|
PR CORF RELATED SERV 15 MINS EA
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0409
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$1,772.97 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,772.97
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.99
|
| Rate for Payer: UHC Exchange |
$8.99
|
|
|
PR CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT
|
Professional
|
Both
|
$4,046.00
|
|
|
Service Code
|
HCPCS 33510
|
| Min. Negotiated Rate |
$1,216.02 |
| Max. Negotiated Rate |
$3,025.01 |
| Rate for Payer: Aetna Commercial |
$2,596.25
|
| Rate for Payer: Aetna Medicare |
$2,023.00
|
| Rate for Payer: BCBS Complete |
$1,276.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,333.43
|
| Rate for Payer: BCN Commercial |
$2,770.80
|
| Rate for Payer: Cash Price |
$3,236.80
|
| Rate for Payer: Cash Price |
$3,236.80
|
| Rate for Payer: Meridian Medicaid |
$1,276.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,216.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,025.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,025.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,572.99
|
| Rate for Payer: UHC Exchange |
$2,572.99
|
| Rate for Payer: UHCCP Medicaid |
$1,216.02
|
|
|
PR CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$4,444.00
|
|
|
Service Code
|
HCPCS 33511
|
| Min. Negotiated Rate |
$1,241.51 |
| Max. Negotiated Rate |
$3,321.78 |
| Rate for Payer: Aetna Commercial |
$2,850.71
|
| Rate for Payer: Aetna Medicare |
$2,222.00
|
| Rate for Payer: BCBS Complete |
$1,402.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.51
|
| Rate for Payer: BCN Commercial |
$3,041.04
|
| Rate for Payer: Cash Price |
$3,555.20
|
| Rate for Payer: Cash Price |
$3,555.20
|
| Rate for Payer: Meridian Medicaid |
$1,402.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,335.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,888.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,321.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,321.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,819.30
|
| Rate for Payer: UHC Exchange |
$2,819.30
|
| Rate for Payer: UHCCP Medicaid |
$1,335.72
|
|
|
PR CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$9,917.00
|
|
|
Service Code
|
HCPCS 33512
|
| Min. Negotiated Rate |
$1,337.66 |
| Max. Negotiated Rate |
$6,446.05 |
| Rate for Payer: Aetna Commercial |
$3,251.77
|
| Rate for Payer: Aetna Medicare |
$4,958.50
|
| Rate for Payer: BCBS Complete |
$1,595.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,337.66
|
| Rate for Payer: BCN Commercial |
$3,467.66
|
| Rate for Payer: Cash Price |
$7,933.60
|
| Rate for Payer: Cash Price |
$7,933.60
|
| Rate for Payer: Meridian Medicaid |
$1,595.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,519.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,446.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,783.94
|
| Rate for Payer: Priority Health Narrow Network |
$3,783.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,196.31
|
| Rate for Payer: UHC Exchange |
$3,196.31
|
| Rate for Payer: UHCCP Medicaid |
$1,519.76
|
|
|
PR CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS
|
Professional
|
Both
|
$10,120.00
|
|
|
Service Code
|
HCPCS 33513
|
| Min. Negotiated Rate |
$1,257.88 |
| Max. Negotiated Rate |
$6,578.00 |
| Rate for Payer: Aetna Commercial |
$3,340.84
|
| Rate for Payer: Aetna Medicare |
$5,060.00
|
| Rate for Payer: BCBS Complete |
$1,630.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,257.88
|
| Rate for Payer: BCN Commercial |
$3,547.31
|
| Rate for Payer: Cash Price |
$8,096.00
|
| Rate for Payer: Cash Price |
$8,096.00
|
| Rate for Payer: Meridian Medicaid |
$1,630.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,552.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,578.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,863.71
|
| Rate for Payer: Priority Health Narrow Network |
$3,863.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,272.53
|
| Rate for Payer: UHC Exchange |
$3,272.53
|
| Rate for Payer: UHCCP Medicaid |
$1,552.77
|
|
|
PR CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT
|
Professional
|
Both
|
$11,382.00
|
|
|
Service Code
|
HCPCS 33516
|
| Min. Negotiated Rate |
$1,382.03 |
| Max. Negotiated Rate |
$7,398.30 |
| Rate for Payer: Aetna Commercial |
$3,631.83
|
| Rate for Payer: Aetna Medicare |
$5,691.00
|
| Rate for Payer: BCBS Complete |
$1,775.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,382.03
|
| Rate for Payer: BCN Commercial |
$3,858.60
|
| Rate for Payer: Cash Price |
$9,105.60
|
| Rate for Payer: Cash Price |
$9,105.60
|
| Rate for Payer: Meridian Medicaid |
$1,775.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,691.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,398.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,204.08
|
| Rate for Payer: Priority Health Narrow Network |
$4,204.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,611.64
|
| Rate for Payer: UHC Exchange |
$3,611.64
|
| Rate for Payer: UHCCP Medicaid |
$1,691.01
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 33517
|
| Min. Negotiated Rate |
$116.72 |
| Max. Negotiated Rate |
$1,181.81 |
| Rate for Payer: Aetna Commercial |
$252.04
|
| Rate for Payer: Aetna Medicare |
$402.00
|
| Rate for Payer: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.81
|
| Rate for Payer: BCN Commercial |
$266.33
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Meridian Medicaid |
$122.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.45
|
| Rate for Payer: Priority Health Narrow Network |
$291.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.94
|
| Rate for Payer: UHC Exchange |
$247.94
|
| Rate for Payer: UHCCP Medicaid |
$116.72
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 2 VEIN
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 33518
|
| Min. Negotiated Rate |
$256.88 |
| Max. Negotiated Rate |
$1,337.66 |
| Rate for Payer: Aetna Commercial |
$554.43
|
| Rate for Payer: Aetna Medicare |
$662.50
|
| Rate for Payer: BCBS Complete |
$269.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,337.66
|
| Rate for Payer: BCN Commercial |
$586.90
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Meridian Medicaid |
$269.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.19
|
| Rate for Payer: Priority Health Narrow Network |
$638.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
| Rate for Payer: UHC Exchange |
$543.58
|
| Rate for Payer: UHCCP Medicaid |
$256.88
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 3 VEIN
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 33519
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$1,254.50 |
| Rate for Payer: Aetna Commercial |
$733.06
|
| Rate for Payer: Aetna Medicare |
$965.00
|
| Rate for Payer: BCBS Complete |
$355.82
|
| Rate for Payer: BCBS Trust/PPO |
$987.39
|
| Rate for Payer: BCN Commercial |
$775.53
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Meridian Medicaid |
$355.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$844.54
|
| Rate for Payer: Priority Health Narrow Network |
$844.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$721.28
|
| Rate for Payer: UHC Exchange |
$721.28
|
| Rate for Payer: UHCCP Medicaid |
$338.88
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 4 VEIN
|
Professional
|
Both
|
$2,591.00
|
|
|
Service Code
|
HCPCS 33521
|
| Min. Negotiated Rate |
$158.49 |
| Max. Negotiated Rate |
$1,684.15 |
| Rate for Payer: Aetna Commercial |
$879.90
|
| Rate for Payer: Aetna Medicare |
$1,295.50
|
| Rate for Payer: BCBS Complete |
$427.17
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Commercial |
$929.47
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Cash Price |
$2,072.80
|
| Rate for Payer: Meridian Medicaid |
$427.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$406.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,684.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$869.01
|
| Rate for Payer: UHC Exchange |
$869.01
|
| Rate for Payer: UHCCP Medicaid |
$406.83
|
|
|
PR CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 5 VEIN
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 33522
|
| Min. Negotiated Rate |
$456.89 |
| Max. Negotiated Rate |
$2,139.80 |
| Rate for Payer: Aetna Commercial |
$988.00
|
| Rate for Payer: Aetna Medicare |
$1,646.00
|
| Rate for Payer: BCBS Complete |
$479.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,230.94
|
| Rate for Payer: BCN Commercial |
$1,044.31
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Meridian Medicaid |
$479.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$979.26
|
| Rate for Payer: UHC Exchange |
$979.26
|
| Rate for Payer: UHCCP Medicaid |
$456.89
|
|
|
PR CORONARY ENDARTERCOMY OPEN ANY METHOD
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
HCPCS 33572
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$863.77 |
| Rate for Payer: Aetna Commercial |
$310.69
|
| Rate for Payer: Aetna Medicare |
$647.50
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS Trust/PPO |
$863.77
|
| Rate for Payer: BCN Commercial |
$329.36
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,036.00
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.98
|
| Rate for Payer: Priority Health Narrow Network |
$358.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.81
|
| Rate for Payer: UHC Exchange |
$308.81
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
|
|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$410.66 |
| Max. Negotiated Rate |
$3,265.16 |
| Rate for Payer: Aetna Commercial |
$819.70
|
| Rate for Payer: Aetna Medicare |
$937.00
|
| Rate for Payer: BCBS Complete |
$431.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.16
|
| Rate for Payer: BCN Commercial |
$922.62
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Meridian Medicaid |
$431.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,019.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$773.27
|
| Rate for Payer: UHC Exchange |
$773.27
|
| Rate for Payer: UHCCP Medicaid |
$410.66
|
|
|
PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 54435
|
| Min. Negotiated Rate |
$267.53 |
| Max. Negotiated Rate |
$1,738.11 |
| Rate for Payer: Aetna Commercial |
$529.89
|
| Rate for Payer: Aetna Medicare |
$376.50
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.11
|
| Rate for Payer: BCN Commercial |
$600.09
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Meridian Medicaid |
$280.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$664.16
|
| Rate for Payer: Priority Health Narrow Network |
$664.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$500.09
|
| Rate for Payer: UHC Exchange |
$500.09
|
| Rate for Payer: UHCCP Medicaid |
$267.53
|
|
|
PR CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 54420
|
| Min. Negotiated Rate |
$450.50 |
| Max. Negotiated Rate |
$2,612.13 |
| Rate for Payer: Aetna Commercial |
$903.25
|
| Rate for Payer: Aetna Medicare |
$674.00
|
| Rate for Payer: BCBS Complete |
$473.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,612.13
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Meridian Medicaid |
$473.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$450.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,119.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,119.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$853.44
|
| Rate for Payer: UHC Exchange |
$853.44
|
| Rate for Payer: UHCCP Medicaid |
$450.50
|
|
|
PR CORRECT BUNION,SIMPLE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 28290
|
| Min. Negotiated Rate |
$553.60 |
| Max. Negotiated Rate |
$899.60 |
| Rate for Payer: Aetna Medicare |
$692.00
|
| Rate for Payer: BCBS Complete |
$553.60
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.60
|
|
|
PR CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 28286
|
| Min. Negotiated Rate |
$192.13 |
| Max. Negotiated Rate |
$2,002.26 |
| Rate for Payer: Aetna Commercial |
$390.83
|
| Rate for Payer: Aetna Medicare |
$469.00
|
| Rate for Payer: BCBS Complete |
$201.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,002.26
|
| Rate for Payer: BCN Commercial |
$639.19
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Meridian Medicaid |
$201.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.99
|
| Rate for Payer: Priority Health Narrow Network |
$458.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.09
|
| Rate for Payer: UHC Exchange |
$355.09
|
| Rate for Payer: UHCCP Medicaid |
$192.13
|
|
|
PR CORRECTION HAMMERTOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Aetna Commercial |
$502.98
|
| Rate for Payer: Aetna Medicare |
$478.00
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.65
|
| Rate for Payer: BCN Commercial |
$860.92
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.89
|
| Rate for Payer: Priority Health Narrow Network |
$596.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.28
|
| Rate for Payer: UHC Exchange |
$373.28
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
|
|
PR CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 19355
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,109.79 |
| Rate for Payer: Aetna Commercial |
$666.64
|
| Rate for Payer: Aetna Medicare |
$827.50
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$1,109.79
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.36
|
| Rate for Payer: Priority Health Narrow Network |
$839.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$603.04
|
| Rate for Payer: UHC Exchange |
$603.04
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
|
|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$668.83 |
| Rate for Payer: Aetna Commercial |
$29.30
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS Trust/PPO |
$668.83
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.60
|
| Rate for Payer: Priority Health Narrow Network |
$38.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.03
|
| Rate for Payer: UHC Exchange |
$57.03
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$334.62 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$677.65
|
| Rate for Payer: Aetna Medicare |
$1,120.50
|
| Rate for Payer: BCBS Complete |
$351.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.56
|
| Rate for Payer: BCN Commercial |
$1,288.16
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Meridian Medicaid |
$351.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.25
|
| Rate for Payer: Priority Health Narrow Network |
$790.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$618.07
|
| Rate for Payer: UHC Exchange |
$618.07
|
| Rate for Payer: UHCCP Medicaid |
$334.62
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 28297
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,499.26 |
| Rate for Payer: Aetna Commercial |
$799.03
|
| Rate for Payer: Aetna Medicare |
$989.00
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.37
|
| Rate for Payer: BCN Commercial |
$1,499.26
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.62
|
| Rate for Payer: Priority Health Narrow Network |
$925.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$702.85
|
| Rate for Payer: UHC Exchange |
$702.85
|
| Rate for Payer: UHCCP Medicaid |
$388.30
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,499.26 |
| Rate for Payer: Aetna Commercial |
$799.03
|
| Rate for Payer: Aetna Medicare |
$989.00
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.37
|
| Rate for Payer: BCN Commercial |
$1,499.26
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.62
|
| Rate for Payer: Priority Health Narrow Network |
$925.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$702.85
|
| Rate for Payer: UHC Exchange |
$702.85
|
| Rate for Payer: UHCCP Medicaid |
$388.30
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,285.70 |
| Max. Negotiated Rate |
$19,540.31 |
| Rate for Payer: Aetna Commercial |
$1,780.20
|
| Rate for Payer: Aetna Medicare |
$12,606.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: ASR ASR |
$1,918.66
|
| Rate for Payer: ASR Commercial |
$1,918.66
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.78
|
| Rate for Payer: BCN Commercial |
$1,533.54
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,859.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Healthscope Commercial |
$1,978.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,606.65
|
| Rate for Payer: Mclaren Commercial |
$1,780.20
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.30
|
| Rate for Payer: Nomi Health Commercial |
$1,621.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Commercial |
$13,867.32
|
| Rate for Payer: PHP Medicaid |
$6,757.16
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.12
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,386.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$19,540.31
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP DNSP |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$6,757.16
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,285.70 |
| Max. Negotiated Rate |
$1,978.00 |
| Rate for Payer: Aetna Commercial |
$1,780.20
|
| Rate for Payer: ASR ASR |
$1,918.66
|
| Rate for Payer: ASR Commercial |
$1,918.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.87
|
| Rate for Payer: BCN Commercial |
$1,533.54
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,859.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.40
|
| Rate for Payer: Healthscope Commercial |
$1,978.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.66
|
| Rate for Payer: Mclaren Commercial |
$1,780.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.30
|
| Rate for Payer: Nomi Health Commercial |
$1,621.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.64
|
|
