|
PR Makena, 10 mg
|
Professional
|
Both
|
$2.50
|
|
|
Service Code
|
HCPCS J1726
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19.41 |
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.80
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
|
|
PR MAMMAPLASTY AUGMENTATION - GEL
|
Professional
|
Both
|
$4,840.00
|
|
|
Service Code
|
HCPCS 00261
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$3,388.00 |
| Rate for Payer: BCBS Complete |
$1,936.00
|
| Rate for Payer: Cash Price |
$3,872.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,388.00
|
|
|
PR MAMMAPLASTY AUGMENTATION - SALINE
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 00262
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,480.00 |
| Max. Negotiated Rate |
$2,590.00 |
| Rate for Payer: BCBS Complete |
$1,480.00
|
| Rate for Payer: Cash Price |
$2,960.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,590.00
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$354.49 |
| Rate for Payer: Aetna Commercial |
$102.66
|
| Rate for Payer: Aetna Medicare |
$76.61
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$76.61
|
| Rate for Payer: BCBS Trust/PPO |
$354.49
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: BCN Medicare Advantage |
$76.61
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$102.66
|
| Rate for Payer: Cofinity Commercial |
$110.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.61
|
| Rate for Payer: Healthscope Commercial |
$91.93
|
| Rate for Payer: Healthscope Whirlpool |
$91.93
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.44
|
| Rate for Payer: PACE SWMI |
$76.61
|
| Rate for Payer: PHP Medicare Advantage |
$76.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.51
|
| Rate for Payer: Priority Health Medicare |
$76.61
|
| Rate for Payer: Priority Health Narrow Network |
$120.51
|
| Rate for Payer: UHC Medicare Advantage |
$78.91
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$1,252.07 |
| Rate for Payer: Aetna Commercial |
$216.14
|
| Rate for Payer: Aetna Medicare |
$161.30
|
| Rate for Payer: BCBS Complete |
$110.71
|
| Rate for Payer: BCBS MAPPO |
$161.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.07
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: BCN Medicare Advantage |
$161.30
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cofinity Commercial |
$232.27
|
| Rate for Payer: Cofinity Commercial |
$216.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.30
|
| Rate for Payer: Healthscope Commercial |
$193.56
|
| Rate for Payer: Healthscope Whirlpool |
$193.56
|
| Rate for Payer: Meridian Medicaid |
$110.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$169.36
|
| Rate for Payer: PACE SWMI |
$161.30
|
| Rate for Payer: PHP Medicare Advantage |
$161.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.74
|
| Rate for Payer: Priority Health Medicare |
$161.30
|
| Rate for Payer: Priority Health Narrow Network |
$251.74
|
| Rate for Payer: UHC Medicare Advantage |
$166.14
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$92.45 |
| Max. Negotiated Rate |
$678.14 |
| Rate for Payer: Aetna Commercial |
$571.23
|
| Rate for Payer: Aetna Medicare |
$426.29
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: BCBS MAPPO |
$426.29
|
| Rate for Payer: BCBS Trust/PPO |
$92.45
|
| Rate for Payer: BCN Commercial |
$648.96
|
| Rate for Payer: BCN Medicare Advantage |
$426.29
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$613.86
|
| Rate for Payer: Cofinity Commercial |
$571.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.29
|
| Rate for Payer: Healthscope Commercial |
$511.55
|
| Rate for Payer: Healthscope Whirlpool |
$511.55
|
| Rate for Payer: Meridian Medicaid |
$303.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$447.60
|
| Rate for Payer: PACE SWMI |
$426.29
|
| Rate for Payer: PHP Medicare Advantage |
$426.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.14
|
| Rate for Payer: Priority Health Medicare |
$426.29
|
| Rate for Payer: Priority Health Narrow Network |
$678.14
|
| Rate for Payer: UHC Medicare Advantage |
$439.08
|
|
|
PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26340
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$552.01 |
| Rate for Payer: Aetna Commercial |
$462.31
|
| Rate for Payer: Aetna Medicare |
$345.01
|
| Rate for Payer: BCBS Complete |
$247.14
|
| Rate for Payer: BCBS MAPPO |
$345.01
|
| Rate for Payer: BCBS Trust/PPO |
$108.30
|
| Rate for Payer: BCN Commercial |
$528.26
|
| Rate for Payer: BCN Medicare Advantage |
$345.01
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$496.81
|
| Rate for Payer: Cofinity Commercial |
$462.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.01
|
| Rate for Payer: Healthscope Commercial |
$414.01
|
| Rate for Payer: Healthscope Whirlpool |
$414.01
|
| Rate for Payer: Meridian Medicaid |
$247.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$362.26
|
| Rate for Payer: PACE SWMI |
$345.01
|
| Rate for Payer: PHP Medicare Advantage |
$345.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.01
|
| Rate for Payer: Priority Health Medicare |
$345.01
|
| Rate for Payer: Priority Health Narrow Network |
$552.01
|
| Rate for Payer: UHC Medicare Advantage |
$355.36
|
|
|
PR MANIPULATION HIP JOINT GENERAL ANESTHESIA
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 27275
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$4,431.91 |
| Rate for Payer: Aetna Commercial |
$241.84
|
| Rate for Payer: Aetna Medicare |
$180.48
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS MAPPO |
$180.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,431.91
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Medicare Advantage |
$180.48
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$259.89
|
| Rate for Payer: Cofinity Commercial |
$241.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$216.58
|
| Rate for Payer: Healthscope Whirlpool |
$216.58
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$189.50
|
| Rate for Payer: PACE SWMI |
$180.48
|
| Rate for Payer: PHP Medicare Advantage |
$180.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$691.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.91
|
| Rate for Payer: Priority Health Medicare |
$180.48
|
| Rate for Payer: Priority Health Narrow Network |
$282.91
|
| Rate for Payer: UHC Medicare Advantage |
$185.89
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: ASR ASR |
$636.32
|
| Rate for Payer: BCBS Trust/PPO |
$508.60
|
| Rate for Payer: BCN Commercial |
$508.60
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$616.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.80
|
| Rate for Payer: Healthscope Commercial |
$656.00
|
| Rate for Payer: Healthscope Whirlpool |
$636.32
|
| Rate for Payer: Mclaren Commercial |
$590.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$557.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.28
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 27570
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$1,799.92 |
| Rate for Payer: Aetna Commercial |
$201.47
|
| Rate for Payer: Aetna Medicare |
$150.35
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS MAPPO |
$150.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$150.35
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$201.47
|
| Rate for Payer: Cofinity Commercial |
$216.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.35
|
| Rate for Payer: Healthscope Commercial |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$180.42
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.87
|
| Rate for Payer: PACE SWMI |
$150.35
|
| Rate for Payer: PHP Medicare Advantage |
$150.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.43
|
| Rate for Payer: Priority Health Medicare |
$150.35
|
| Rate for Payer: Priority Health Narrow Network |
$236.43
|
| Rate for Payer: UHC Medicare Advantage |
$154.86
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$1,799.92 |
| Rate for Payer: Aetna Commercial |
$201.47
|
| Rate for Payer: Aetna Medicare |
$150.35
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS MAPPO |
$150.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$150.35
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$216.50
|
| Rate for Payer: Cofinity Commercial |
$201.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.35
|
| Rate for Payer: Healthscope Commercial |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$180.42
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.87
|
| Rate for Payer: PACE SWMI |
$150.35
|
| Rate for Payer: PHP Medicare Advantage |
$150.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.43
|
| Rate for Payer: Priority Health Medicare |
$150.35
|
| Rate for Payer: Priority Health Narrow Network |
$236.43
|
| Rate for Payer: UHC Medicare Advantage |
$154.86
|
|
|
PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
27570
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$1,785.76 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Medicare |
$1,428.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: ASR ASR |
$636.32
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$508.60
|
| Rate for Payer: BCN Commercial |
$508.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$616.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Healthscope Commercial |
$656.00
|
| Rate for Payer: Healthscope Whirlpool |
$636.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,428.61
|
| Rate for Payer: Mclaren Commercial |
$590.40
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$557.60
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Commercial |
$1,571.47
|
| Rate for Payer: PHP Medicaid |
$781.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.96
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$465.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
PR MANIPULATION SPINE REQUIRING ANESTHESIA
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 22505
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Aetna Commercial |
$171.25
|
| Rate for Payer: Aetna Medicare |
$127.80
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS MAPPO |
$127.80
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$209.31
|
| Rate for Payer: BCN Medicare Advantage |
$127.80
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cofinity Commercial |
$184.03
|
| Rate for Payer: Cofinity Commercial |
$171.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.80
|
| Rate for Payer: Healthscope Commercial |
$153.36
|
| Rate for Payer: Healthscope Whirlpool |
$153.36
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.19
|
| Rate for Payer: PACE SWMI |
$127.80
|
| Rate for Payer: PHP Medicare Advantage |
$127.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.64
|
| Rate for Payer: Priority Health Medicare |
$127.80
|
| Rate for Payer: Priority Health Narrow Network |
$198.64
|
| Rate for Payer: UHC Medicare Advantage |
$131.63
|
|
|
PR MANIPULATION WRIST UNDER ANESTHESIA
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 25259
|
| Min. Negotiated Rate |
$284.57 |
| Max. Negotiated Rate |
$1,324.45 |
| Rate for Payer: Aetna Commercial |
$566.34
|
| Rate for Payer: Aetna Medicare |
$422.64
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$422.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.45
|
| Rate for Payer: BCN Commercial |
$643.10
|
| Rate for Payer: BCN Medicare Advantage |
$422.64
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$566.34
|
| Rate for Payer: Cofinity Commercial |
$608.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.64
|
| Rate for Payer: Healthscope Commercial |
$507.17
|
| Rate for Payer: Healthscope Whirlpool |
$507.17
|
| Rate for Payer: Meridian Medicaid |
$298.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$443.77
|
| Rate for Payer: PACE SWMI |
$422.64
|
| Rate for Payer: PHP Medicare Advantage |
$422.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$672.02
|
| Rate for Payer: Priority Health Medicare |
$422.64
|
| Rate for Payer: Priority Health Narrow Network |
$672.02
|
| Rate for Payer: UHC Medicare Advantage |
$435.32
|
|
|
PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 20700
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,725.86 |
| Rate for Payer: Aetna Commercial |
$111.92
|
| Rate for Payer: Aetna Medicare |
$83.52
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$83.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.86
|
| Rate for Payer: BCN Commercial |
$122.66
|
| Rate for Payer: BCN Medicare Advantage |
$83.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$120.27
|
| Rate for Payer: Cofinity Commercial |
$111.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.52
|
| Rate for Payer: Healthscope Commercial |
$100.22
|
| Rate for Payer: Healthscope Whirlpool |
$100.22
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.70
|
| Rate for Payer: PACE SWMI |
$83.52
|
| Rate for Payer: PHP Medicare Advantage |
$83.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.18
|
| Rate for Payer: Priority Health Medicare |
$83.52
|
| Rate for Payer: Priority Health Narrow Network |
$128.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.03
|
|
|
PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 20702
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna Medicare |
$140.87
|
| Rate for Payer: BCBS Complete |
$94.83
|
| Rate for Payer: BCBS MAPPO |
$140.87
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$206.71
|
| Rate for Payer: BCN Medicare Advantage |
$140.87
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$202.85
|
| Rate for Payer: Cofinity Commercial |
$188.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.87
|
| Rate for Payer: Healthscope Commercial |
$169.04
|
| Rate for Payer: Healthscope Whirlpool |
$169.04
|
| Rate for Payer: Meridian Medicaid |
$94.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.91
|
| Rate for Payer: PACE SWMI |
$140.87
|
| Rate for Payer: PHP Medicare Advantage |
$140.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.00
|
| Rate for Payer: Priority Health Medicare |
$140.87
|
| Rate for Payer: Priority Health Narrow Network |
$216.00
|
| Rate for Payer: UHC Medicare Advantage |
$145.10
|
|
|
PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 97140
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$1,604.98 |
| Rate for Payer: Aetna Commercial |
$35.32
|
| Rate for Payer: Aetna Medicare |
$26.36
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$26.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.98
|
| Rate for Payer: BCN Commercial |
$26.43
|
| Rate for Payer: BCN Medicare Advantage |
$26.36
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$37.96
|
| Rate for Payer: Cofinity Commercial |
$35.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.36
|
| Rate for Payer: Healthscope Commercial |
$31.63
|
| Rate for Payer: Healthscope Whirlpool |
$31.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.68
|
| Rate for Payer: PACE SWMI |
$26.36
|
| Rate for Payer: PHP Medicare Advantage |
$26.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$26.36
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$27.15
|
|
|
PR MARSUPIALIZATION BARTHOLINS GLAND CYST
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 56440
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$539.00 |
| Rate for Payer: Aetna Commercial |
$239.82
|
| Rate for Payer: Aetna Medicare |
$178.97
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$178.97
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: BCN Commercial |
$265.35
|
| Rate for Payer: BCN Medicare Advantage |
$178.97
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$239.82
|
| Rate for Payer: Cofinity Commercial |
$257.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.97
|
| Rate for Payer: Healthscope Commercial |
$214.76
|
| Rate for Payer: Healthscope Whirlpool |
$214.76
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.92
|
| Rate for Payer: PACE SWMI |
$178.97
|
| Rate for Payer: PHP Medicare Advantage |
$178.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.07
|
| Rate for Payer: Priority Health Medicare |
$178.97
|
| Rate for Payer: Priority Health Narrow Network |
$257.07
|
| Rate for Payer: UHC Medicare Advantage |
$184.34
|
|
|
PR MARSUPIALIZATION CST/ABSC LVR
|
Professional
|
Both
|
$2,296.00
|
|
|
Service Code
|
HCPCS 47300
|
| Min. Negotiated Rate |
$727.40 |
| Max. Negotiated Rate |
$2,350.41 |
| Rate for Payer: Aetna Commercial |
$1,512.43
|
| Rate for Payer: Aetna Medicare |
$1,128.68
|
| Rate for Payer: BCBS Complete |
$763.77
|
| Rate for Payer: BCBS MAPPO |
$1,128.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.41
|
| Rate for Payer: BCN Commercial |
$1,661.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,128.68
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cash Price |
$1,836.80
|
| Rate for Payer: Cofinity Commercial |
$1,625.30
|
| Rate for Payer: Cofinity Commercial |
$1,512.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,128.68
|
| Rate for Payer: Healthscope Commercial |
$1,354.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,354.42
|
| Rate for Payer: Meridian Medicaid |
$763.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,185.11
|
| Rate for Payer: PACE SWMI |
$1,128.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,128.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$727.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,607.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,998.53
|
| Rate for Payer: Priority Health Medicare |
$1,128.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,998.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,162.54
|
|
|
PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 42409
|
| Min. Negotiated Rate |
$150.38 |
| Max. Negotiated Rate |
$641.36 |
| Rate for Payer: Aetna Commercial |
$303.66
|
| Rate for Payer: Aetna Medicare |
$226.61
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: BCBS MAPPO |
$226.61
|
| Rate for Payer: BCBS Trust/PPO |
$641.36
|
| Rate for Payer: BCN Commercial |
$586.41
|
| Rate for Payer: BCN Medicare Advantage |
$226.61
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Cofinity Commercial |
$303.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.61
|
| Rate for Payer: Healthscope Commercial |
$271.93
|
| Rate for Payer: Healthscope Whirlpool |
$271.93
|
| Rate for Payer: Meridian Medicaid |
$157.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.94
|
| Rate for Payer: PACE SWMI |
$226.61
|
| Rate for Payer: PHP Medicare Advantage |
$226.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.40
|
| Rate for Payer: Priority Health Medicare |
$226.61
|
| Rate for Payer: Priority Health Narrow Network |
$410.40
|
| Rate for Payer: UHC Medicare Advantage |
$233.41
|
|
|
PR MASTECTOMY GYNECOMASTIA
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 19300
|
| Min. Negotiated Rate |
$278.39 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$570.18
|
| Rate for Payer: Aetna Medicare |
$425.51
|
| Rate for Payer: BCBS Complete |
$292.31
|
| Rate for Payer: BCBS MAPPO |
$425.51
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: BCN Medicare Advantage |
$425.51
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cofinity Commercial |
$612.73
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.51
|
| Rate for Payer: Healthscope Commercial |
$510.61
|
| Rate for Payer: Healthscope Whirlpool |
$510.61
|
| Rate for Payer: Meridian Medicaid |
$292.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$446.79
|
| Rate for Payer: PACE SWMI |
$425.51
|
| Rate for Payer: PHP Medicare Advantage |
$425.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.00
|
| Rate for Payer: Priority Health Medicare |
$425.51
|
| Rate for Payer: Priority Health Narrow Network |
$536.00
|
| Rate for Payer: UHC Medicare Advantage |
$438.28
|
|
|
PR MASTECTOMY GYNECOMASTIA
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,440.00
|
| Rate for Payer: ASR ASR |
$1,552.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,240.48
|
| Rate for Payer: BCN Commercial |
$1,240.48
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cofinity Commercial |
$1,504.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,280.00
|
| Rate for Payer: Healthscope Commercial |
$1,600.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,552.00
|
| Rate for Payer: Mclaren Commercial |
$1,440.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,408.00
|
|
|
PR MASTECTOMY GYNECOMASTIA
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
19300
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$4,235.21 |
| Rate for Payer: Aetna Commercial |
$1,440.00
|
| Rate for Payer: Aetna Medicare |
$3,388.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: ASR ASR |
$1,552.00
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,240.48
|
| Rate for Payer: BCN Commercial |
$1,240.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cofinity Commercial |
$1,504.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,280.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$1,600.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,552.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,388.17
|
| Rate for Payer: Mclaren Commercial |
$1,440.00
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,360.00
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$3,726.99
|
| Rate for Payer: PHP Medicaid |
$1,853.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,456.00
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,408.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
PR MASTECTOMY GYNECOMASTIA
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 19300
|
| Hospital Charge Code |
19300
|
| Min. Negotiated Rate |
$278.39 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$570.18
|
| Rate for Payer: Aetna Medicare |
$425.51
|
| Rate for Payer: BCBS Complete |
$292.31
|
| Rate for Payer: BCBS MAPPO |
$425.51
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$858.11
|
| Rate for Payer: BCN Medicare Advantage |
$425.51
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cofinity Commercial |
$612.73
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.51
|
| Rate for Payer: Healthscope Commercial |
$510.61
|
| Rate for Payer: Healthscope Whirlpool |
$510.61
|
| Rate for Payer: Meridian Medicaid |
$292.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$446.79
|
| Rate for Payer: PACE SWMI |
$425.51
|
| Rate for Payer: PHP Medicare Advantage |
$425.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.00
|
| Rate for Payer: Priority Health Medicare |
$425.51
|
| Rate for Payer: Priority Health Narrow Network |
$536.00
|
| Rate for Payer: UHC Medicare Advantage |
$438.28
|
|
|
PR MASTECTOMY PARTIAL
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
19301
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Aetna Commercial |
$878.18
|
| Rate for Payer: Aetna Medicare |
$655.36
|
| Rate for Payer: BCBS Complete |
$445.74
|
| Rate for Payer: BCBS MAPPO |
$655.36
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$967.10
|
| Rate for Payer: BCN Medicare Advantage |
$655.36
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$943.72
|
| Rate for Payer: Cofinity Commercial |
$878.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.36
|
| Rate for Payer: Healthscope Commercial |
$786.43
|
| Rate for Payer: Healthscope Whirlpool |
$786.43
|
| Rate for Payer: Meridian Medicaid |
$445.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$688.13
|
| Rate for Payer: PACE SWMI |
$655.36
|
| Rate for Payer: PHP Medicare Advantage |
$655.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.45
|
| Rate for Payer: Priority Health Medicare |
$655.36
|
| Rate for Payer: Priority Health Narrow Network |
$813.45
|
| Rate for Payer: UHC Medicare Advantage |
$675.02
|
|
