|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$955.37 |
| Rate for Payer: Aetna Commercial |
$453.05
|
| Rate for Payer: Aetna Medicare |
$609.00
|
| Rate for Payer: BCBS Complete |
$278.89
|
| Rate for Payer: BCBS Trust/PPO |
$25.40
|
| Rate for Payer: BCN Commercial |
$955.37
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Meridian Medicaid |
$278.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.89
|
| Rate for Payer: Priority Health Narrow Network |
$559.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.29
|
| Rate for Payer: UHC Exchange |
$461.29
|
| Rate for Payer: UHCCP Medicaid |
$265.61
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$360.18 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$627.05
|
| Rate for Payer: Aetna Medicare |
$533.50
|
| Rate for Payer: BCBS Complete |
$378.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$820.97
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Meridian Medicaid |
$378.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.35
|
| Rate for Payer: Priority Health Narrow Network |
$760.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$643.48
|
| Rate for Payer: UHC Exchange |
$643.48
|
| Rate for Payer: UHCCP Medicaid |
$360.18
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$924.95 |
| Max. Negotiated Rate |
$1,423.00 |
| Rate for Payer: Aetna Commercial |
$1,280.70
|
| Rate for Payer: ASR ASR |
$1,380.31
|
| Rate for Payer: ASR Commercial |
$1,380.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.60
|
| Rate for Payer: BCN Commercial |
$1,103.25
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,337.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,423.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.31
|
| Rate for Payer: Mclaren Commercial |
$1,280.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: Nomi Health Commercial |
$1,166.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,252.24
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$855.76
|
| Rate for Payer: Aetna Medicare |
$711.50
|
| Rate for Payer: BCBS Complete |
$514.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Meridian Medicaid |
$514.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$857.90
|
| Rate for Payer: UHC Exchange |
$857.90
|
| Rate for Payer: UHCCP Medicaid |
$490.33
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$855.76
|
| Rate for Payer: Aetna Medicare |
$711.50
|
| Rate for Payer: BCBS Complete |
$514.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Meridian Medicaid |
$514.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$857.90
|
| Rate for Payer: UHC Exchange |
$857.90
|
| Rate for Payer: UHCCP Medicaid |
$490.33
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$1,423.00 |
| Rate for Payer: Aetna Commercial |
$1,280.70
|
| Rate for Payer: Aetna Medicare |
$711.50
|
| Rate for Payer: ASR ASR |
$1,380.31
|
| Rate for Payer: ASR Commercial |
$1,380.31
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.29
|
| Rate for Payer: BCN Commercial |
$1,103.25
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,337.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,423.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.31
|
| Rate for Payer: Mclaren Commercial |
$1,280.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: Nomi Health Commercial |
$1,166.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,246.83
|
| Rate for Payer: Priority Health Narrow Network |
$997.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,252.24
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$2,187.45 |
| Rate for Payer: Aetna Commercial |
$771.49
|
| Rate for Payer: Aetna Medicare |
$650.50
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,187.45
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$937.35
|
| Rate for Payer: Priority Health Narrow Network |
$937.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.65
|
| Rate for Payer: UHC Exchange |
$783.65
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$664.60 |
| Rate for Payer: Aetna Commercial |
$296.95
|
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: BCBS Complete |
$186.30
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Meridian Medicaid |
$186.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.95
|
| Rate for Payer: Priority Health Narrow Network |
$372.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.17
|
| Rate for Payer: UHC Exchange |
$297.17
|
| Rate for Payer: UHCCP Medicaid |
$177.43
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$729.59 |
| Rate for Payer: Aetna Commercial |
$324.99
|
| Rate for Payer: Aetna Medicare |
$444.50
|
| Rate for Payer: BCBS Complete |
$200.61
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$729.59
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Meridian Medicaid |
$200.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.94
|
| Rate for Payer: Priority Health Narrow Network |
$400.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.30
|
| Rate for Payer: UHC Exchange |
$323.30
|
| Rate for Payer: UHCCP Medicaid |
$191.06
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$652.85 |
| Max. Negotiated Rate |
$4,478.93 |
| Rate for Payer: Aetna Commercial |
$1,352.98
|
| Rate for Payer: Aetna Medicare |
$875.50
|
| Rate for Payer: BCBS Complete |
$685.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,478.93
|
| Rate for Payer: BCN Commercial |
$1,477.76
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Meridian Medicaid |
$685.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,547.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,547.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,078.92
|
| Rate for Payer: UHC Exchange |
$1,078.92
|
| Rate for Payer: UHCCP Medicaid |
$652.85
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$875.65
|
| Rate for Payer: Aetna Medicare |
$670.00
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$970.03
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.42
|
| Rate for Payer: UHC Exchange |
$698.42
|
| Rate for Payer: UHCCP Medicaid |
$431.54
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$795.34 |
| Max. Negotiated Rate |
$1,884.82 |
| Rate for Payer: Aetna Commercial |
$1,589.91
|
| Rate for Payer: Aetna Medicare |
$1,090.50
|
| Rate for Payer: BCBS Complete |
$835.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: BCN Commercial |
$1,796.87
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Meridian Medicaid |
$835.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$795.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,884.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,884.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.87
|
| Rate for Payer: UHC Exchange |
$1,390.87
|
| Rate for Payer: UHCCP Medicaid |
$795.34
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 25023
|
| Min. Negotiated Rate |
$841.35 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,702.85
|
| Rate for Payer: Aetna Medicare |
$984.50
|
| Rate for Payer: BCBS Complete |
$883.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$1,928.32
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Meridian Medicaid |
$883.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$841.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,013.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,013.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,254.38
|
| Rate for Payer: UHC Exchange |
$1,254.38
|
| Rate for Payer: UHCCP Medicaid |
$841.35
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB
|
Professional
|
Both
|
$1,823.00
|
|
|
Service Code
|
HCPCS 25024
|
| Min. Negotiated Rate |
$218.72 |
| Max. Negotiated Rate |
$1,205.49 |
| Rate for Payer: Aetna Commercial |
$1,042.37
|
| Rate for Payer: Aetna Medicare |
$911.50
|
| Rate for Payer: BCBS Complete |
$532.51
|
| Rate for Payer: BCBS Trust/PPO |
$218.72
|
| Rate for Payer: BCN Commercial |
$1,139.60
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Meridian Medicaid |
$532.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$507.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,184.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,205.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,205.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$886.75
|
| Rate for Payer: UHC Exchange |
$886.75
|
| Rate for Payer: UHCCP Medicaid |
$507.15
|
|
|
PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 25020
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,140.35 |
| Rate for Payer: Aetna Commercial |
$936.55
|
| Rate for Payer: Aetna Medicare |
$709.00
|
| Rate for Payer: BCBS Complete |
$496.95
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: BCN Commercial |
$1,100.99
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Meridian Medicaid |
$496.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,140.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$638.39
|
| Rate for Payer: UHC Exchange |
$638.39
|
| Rate for Payer: UHCCP Medicaid |
$473.29
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
HCPCS 27600
|
| Min. Negotiated Rate |
$259.65 |
| Max. Negotiated Rate |
$863.24 |
| Rate for Payer: Aetna Commercial |
$540.38
|
| Rate for Payer: Aetna Medicare |
$620.50
|
| Rate for Payer: BCBS Complete |
$272.63
|
| Rate for Payer: BCBS Trust/PPO |
$863.24
|
| Rate for Payer: BCN Commercial |
$588.36
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Meridian Medicaid |
$272.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.69
|
| Rate for Payer: Priority Health Narrow Network |
$613.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$492.29
|
| Rate for Payer: UHC Exchange |
$492.29
|
| Rate for Payer: UHCCP Medicaid |
$259.65
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 27602
|
| Min. Negotiated Rate |
$305.23 |
| Max. Negotiated Rate |
$1,903.46 |
| Rate for Payer: Aetna Commercial |
$647.06
|
| Rate for Payer: Aetna Medicare |
$884.50
|
| Rate for Payer: BCBS Complete |
$320.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,903.46
|
| Rate for Payer: BCN Commercial |
$695.39
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Meridian Medicaid |
$320.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.66
|
| Rate for Payer: Priority Health Narrow Network |
$726.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$609.54
|
| Rate for Payer: UHC Exchange |
$609.54
|
| Rate for Payer: UHCCP Medicaid |
$305.23
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 27894
|
| Min. Negotiated Rate |
$530.16 |
| Max. Negotiated Rate |
$2,785.73 |
| Rate for Payer: Aetna Commercial |
$1,109.32
|
| Rate for Payer: Aetna Medicare |
$1,120.50
|
| Rate for Payer: BCBS Complete |
$556.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.73
|
| Rate for Payer: BCN Commercial |
$1,189.44
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Meridian Medicaid |
$556.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$530.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,247.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,247.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,001.03
|
| Rate for Payer: UHC Exchange |
$1,001.03
|
| Rate for Payer: UHCCP Medicaid |
$530.16
|
|
|
PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 27892
|
| Min. Negotiated Rate |
$351.66 |
| Max. Negotiated Rate |
$2,576.52 |
| Rate for Payer: Aetna Commercial |
$716.58
|
| Rate for Payer: Aetna Medicare |
$822.50
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,576.52
|
| Rate for Payer: BCN Commercial |
$784.82
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.86
|
| Rate for Payer: Priority Health Narrow Network |
$824.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.96
|
| Rate for Payer: UHC Exchange |
$639.96
|
| Rate for Payer: UHCCP Medicaid |
$351.66
|
|
|
PR DCMPRN FASCT LEG POST COMPARTMENT ONLY
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 27601
|
| Min. Negotiated Rate |
$284.99 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$591.31
|
| Rate for Payer: Aetna Medicare |
$694.00
|
| Rate for Payer: BCBS Complete |
$299.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Meridian Medicaid |
$299.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.39
|
| Rate for Payer: Priority Health Narrow Network |
$682.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.60
|
| Rate for Payer: UHC Exchange |
$513.60
|
| Rate for Payer: UHCCP Medicaid |
$284.99
|
|
|
PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 27499
|
| Min. Negotiated Rate |
$459.44 |
| Max. Negotiated Rate |
$2,735.54 |
| Rate for Payer: Aetna Commercial |
$936.47
|
| Rate for Payer: Aetna Medicare |
$578.00
|
| Rate for Payer: BCBS Complete |
$482.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.54
|
| Rate for Payer: BCN Commercial |
$1,036.00
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Meridian Medicaid |
$482.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.12
|
| Rate for Payer: UHC Exchange |
$765.12
|
| Rate for Payer: UHCCP Medicaid |
$459.44
|
|
|
PR DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR
|
Professional
|
Both
|
$3,001.00
|
|
|
Service Code
|
HCPCS 62287
|
| Min. Negotiated Rate |
$386.38 |
| Max. Negotiated Rate |
$1,950.65 |
| Rate for Payer: Aetna Commercial |
$740.20
|
| Rate for Payer: Aetna Medicare |
$1,500.50
|
| Rate for Payer: BCBS Complete |
$405.70
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$820.49
|
| Rate for Payer: Cash Price |
$2,400.80
|
| Rate for Payer: Cash Price |
$2,400.80
|
| Rate for Payer: Meridian Medicaid |
$405.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.73
|
| Rate for Payer: UHC Exchange |
$637.73
|
| Rate for Payer: UHCCP Medicaid |
$386.38
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$245.41
|
| Rate for Payer: Aetna Medicare |
$421.00
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$452.52
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.42
|
| Rate for Payer: Priority Health Narrow Network |
$303.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.12
|
| Rate for Payer: UHC Exchange |
$347.12
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
11044
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Aetna Commercial |
$245.41
|
| Rate for Payer: Aetna Medicare |
$421.00
|
| Rate for Payer: BCBS Complete |
$150.52
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$452.52
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Meridian Medicaid |
$150.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.42
|
| Rate for Payer: Priority Health Narrow Network |
$303.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.12
|
| Rate for Payer: UHC Exchange |
$347.12
|
| Rate for Payer: UHCCP Medicaid |
$143.35
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
11044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$547.30 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna Commercial |
$757.80
|
| Rate for Payer: ASR ASR |
$816.74
|
| Rate for Payer: ASR Commercial |
$816.74
|
| Rate for Payer: BCBS Trust/PPO |
$686.15
|
| Rate for Payer: BCN Commercial |
$652.80
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$791.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.60
|
| Rate for Payer: Healthscope Commercial |
$842.00
|
| Rate for Payer: Healthscope Whirlpool |
$816.74
|
| Rate for Payer: Mclaren Commercial |
$757.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.70
|
| Rate for Payer: Nomi Health Commercial |
$690.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.96
|
|
