|
PR CHOLINESTERASE INHIBITOR CHALLENGE TEST
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 95857
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$35.67
|
| Rate for Payer: Aetna Medicare |
$26.62
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$26.62
|
| Rate for Payer: BCN Medicare Advantage |
$26.62
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$38.33
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.62
|
| Rate for Payer: Healthscope Commercial |
$31.94
|
| Rate for Payer: Healthscope Whirlpool |
$31.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$31.94
|
| Rate for Payer: PACE SWMI |
$26.62
|
| Rate for Payer: PHP Medicare Advantage |
$26.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Medicare |
$26.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.62
|
| Rate for Payer: UHC Medicare Advantage |
$26.62
|
| Rate for Payer: UHCCP DNSP |
$26.62
|
|
|
PR CHORIONIC VILLUS SAMPLING
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 59015
|
| Min. Negotiated Rate |
$128.03 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$171.56
|
| Rate for Payer: Aetna Medicare |
$128.03
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$128.03
|
| Rate for Payer: BCN Medicare Advantage |
$128.03
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$184.36
|
| Rate for Payer: Cofinity Commercial |
$171.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.03
|
| Rate for Payer: Healthscope Commercial |
$153.64
|
| Rate for Payer: Healthscope Whirlpool |
$153.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.43
|
| Rate for Payer: Nomi Health Commercial |
$153.64
|
| Rate for Payer: PACE SWMI |
$128.03
|
| Rate for Payer: PHP Medicare Advantage |
$128.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Medicare |
$128.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.03
|
| Rate for Payer: UHC Medicare Advantage |
$128.03
|
| Rate for Payer: UHCCP DNSP |
$128.03
|
|
|
PR CHROMOTUBATION OVIDUCT W/MATERIALS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 58350
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Medicare |
$88.48
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$88.48
|
| Rate for Payer: BCN Medicare Advantage |
$88.48
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$127.41
|
| Rate for Payer: Cofinity Commercial |
$118.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$106.18
|
| Rate for Payer: Healthscope Whirlpool |
$106.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.90
|
| Rate for Payer: Nomi Health Commercial |
$106.18
|
| Rate for Payer: PACE SWMI |
$88.48
|
| Rate for Payer: PHP Medicare Advantage |
$88.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$88.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.48
|
| Rate for Payer: UHC Medicare Advantage |
$88.48
|
| Rate for Payer: UHCCP DNSP |
$88.48
|
|
|
PR CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE
|
Professional
|
Both
|
$3,535.00
|
|
|
Service Code
|
HCPCS 24940
|
| Min. Negotiated Rate |
$1,414.00 |
| Max. Negotiated Rate |
$2,297.75 |
| Rate for Payer: Aetna Medicare |
$1,767.50
|
| Rate for Payer: BCBS Complete |
$1,414.00
|
| Rate for Payer: Cash Price |
$2,828.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,297.75
|
|
|
PR CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 94772
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Medicare |
$323.00
|
| Rate for Payer: BCBS Complete |
$258.40
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
54161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,002.95 |
| Max. Negotiated Rate |
$1,543.00 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: ASR ASR |
$1,496.71
|
| Rate for Payer: ASR Commercial |
$1,496.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,257.39
|
| Rate for Payer: BCN Commercial |
$1,196.29
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cofinity Commercial |
$1,450.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,234.40
|
| Rate for Payer: Healthscope Commercial |
$1,543.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.71
|
| Rate for Payer: Mclaren Commercial |
$1,388.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,311.55
|
| Rate for Payer: Nomi Health Commercial |
$1,265.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,357.84
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$1,543.00
|
|
|
Service Code
|
HCPCS 54161
|
| Min. Negotiated Rate |
$188.87 |
| Max. Negotiated Rate |
$1,002.95 |
| Rate for Payer: Aetna Commercial |
$253.09
|
| Rate for Payer: Aetna Medicare |
$188.87
|
| Rate for Payer: BCBS Complete |
$617.20
|
| Rate for Payer: BCBS MAPPO |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$188.87
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cofinity Commercial |
$271.97
|
| Rate for Payer: Cofinity Commercial |
$253.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.87
|
| Rate for Payer: Healthscope Commercial |
$226.64
|
| Rate for Payer: Healthscope Whirlpool |
$226.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.31
|
| Rate for Payer: Nomi Health Commercial |
$226.64
|
| Rate for Payer: PACE SWMI |
$188.87
|
| Rate for Payer: PHP Medicare Advantage |
$188.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.95
|
| Rate for Payer: Priority Health Medicare |
$188.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.87
|
| Rate for Payer: UHC Medicare Advantage |
$188.87
|
| Rate for Payer: UHCCP DNSP |
$188.87
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
54161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,002.95 |
| Max. Negotiated Rate |
$3,096.70 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: ASR ASR |
$1,496.71
|
| Rate for Payer: ASR Commercial |
$1,496.71
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.56
|
| Rate for Payer: BCN Commercial |
$1,196.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cofinity Commercial |
$1,450.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,234.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$1,543.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,496.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren Commercial |
$1,388.70
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,311.55
|
| Rate for Payer: Nomi Health Commercial |
$1,265.26
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,351.98
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,081.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,357.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$1,543.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
54161
|
| Min. Negotiated Rate |
$188.87 |
| Max. Negotiated Rate |
$1,002.95 |
| Rate for Payer: Aetna Commercial |
$253.09
|
| Rate for Payer: Aetna Medicare |
$188.87
|
| Rate for Payer: BCBS Complete |
$617.20
|
| Rate for Payer: BCBS MAPPO |
$188.87
|
| Rate for Payer: BCN Medicare Advantage |
$188.87
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cash Price |
$1,234.40
|
| Rate for Payer: Cofinity Commercial |
$271.97
|
| Rate for Payer: Cofinity Commercial |
$253.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.87
|
| Rate for Payer: Healthscope Commercial |
$226.64
|
| Rate for Payer: Healthscope Whirlpool |
$226.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.31
|
| Rate for Payer: Nomi Health Commercial |
$226.64
|
| Rate for Payer: PACE SWMI |
$188.87
|
| Rate for Payer: PHP Medicare Advantage |
$188.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.95
|
| Rate for Payer: Priority Health Medicare |
$188.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.87
|
| Rate for Payer: UHC Medicare Advantage |
$188.87
|
| Rate for Payer: UHCCP DNSP |
$188.87
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 54160
|
| Min. Negotiated Rate |
$138.51 |
| Max. Negotiated Rate |
$393.90 |
| Rate for Payer: Aetna Commercial |
$185.60
|
| Rate for Payer: Aetna Medicare |
$138.51
|
| Rate for Payer: BCBS Complete |
$242.40
|
| Rate for Payer: BCBS MAPPO |
$138.51
|
| Rate for Payer: BCN Medicare Advantage |
$138.51
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cofinity Commercial |
$199.45
|
| Rate for Payer: Cofinity Commercial |
$185.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.51
|
| Rate for Payer: Healthscope Commercial |
$166.21
|
| Rate for Payer: Healthscope Whirlpool |
$166.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.44
|
| Rate for Payer: Nomi Health Commercial |
$166.21
|
| Rate for Payer: PACE SWMI |
$138.51
|
| Rate for Payer: PHP Medicare Advantage |
$138.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.90
|
| Rate for Payer: Priority Health Medicare |
$138.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.51
|
| Rate for Payer: UHC Medicare Advantage |
$138.51
|
| Rate for Payer: UHCCP DNSP |
$138.51
|
|
|
PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 54150
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$338.65 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$92.08
|
| Rate for Payer: BCBS Complete |
$208.40
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$110.50
|
| Rate for Payer: Healthscope Whirlpool |
$110.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$92.08
|
| Rate for Payer: UHCCP DNSP |
$92.08
|
|
|
PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 61050
|
| Min. Negotiated Rate |
$76.64 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$102.70
|
| Rate for Payer: Aetna Medicare |
$76.64
|
| Rate for Payer: BCBS Complete |
$191.60
|
| Rate for Payer: BCBS MAPPO |
$76.64
|
| Rate for Payer: BCN Medicare Advantage |
$76.64
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$110.36
|
| Rate for Payer: Cofinity Commercial |
$102.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.64
|
| Rate for Payer: Healthscope Commercial |
$91.97
|
| Rate for Payer: Healthscope Whirlpool |
$91.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.47
|
| Rate for Payer: Nomi Health Commercial |
$91.97
|
| Rate for Payer: PACE SWMI |
$76.64
|
| Rate for Payer: PHP Medicare Advantage |
$76.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Medicare |
$76.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.64
|
| Rate for Payer: UHC Medicare Advantage |
$76.64
|
| Rate for Payer: UHCCP DNSP |
$76.64
|
|
|
PR CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 23120
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$817.47 |
| Rate for Payer: Aetna Commercial |
$760.70
|
| Rate for Payer: Aetna Medicare |
$567.69
|
| Rate for Payer: BCBS Complete |
$436.80
|
| Rate for Payer: BCBS MAPPO |
$567.69
|
| Rate for Payer: BCN Medicare Advantage |
$567.69
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cofinity Commercial |
$817.47
|
| Rate for Payer: Cofinity Commercial |
$760.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.69
|
| Rate for Payer: Healthscope Commercial |
$681.23
|
| Rate for Payer: Healthscope Whirlpool |
$681.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.07
|
| Rate for Payer: Nomi Health Commercial |
$681.23
|
| Rate for Payer: PACE SWMI |
$567.69
|
| Rate for Payer: PHP Medicare Advantage |
$567.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.80
|
| Rate for Payer: Priority Health Medicare |
$567.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.69
|
| Rate for Payer: UHC Medicare Advantage |
$567.69
|
| Rate for Payer: UHCCP DNSP |
$567.69
|
|
|
PR CLAVICULECTOMY TOTAL
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 23125
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$1,039.35 |
| Rate for Payer: Aetna Commercial |
$920.77
|
| Rate for Payer: Aetna Medicare |
$687.14
|
| Rate for Payer: BCBS Complete |
$639.60
|
| Rate for Payer: BCBS MAPPO |
$687.14
|
| Rate for Payer: BCN Medicare Advantage |
$687.14
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cofinity Commercial |
$989.48
|
| Rate for Payer: Cofinity Commercial |
$920.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.14
|
| Rate for Payer: Healthscope Commercial |
$824.57
|
| Rate for Payer: Healthscope Whirlpool |
$824.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$721.50
|
| Rate for Payer: Nomi Health Commercial |
$824.57
|
| Rate for Payer: PACE SWMI |
$687.14
|
| Rate for Payer: PHP Medicare Advantage |
$687.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.35
|
| Rate for Payer: Priority Health Medicare |
$687.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.14
|
| Rate for Payer: UHC Medicare Advantage |
$687.14
|
| Rate for Payer: UHCCP DNSP |
$687.14
|
|
|
PR CLOSED RX PELVIC RING FX/SUBLUX
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 27193
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$630.50 |
| Rate for Payer: Aetna Medicare |
$485.00
|
| Rate for Payer: BCBS Complete |
$388.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
|
|
PR CLOSED RX PELV RING FX/SUBLUX,MANIP
|
Professional
|
Both
|
$1,941.00
|
|
|
Service Code
|
HCPCS 27194
|
| Min. Negotiated Rate |
$776.40 |
| Max. Negotiated Rate |
$1,261.65 |
| Rate for Payer: Aetna Medicare |
$970.50
|
| Rate for Payer: BCBS Complete |
$776.40
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,261.65
|
|
|
PR CLOSED RX RIB FRACTURE
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 21800
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
|
|
PR CLOSED TREATMENT COCCYGEAL FRACTURE
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 27200
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$270.29 |
| Rate for Payer: Aetna Commercial |
$251.52
|
| Rate for Payer: Aetna Medicare |
$187.70
|
| Rate for Payer: BCBS Complete |
$156.00
|
| Rate for Payer: BCBS MAPPO |
$187.70
|
| Rate for Payer: BCN Medicare Advantage |
$187.70
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$251.52
|
| Rate for Payer: Cofinity Commercial |
$270.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.70
|
| Rate for Payer: Healthscope Commercial |
$225.24
|
| Rate for Payer: Healthscope Whirlpool |
$225.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.09
|
| Rate for Payer: Nomi Health Commercial |
$225.24
|
| Rate for Payer: PACE SWMI |
$187.70
|
| Rate for Payer: PHP Medicare Advantage |
$187.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.50
|
| Rate for Payer: Priority Health Medicare |
$187.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.70
|
| Rate for Payer: UHC Medicare Advantage |
$187.70
|
| Rate for Payer: UHCCP DNSP |
$187.70
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 27768
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$628.49 |
| Rate for Payer: Aetna Commercial |
$584.84
|
| Rate for Payer: Aetna Medicare |
$436.45
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$436.45
|
| Rate for Payer: BCN Medicare Advantage |
$436.45
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$628.49
|
| Rate for Payer: Cofinity Commercial |
$584.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.45
|
| Rate for Payer: Healthscope Commercial |
$523.74
|
| Rate for Payer: Healthscope Whirlpool |
$523.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.27
|
| Rate for Payer: Nomi Health Commercial |
$523.74
|
| Rate for Payer: PACE SWMI |
$436.45
|
| Rate for Payer: PHP Medicare Advantage |
$436.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$436.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.45
|
| Rate for Payer: UHC Medicare Advantage |
$436.45
|
| Rate for Payer: UHCCP DNSP |
$436.45
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 27767
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$472.55 |
| Rate for Payer: Aetna Commercial |
$380.72
|
| Rate for Payer: Aetna Medicare |
$284.12
|
| Rate for Payer: BCBS Complete |
$290.80
|
| Rate for Payer: BCBS MAPPO |
$284.12
|
| Rate for Payer: BCN Medicare Advantage |
$284.12
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$409.13
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.12
|
| Rate for Payer: Healthscope Commercial |
$340.94
|
| Rate for Payer: Healthscope Whirlpool |
$340.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.33
|
| Rate for Payer: Nomi Health Commercial |
$340.94
|
| Rate for Payer: PACE SWMI |
$284.12
|
| Rate for Payer: PHP Medicare Advantage |
$284.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.55
|
| Rate for Payer: Priority Health Medicare |
$284.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.12
|
| Rate for Payer: UHC Medicare Advantage |
$284.12
|
| Rate for Payer: UHCCP DNSP |
$284.12
|
|
|
PR CLOSED TREATMENT SESAMOID FRACTURE
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 28530
|
| Min. Negotiated Rate |
$100.07 |
| Max. Negotiated Rate |
$228.80 |
| Rate for Payer: Aetna Commercial |
$134.09
|
| Rate for Payer: Aetna Medicare |
$100.07
|
| Rate for Payer: BCBS Complete |
$140.80
|
| Rate for Payer: BCBS MAPPO |
$100.07
|
| Rate for Payer: BCN Medicare Advantage |
$100.07
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$144.10
|
| Rate for Payer: Cofinity Commercial |
$134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.07
|
| Rate for Payer: Healthscope Commercial |
$120.08
|
| Rate for Payer: Healthscope Whirlpool |
$120.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.07
|
| Rate for Payer: Nomi Health Commercial |
$120.08
|
| Rate for Payer: PACE SWMI |
$100.07
|
| Rate for Payer: PHP Medicare Advantage |
$100.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.80
|
| Rate for Payer: Priority Health Medicare |
$100.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.07
|
| Rate for Payer: UHC Medicare Advantage |
$100.07
|
| Rate for Payer: UHCCP DNSP |
$100.07
|
|
|
PR CLOSED TREATMENT STERNUM FRACTURE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 21820
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$208.92 |
| Rate for Payer: Aetna Commercial |
$194.41
|
| Rate for Payer: Aetna Medicare |
$145.08
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$145.08
|
| Rate for Payer: BCN Medicare Advantage |
$145.08
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$194.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.08
|
| Rate for Payer: Healthscope Commercial |
$174.10
|
| Rate for Payer: Healthscope Whirlpool |
$174.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.33
|
| Rate for Payer: Nomi Health Commercial |
$174.10
|
| Rate for Payer: PACE SWMI |
$145.08
|
| Rate for Payer: PHP Medicare Advantage |
$145.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$145.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.08
|
| Rate for Payer: UHC Medicare Advantage |
$145.08
|
| Rate for Payer: UHCCP DNSP |
$145.08
|
|
|
PR CLOSED TREATMENT ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 25650
|
| Min. Negotiated Rate |
$300.18 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Aetna Commercial |
$402.24
|
| Rate for Payer: Aetna Medicare |
$300.18
|
| Rate for Payer: BCBS Complete |
$333.20
|
| Rate for Payer: BCBS MAPPO |
$300.18
|
| Rate for Payer: BCN Medicare Advantage |
$300.18
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$432.26
|
| Rate for Payer: Cofinity Commercial |
$402.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.18
|
| Rate for Payer: Healthscope Commercial |
$360.22
|
| Rate for Payer: Healthscope Whirlpool |
$360.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.19
|
| Rate for Payer: Nomi Health Commercial |
$360.22
|
| Rate for Payer: PACE SWMI |
$300.18
|
| Rate for Payer: PHP Medicare Advantage |
$300.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health Medicare |
$300.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.18
|
| Rate for Payer: UHC Medicare Advantage |
$300.18
|
| Rate for Payer: UHCCP DNSP |
$300.18
|
|
|
PR CLOSED TREAT SPINE PROCESS FX
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 22305
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Medicare |
$211.50
|
| Rate for Payer: BCBS Complete |
$169.20
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
|
|
PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 27840
|
| Min. Negotiated Rate |
$368.40 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$506.81
|
| Rate for Payer: Aetna Medicare |
$378.22
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$378.22
|
| Rate for Payer: BCN Medicare Advantage |
$378.22
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$544.64
|
| Rate for Payer: Cofinity Commercial |
$506.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.22
|
| Rate for Payer: Healthscope Commercial |
$453.86
|
| Rate for Payer: Healthscope Whirlpool |
$453.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.13
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: PACE SWMI |
$378.22
|
| Rate for Payer: PHP Medicare Advantage |
$378.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$378.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.22
|
| Rate for Payer: UHC Medicare Advantage |
$378.22
|
| Rate for Payer: UHCCP DNSP |
$378.22
|
|
