage |
$37.12
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Cofinity Commercial |
$53.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.12
|
| Rate for Payer: Healthscope Commercial |
$44.54
|
| Rate for Payer: Healthscope Whirlpool |
$44.54
|
| Rate for Payer: Meridian Medicaid |
$25.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.98
|
| Rate for Payer: PACE SWMI |
$37.12
|
| Rate for Payer: PHP Medicare Advantage |
$37.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.20
|
| Rate for Payer: Priority Health Medicare |
$37.12
|
| Rate for Payer: Priority Health Narrow Network |
$73.20
|
| Rate for Payer: UHC Medicare Advantage |
$38.23
|
|
|
PR INJ DEXAMETHASONE ACETATE
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1094
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
|
|
PR INJ, DUROLANE 1 MG
|
Professional
|
Both
|
$20.67
|
|
|
Service Code
|
HCPCS J7318
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$16.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$7.27
|
| Rate for Payer: Healthscope Whirlpool |
$7.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.06
|
| Rate for Payer: PHP Medicare Advantage |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$377.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$137.74
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$110.09
|
| Rate for Payer: BCN Commercial |
$110.09
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$133.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$142.00
|
| Rate for Payer: Healthscope Whirlpool |
$137.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$127.80
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.70
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.64
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$302.11
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.96
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
20550
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna Medicare |
$38.63
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$38.63
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$55.63
|
| Rate for Payer: Cofinity Commercial |
$51.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.63
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Healthscope Whirlpool |
$46.36
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.56
|
| Rate for Payer: PACE SWMI |
$38.63
|
| Rate for Payer: PHP Medicare Advantage |
$38.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.24
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow Network |
$59.24
|
| Rate for Payer: UHC Medicare Advantage |
$39.79
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna Medicare |
$38.63
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$38.63
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$55.63
|
| Rate for Payer: Cofinity Commercial |
$51.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.63
|
| Rate for Payer: Healthscope Commercial |
$46.36
|
| Rate for Payer: Healthscope Whirlpool |
$46.36
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.56
|
| Rate for Payer: PACE SWMI |
$38.63
|
| Rate for Payer: PHP Medicare Advantage |
$38.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.24
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow Network |
$59.24
|
| Rate for Payer: UHC Medicare Advantage |
$39.79
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: ASR ASR |
$137.74
|
| Rate for Payer: BCBS Trust/PPO |
$110.09
|
| Rate for Payer: BCN Commercial |
$110.09
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$133.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.60
|
| Rate for Payer: Healthscope Commercial |
$142.00
|
| Rate for Payer: Healthscope Whirlpool |
$137.74
|
| Rate for Payer: Mclaren Commercial |
$127.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.96
|
|
|
PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 64417
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$234.08 |
| Rate for Payer: Aetna Commercial |
$83.55
|
| Rate for Payer: Aetna Medicare |
$62.35
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$62.35
|
| Rate for Payer: BCBS Trust/PPO |
$82.94
|
| Rate for Payer: BCN Commercial |
$234.08
|
| Rate for Payer: BCN Medicare Advantage |
$62.35
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$83.55
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.35
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Healthscope Whirlpool |
$74.82
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.47
|
| Rate for Payer: PACE SWMI |
$62.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.89
|
| Rate for Payer: Priority Health Medicare |
$62.35
|
| Rate for Payer: Priority Health Narrow Network |
$105.89
|
| Rate for Payer: UHC Medicare Advantage |
$64.22
|
|
|
PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 64415
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: Aetna Medicare |
$68.48
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$68.48
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$196.93
|
| Rate for Payer: BCN Medicare Advantage |
$68.48
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$98.61
|
| Rate for Payer: Cofinity Commercial |
$91.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.48
|
| Rate for Payer: Healthscope Commercial |
$82.18
|
| Rate for Payer: Healthscope Whirlpool |
$82.18
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.90
|
| Rate for Payer: PACE SWMI |
$68.48
|
| Rate for Payer: PHP Medicare Advantage |
$68.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.08
|
| Rate for Payer: Priority Health Medicare |
$68.48
|
| Rate for Payer: Priority Health Narrow Network |
$116.08
|
| Rate for Payer: UHC Medicare Advantage |
$70.53
|
|
|
PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 64447
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$2,134.86 |
| Rate for Payer: Aetna Commercial |
$83.19
|
| Rate for Payer: Aetna Medicare |
$62.08
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$62.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,134.86
|
| Rate for Payer: BCN Commercial |
$170.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.08
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$83.19
|
| Rate for Payer: Cofinity Commercial |
$89.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.08
|
| Rate for Payer: Healthscope Commercial |
$74.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.50
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.18
|
| Rate for Payer: PACE SWMI |
$62.08
|
| Rate for Payer: PHP Medicare Advantage |
$62.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.32
|
| Rate for Payer: Priority Health Medicare |
$62.08
|
| Rate for Payer: Priority Health Narrow Network |
$105.32
|
| Rate for Payer: UHC Medicare Advantage |
$63.94
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$107.31
|
| Rate for Payer: Aetna Medicare |
$80.08
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$80.08
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: BCN Medicare Advantage |
$80.08
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$115.32
|
| Rate for Payer: Cofinity Commercial |
$107.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.08
|
| Rate for Payer: Healthscope Commercial |
$96.10
|
| Rate for Payer: Healthscope Whirlpool |
$96.10
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.08
|
| Rate for Payer: PACE SWMI |
$80.08
|
| Rate for Payer: PHP Medicare Advantage |
$80.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.03
|
| Rate for Payer: Priority Health Medicare |
$80.08
|
| Rate for Payer: Priority Health Narrow Network |
$137.03
|
| Rate for Payer: UHC Medicare Advantage |
$82.48
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: BCBS Trust/PPO |
$316.32
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
|
