|
PR CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON
|
Professional
|
Both
|
$2,867.00
|
|
|
Service Code
|
HCPCS 23450
|
| Min. Negotiated Rate |
$146.45 |
| Max. Negotiated Rate |
$1,863.55 |
| Rate for Payer: Aetna Commercial |
$1,266.50
|
| Rate for Payer: Aetna Medicare |
$1,433.50
|
| Rate for Payer: BCBS Complete |
$645.00
|
| Rate for Payer: BCBS Trust/PPO |
$146.45
|
| Rate for Payer: BCN Commercial |
$1,388.33
|
| Rate for Payer: Cash Price |
$2,293.60
|
| Rate for Payer: Cash Price |
$2,293.60
|
| Rate for Payer: Meridian Medicaid |
$645.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,455.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,455.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,093.58
|
| Rate for Payer: UHC Exchange |
$1,093.58
|
| Rate for Payer: UHCCP Medicaid |
$614.29
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 23462
|
| Min. Negotiated Rate |
$313.71 |
| Max. Negotiated Rate |
$2,219.10 |
| Rate for Payer: Aetna Commercial |
$1,427.63
|
| Rate for Payer: Aetna Medicare |
$1,707.00
|
| Rate for Payer: BCBS Complete |
$726.41
|
| Rate for Payer: BCBS Trust/PPO |
$313.71
|
| Rate for Payer: BCN Commercial |
$1,564.75
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Meridian Medicaid |
$726.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,219.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,640.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,640.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,240.33
|
| Rate for Payer: UHC Exchange |
$1,240.33
|
| Rate for Payer: UHCCP Medicaid |
$691.82
|
|
|
PR CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 23460
|
| Min. Negotiated Rate |
$208.43 |
| Max. Negotiated Rate |
$1,815.45 |
| Rate for Payer: Aetna Commercial |
$1,456.90
|
| Rate for Payer: Aetna Medicare |
$1,396.50
|
| Rate for Payer: BCBS Complete |
$742.52
|
| Rate for Payer: BCBS Trust/PPO |
$208.43
|
| Rate for Payer: BCN Commercial |
$1,598.46
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Meridian Medicaid |
$742.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$707.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,676.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,676.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,261.84
|
| Rate for Payer: UHC Exchange |
$1,261.84
|
| Rate for Payer: UHCCP Medicaid |
$707.16
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$3,203.00
|
|
|
Service Code
|
HCPCS 23455
|
| Min. Negotiated Rate |
$188.90 |
| Max. Negotiated Rate |
$2,081.95 |
| Rate for Payer: Aetna Commercial |
$1,328.69
|
| Rate for Payer: Aetna Medicare |
$1,601.50
|
| Rate for Payer: BCBS Complete |
$661.55
|
| Rate for Payer: BCBS Trust/PPO |
$188.90
|
| Rate for Payer: BCN Commercial |
$1,449.42
|
| Rate for Payer: Cash Price |
$2,562.40
|
| Rate for Payer: Cash Price |
$2,562.40
|
| Rate for Payer: Meridian Medicaid |
$661.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,081.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,516.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,516.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,163.48
|
| Rate for Payer: UHC Exchange |
$1,163.48
|
| Rate for Payer: UHCCP Medicaid |
$630.05
|
|
|
PR CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 23465
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$2,275.00 |
| Rate for Payer: Aetna Commercial |
$1,495.78
|
| Rate for Payer: Aetna Medicare |
$1,750.00
|
| Rate for Payer: BCBS Complete |
$761.08
|
| Rate for Payer: BCBS Trust/PPO |
$104.00
|
| Rate for Payer: BCN Commercial |
$1,639.03
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Meridian Medicaid |
$761.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$724.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,718.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,718.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,291.06
|
| Rate for Payer: UHC Exchange |
$1,291.06
|
| Rate for Payer: UHCCP Medicaid |
$724.84
|
|
|
PR CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 23466
|
| Min. Negotiated Rate |
$138.81 |
| Max. Negotiated Rate |
$1,728.61 |
| Rate for Payer: Aetna Commercial |
$1,490.07
|
| Rate for Payer: Aetna Medicare |
$1,004.00
|
| Rate for Payer: BCBS Complete |
$762.87
|
| Rate for Payer: BCBS Trust/PPO |
$138.81
|
| Rate for Payer: BCN Commercial |
$1,644.40
|
| Rate for Payer: Cash Price |
$1,606.40
|
| Rate for Payer: Cash Price |
$1,606.40
|
| Rate for Payer: Meridian Medicaid |
$762.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,728.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,728.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,286.87
|
| Rate for Payer: UHC Exchange |
$1,286.87
|
| Rate for Payer: UHCCP Medicaid |
$726.54
|
|
|
PR CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 28260
|
| Min. Negotiated Rate |
$348.68 |
| Max. Negotiated Rate |
$1,049.19 |
| Rate for Payer: Aetna Commercial |
$691.20
|
| Rate for Payer: Aetna Medicare |
$778.00
|
| Rate for Payer: BCBS Complete |
$366.11
|
| Rate for Payer: BCN Commercial |
$1,049.19
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Meridian Medicaid |
$366.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$833.01
|
| Rate for Payer: Priority Health Narrow Network |
$833.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.96
|
| Rate for Payer: UHC Exchange |
$606.96
|
| Rate for Payer: UHCCP Medicaid |
$348.68
|
|
|
PR CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$2,715.00
|
|
|
Service Code
|
HCPCS 27435
|
| Min. Negotiated Rate |
$527.18 |
| Max. Negotiated Rate |
$1,764.75 |
| Rate for Payer: Aetna Commercial |
$1,080.31
|
| Rate for Payer: Aetna Medicare |
$1,357.50
|
| Rate for Payer: BCBS Complete |
$553.54
|
| Rate for Payer: BCN Commercial |
$1,193.35
|
| Rate for Payer: Cash Price |
$2,172.00
|
| Rate for Payer: Cash Price |
$2,172.00
|
| Rate for Payer: Meridian Medicaid |
$553.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,248.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,248.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.96
|
| Rate for Payer: UHC Exchange |
$915.96
|
| Rate for Payer: UHCCP Medicaid |
$527.18
|
|
|
PR CAPSULOTOMY WRIST
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 25085
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$597.69
|
| Rate for Payer: Aetna Medicare |
$820.00
|
| Rate for Payer: BCBS Complete |
$311.09
|
| Rate for Payer: BCBS Trust/PPO |
$119.92
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Meridian Medicaid |
$311.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$701.21
|
| Rate for Payer: Priority Health Narrow Network |
$701.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.50
|
| Rate for Payer: UHC Exchange |
$519.50
|
| Rate for Payer: UHCCP Medicaid |
$296.28
|
|
|
PR CARDIOPULMONARY EXERCISE TESTING
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 94621
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$256.23 |
| Rate for Payer: Aetna Commercial |
$168.62
|
| Rate for Payer: Aetna Medicare |
$141.50
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS Trust/PPO |
$256.23
|
| Rate for Payer: BCN Commercial |
$222.83
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.01
|
| Rate for Payer: Priority Health Narrow Network |
$90.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.60
|
| Rate for Payer: UHC Exchange |
$163.60
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
|
|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$2,166.03 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$279.50
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.03
|
| Rate for Payer: BCN Commercial |
$475.97
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.73
|
| Rate for Payer: Priority Health Narrow Network |
$254.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.80
|
| Rate for Payer: UHC Exchange |
$223.80
|
| Rate for Payer: UHCCP Medicaid |
$115.66
|
|
|
PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP
|
Professional
|
Both
|
$6,846.00
|
|
|
Service Code
|
HCPCS 33315
|
| Min. Negotiated Rate |
$1,200.89 |
| Max. Negotiated Rate |
$4,449.90 |
| Rate for Payer: Aetna Commercial |
$2,572.47
|
| Rate for Payer: Aetna Medicare |
$3,423.00
|
| Rate for Payer: BCBS Complete |
$1,260.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,311.77
|
| Rate for Payer: BCN Commercial |
$2,745.39
|
| Rate for Payer: Cash Price |
$5,476.80
|
| Rate for Payer: Cash Price |
$5,476.80
|
| Rate for Payer: Meridian Medicaid |
$1,260.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,200.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,449.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,999.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,999.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.30
|
| Rate for Payer: UHC Exchange |
$1,938.30
|
| Rate for Payer: UHCCP Medicaid |
$1,200.89
|
|
|
PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP
|
Professional
|
Both
|
$4,619.00
|
|
|
Service Code
|
HCPCS 33310
|
| Min. Negotiated Rate |
$738.05 |
| Max. Negotiated Rate |
$3,002.35 |
| Rate for Payer: Aetna Commercial |
$1,565.46
|
| Rate for Payer: Aetna Medicare |
$2,309.50
|
| Rate for Payer: BCBS Complete |
$774.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.64
|
| Rate for Payer: BCN Commercial |
$1,678.61
|
| Rate for Payer: Cash Price |
$3,695.20
|
| Rate for Payer: Cash Price |
$3,695.20
|
| Rate for Payer: Meridian Medicaid |
$774.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$738.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,002.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,830.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,830.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,511.03
|
| Rate for Payer: UHC Exchange |
$1,511.03
|
| Rate for Payer: UHCCP Medicaid |
$738.05
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 93660
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$3,564.97 |
| Rate for Payer: Aetna Commercial |
$205.18
|
| Rate for Payer: Aetna Medicare |
$286.50
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,564.97
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.72
|
| Rate for Payer: Priority Health Narrow Network |
$125.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.73
|
| Rate for Payer: UHC Exchange |
$206.73
|
| Rate for Payer: UHCCP Medicaid |
$57.08
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$144.47
|
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$248.59
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.72
|
| Rate for Payer: Priority Health Narrow Network |
$149.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.90
|
| Rate for Payer: UHC Exchange |
$165.90
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.65 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: ASR ASR |
$485.97
|
| Rate for Payer: ASR Commercial |
$485.97
|
| Rate for Payer: BCBS Trust/PPO |
$408.26
|
| Rate for Payer: BCN Commercial |
$388.43
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$470.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.80
|
| Rate for Payer: Healthscope Commercial |
$501.00
|
| Rate for Payer: Healthscope Whirlpool |
$485.97
|
| Rate for Payer: Mclaren Commercial |
$450.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.85
|
| Rate for Payer: Nomi Health Commercial |
$410.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.88
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
92960
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$144.47
|
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: BCN Commercial |
$248.59
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.72
|
| Rate for Payer: Priority Health Narrow Network |
$149.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.90
|
| Rate for Payer: UHC Exchange |
$165.90
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.65 |
| Max. Negotiated Rate |
$993.78 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Medicare |
$641.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.44
|
| Rate for Payer: ASR ASR |
$485.97
|
| Rate for Payer: ASR Commercial |
$485.97
|
| Rate for Payer: BCBS Complete |
$360.84
|
| Rate for Payer: BCBS MAPPO |
$641.15
|
| Rate for Payer: BCBS Trust/PPO |
$410.27
|
| Rate for Payer: BCN Commercial |
$388.43
|
| Rate for Payer: BCN Medicare Advantage |
$641.15
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$470.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.15
|
| Rate for Payer: Healthscope Commercial |
$501.00
|
| Rate for Payer: Healthscope Whirlpool |
$485.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$641.15
|
| Rate for Payer: Mclaren Commercial |
$450.90
|
| Rate for Payer: Mclaren Medicaid |
$343.66
|
| Rate for Payer: Mclaren Medicare |
$641.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.21
|
| Rate for Payer: Meridian Medicaid |
$360.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.85
|
| Rate for Payer: Nomi Health Commercial |
$410.82
|
| Rate for Payer: PACE Medicare |
$609.09
|
| Rate for Payer: PACE SWMI |
$641.15
|
| Rate for Payer: PHP Commercial |
$705.26
|
| Rate for Payer: PHP Medicaid |
$343.66
|
| Rate for Payer: PHP Medicare Advantage |
$641.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.92
|
| Rate for Payer: Priority Health Medicare |
$641.15
|
| Rate for Payer: Priority Health Narrow Network |
$653.54
|
| Rate for Payer: Railroad Medicare Medicare |
$641.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.15
|
| Rate for Payer: UHC Exchange |
$993.78
|
| Rate for Payer: UHC Medicare Advantage |
$641.15
|
| Rate for Payer: UHCCP DNSP |
$641.15
|
| Rate for Payer: UHCCP Medicaid |
$343.66
|
| Rate for Payer: VA VA |
$641.15
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$349.89 |
| Rate for Payer: Aetna Commercial |
$330.21
|
| Rate for Payer: Aetna Medicare |
$251.00
|
| Rate for Payer: BCBS Complete |
$160.14
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$349.89
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Meridian Medicaid |
$160.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.12
|
| Rate for Payer: Priority Health Narrow Network |
$337.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.74
|
| Rate for Payer: UHC Exchange |
$327.74
|
| Rate for Payer: UHCCP Medicaid |
$152.51
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$179.62
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.43
|
| Rate for Payer: Priority Health Narrow Network |
$5.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.84
|
| Rate for Payer: UHC Exchange |
$4.84
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$594.87 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Trust/PPO |
$594.87
|
| Rate for Payer: BCN Commercial |
$58.04
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.79
|
| Rate for Payer: Priority Health Narrow Network |
$58.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.64
|
| Rate for Payer: UHC Exchange |
$36.64
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$654.43
|
| Rate for Payer: Aetna Medicare |
$850.50
|
| Rate for Payer: BCBS Complete |
$341.96
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: BCN Commercial |
$731.55
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Meridian Medicaid |
$341.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.41
|
| Rate for Payer: Priority Health Narrow Network |
$770.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.26
|
| Rate for Payer: UHC Exchange |
$554.26
|
| Rate for Payer: UHCCP Medicaid |
$325.68
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$654.43
|
| Rate for Payer: Aetna Medicare |
$850.50
|
| Rate for Payer: BCBS Complete |
$341.96
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: BCN Commercial |
$731.55
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Meridian Medicaid |
$341.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.41
|
| Rate for Payer: Priority Health Narrow Network |
$770.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.26
|
| Rate for Payer: UHC Exchange |
$554.26
|
| Rate for Payer: UHCCP Medicaid |
$325.68
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,105.65 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,530.90
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$1,649.97
|
| Rate for Payer: ASR Commercial |
$1,649.97
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.95
|
| Rate for Payer: BCN Commercial |
$1,318.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,598.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,701.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,649.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,530.90
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,445.85
|
| Rate for Payer: Nomi Health Commercial |
$1,394.82
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,490.42
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,105.65 |
| Max. Negotiated Rate |
$1,701.00 |
| Rate for Payer: Aetna Commercial |
$1,530.90
|
| Rate for Payer: ASR ASR |
$1,649.97
|
| Rate for Payer: ASR Commercial |
$1,649.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,386.14
|
| Rate for Payer: BCN Commercial |
$1,318.79
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,598.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.80
|
| Rate for Payer: Healthscope Commercial |
$1,701.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,649.97
|
| Rate for Payer: Mclaren Commercial |
$1,530.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,445.85
|
| Rate for Payer: Nomi Health Commercial |
$1,394.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.88
|
|
