|
PR QUAL NONMD EST PT 5-10M
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS G2061
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Narrow Network |
$13.96
|
|
|
PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 90375
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$409.94 |
| Rate for Payer: Aetna Commercial |
$381.47
|
| Rate for Payer: Aetna Medicare |
$284.68
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$284.68
|
| Rate for Payer: BCBS Trust/PPO |
$298.09
|
| Rate for Payer: BCN Commercial |
$345.60
|
| Rate for Payer: BCN Medicare Advantage |
$284.68
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$409.94
|
| Rate for Payer: Cofinity Commercial |
$381.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.68
|
| Rate for Payer: Healthscope Commercial |
$341.61
|
| Rate for Payer: Healthscope Whirlpool |
$341.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$298.91
|
| Rate for Payer: PACE SWMI |
$284.68
|
| Rate for Payer: PHP Medicare Advantage |
$284.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health Medicare |
$284.68
|
| Rate for Payer: UHC Medicare Advantage |
$293.22
|
|
|
PR RABIES VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 90675
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$475.18 |
| Rate for Payer: Aetna Commercial |
$442.19
|
| Rate for Payer: Aetna Medicare |
$329.99
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$329.99
|
| Rate for Payer: BCBS Trust/PPO |
$345.74
|
| Rate for Payer: BCN Commercial |
$364.50
|
| Rate for Payer: BCN Medicare Advantage |
$329.99
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$442.19
|
| Rate for Payer: Cofinity Commercial |
$475.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.99
|
| Rate for Payer: Healthscope Commercial |
$395.99
|
| Rate for Payer: Healthscope Whirlpool |
$395.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$346.49
|
| Rate for Payer: PACE SWMI |
$329.99
|
| Rate for Payer: PHP Medicare Advantage |
$329.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health Medicare |
$329.99
|
| Rate for Payer: UHC Medicare Advantage |
$339.89
|
|
|
PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY
|
Professional
|
Both
|
$5,910.00
|
|
|
Service Code
|
HCPCS 58210
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$4,137.00 |
| Rate for Payer: Aetna Commercial |
$2,414.01
|
| Rate for Payer: Aetna Medicare |
$1,801.50
|
| Rate for Payer: BCBS Complete |
$1,226.27
|
| Rate for Payer: BCBS MAPPO |
$1,801.50
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: BCN Commercial |
$2,658.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,801.50
|
| Rate for Payer: Cash Price |
$4,728.00
|
| Rate for Payer: Cash Price |
$4,728.00
|
| Rate for Payer: Cofinity Commercial |
$2,414.01
|
| Rate for Payer: Cofinity Commercial |
$2,594.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,801.50
|
| Rate for Payer: Healthscope Commercial |
$2,161.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,161.80
|
| Rate for Payer: Meridian Medicaid |
$1,226.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,891.58
|
| Rate for Payer: PACE SWMI |
$1,801.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,801.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,167.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,137.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,575.90
|
| Rate for Payer: Priority Health Medicare |
$1,801.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,575.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,855.54
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
HCPCS 25115
|
| Min. Negotiated Rate |
$306.41 |
| Max. Negotiated Rate |
$1,866.20 |
| Rate for Payer: Aetna Commercial |
$999.55
|
| Rate for Payer: Aetna Medicare |
$745.93
|
| Rate for Payer: BCBS Complete |
$515.74
|
| Rate for Payer: BCBS MAPPO |
$745.93
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$1,116.14
|
| Rate for Payer: BCN Medicare Advantage |
$745.93
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cofinity Commercial |
$999.55
|
| Rate for Payer: Cofinity Commercial |
$1,074.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.93
|
| Rate for Payer: Healthscope Commercial |
$895.12
|
| Rate for Payer: Healthscope Whirlpool |
$895.12
|
| Rate for Payer: Meridian Medicaid |
$515.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$783.23
|
| Rate for Payer: PACE SWMI |
$745.93
|
| Rate for Payer: PHP Medicare Advantage |
$745.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,166.32
|
| Rate for Payer: Priority Health Medicare |
$745.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,166.32
|
| Rate for Payer: UHC Medicare Advantage |
$768.31
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,284.00
|
|
|
Service Code
|
HCPCS 25116
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$1,598.80 |
| Rate for Payer: Aetna Commercial |
$797.09
|
| Rate for Payer: Aetna Medicare |
$594.84
|
| Rate for Payer: BCBS Complete |
$413.97
|
| Rate for Payer: BCBS MAPPO |
$594.84
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$893.30
|
| Rate for Payer: BCN Medicare Advantage |
$594.84
|
| Rate for Payer: Cash Price |
$1,827.20
|
| Rate for Payer: Cash Price |
$1,827.20
|
| Rate for Payer: Cofinity Commercial |
$856.57
|
| Rate for Payer: Cofinity Commercial |
$797.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.84
|
| Rate for Payer: Healthscope Commercial |
$713.81
|
| Rate for Payer: Healthscope Whirlpool |
$713.81
|
| Rate for Payer: Meridian Medicaid |
$413.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$624.58
|
| Rate for Payer: PACE SWMI |
$594.84
|
| Rate for Payer: PHP Medicare Advantage |
$594.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$933.47
|
| Rate for Payer: Priority Health Medicare |
$594.84
|
| Rate for Payer: Priority Health Narrow Network |
$933.47
|
| Rate for Payer: UHC Medicare Advantage |
$612.69
|
|
|
PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 69150
|
| Min. Negotiated Rate |
$645.82 |
| Max. Negotiated Rate |
$2,143.84 |
| Rate for Payer: Aetna Commercial |
$1,328.05
|
| Rate for Payer: Aetna Medicare |
$991.08
|
| Rate for Payer: BCBS Complete |
$678.11
|
| Rate for Payer: BCBS MAPPO |
$991.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,143.84
|
| Rate for Payer: BCN Commercial |
$1,486.07
|
| Rate for Payer: BCN Medicare Advantage |
$991.08
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cash Price |
$1,492.00
|
| Rate for Payer: Cofinity Commercial |
$1,328.05
|
| Rate for Payer: Cofinity Commercial |
$1,427.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$991.08
|
| Rate for Payer: Healthscope Commercial |
$1,189.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.30
|
| Rate for Payer: Meridian Medicaid |
$678.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,040.63
|
| Rate for Payer: PACE SWMI |
$991.08
|
| Rate for Payer: PHP Medicare Advantage |
$991.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,433.71
|
| Rate for Payer: Priority Health Medicare |
$991.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,020.81
|
|
|
PR RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP
|
Professional
|
Both
|
$2,980.00
|
|
|
Service Code
|
HCPCS 42844
|
| Min. Negotiated Rate |
$526.72 |
| Max. Negotiated Rate |
$2,428.33 |
| Rate for Payer: Aetna Commercial |
$1,799.06
|
| Rate for Payer: Aetna Medicare |
$1,342.58
|
| Rate for Payer: BCBS Complete |
$923.00
|
| Rate for Payer: BCBS MAPPO |
$1,342.58
|
| Rate for Payer: BCBS Trust/PPO |
$526.72
|
| Rate for Payer: BCN Commercial |
$2,018.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.58
|
| Rate for Payer: Cash Price |
$2,384.00
|
| Rate for Payer: Cash Price |
$2,384.00
|
| Rate for Payer: Cofinity Commercial |
$1,933.32
|
| Rate for Payer: Cofinity Commercial |
$1,799.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.58
|
| Rate for Payer: Healthscope Commercial |
$1,611.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,611.10
|
| Rate for Payer: Meridian Medicaid |
$923.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,409.71
|
| Rate for Payer: PACE SWMI |
$1,342.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$879.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,086.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,428.33
|
| Rate for Payer: Priority Health Medicare |
$1,342.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,428.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,382.86
|
|
|
PR RADICAL RESECTION STERNUM
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
HCPCS 21630
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$2,006.86 |
| Rate for Payer: Aetna Commercial |
$1,729.18
|
| Rate for Payer: Aetna Medicare |
$1,290.43
|
| Rate for Payer: BCBS Complete |
$881.85
|
| Rate for Payer: BCBS MAPPO |
$1,290.43
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$1,920.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,290.43
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,858.22
|
| Rate for Payer: Cofinity Commercial |
$1,729.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,290.43
|
| Rate for Payer: Healthscope Commercial |
$1,548.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,548.52
|
| Rate for Payer: Meridian Medicaid |
$881.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,354.95
|
| Rate for Payer: PACE SWMI |
$1,290.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,290.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$839.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,006.86
|
| Rate for Payer: Priority Health Medicare |
$1,290.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,006.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.14
|
|
|
PR RADICAL RESECTION TONSIL W/O CLOSURE
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 42842
|
| Min. Negotiated Rate |
$646.46 |
| Max. Negotiated Rate |
$1,786.26 |
| Rate for Payer: Aetna Commercial |
$1,319.35
|
| Rate for Payer: Aetna Medicare |
$984.59
|
| Rate for Payer: BCBS Complete |
$678.78
|
| Rate for Payer: BCBS MAPPO |
$984.59
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$1,484.61
|
| Rate for Payer: BCN Medicare Advantage |
$984.59
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,319.35
|
| Rate for Payer: Cofinity Commercial |
$1,417.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.59
|
| Rate for Payer: Healthscope Commercial |
$1,181.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.51
|
| Rate for Payer: Meridian Medicaid |
$678.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,033.82
|
| Rate for Payer: PACE SWMI |
$984.59
|
| Rate for Payer: PHP Medicare Advantage |
$984.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$646.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,786.26
|
| Rate for Payer: Priority Health Medicare |
$984.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,786.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.13
|
|
|
PR RADICAL RESECTION TUMOR CLAVICLE
|
Professional
|
Both
|
$2,578.00
|
|
|
Service Code
|
HCPCS 23200
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$2,296.40 |
| Rate for Payer: Aetna Commercial |
$1,986.31
|
| Rate for Payer: Aetna Medicare |
$1,482.32
|
| Rate for Payer: BCBS Complete |
$1,012.02
|
| Rate for Payer: BCBS MAPPO |
$1,482.32
|
| Rate for Payer: BCBS Trust/PPO |
$42.87
|
| Rate for Payer: BCN Commercial |
$2,197.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,482.32
|
| Rate for Payer: Cash Price |
$2,062.40
|
| Rate for Payer: Cash Price |
$2,062.40
|
| Rate for Payer: Cofinity Commercial |
$1,986.31
|
| Rate for Payer: Cofinity Commercial |
$2,134.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,482.32
|
| Rate for Payer: Healthscope Commercial |
$1,778.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,778.78
|
| Rate for Payer: Meridian Medicaid |
$1,012.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,556.44
|
| Rate for Payer: PACE SWMI |
$1,482.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,482.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$963.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,804.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,296.40
|
| Rate for Payer: Priority Health Medicare |
$1,482.32
|
| Rate for Payer: Priority Health Narrow Network |
$2,296.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,526.79
|
|
|
PR RADICAL RESECTION TUMOR FEMOR OR KNEE
|
Professional
|
Both
|
$5,403.00
|
|
|
Service Code
|
HCPCS 27365
|
| Min. Negotiated Rate |
$1,309.95 |
| Max. Negotiated Rate |
$3,832.29 |
| Rate for Payer: Aetna Commercial |
$2,708.49
|
| Rate for Payer: Aetna Medicare |
$2,021.26
|
| Rate for Payer: BCBS Complete |
$1,375.45
|
| Rate for Payer: BCBS MAPPO |
$2,021.26
|
| Rate for Payer: BCBS Trust/PPO |
$3,832.29
|
| Rate for Payer: BCN Commercial |
$2,988.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,021.26
|
| Rate for Payer: Cash Price |
$4,322.40
|
| Rate for Payer: Cash Price |
$4,322.40
|
| Rate for Payer: Cofinity Commercial |
$2,910.61
|
| Rate for Payer: Cofinity Commercial |
$2,708.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,021.26
|
| Rate for Payer: Healthscope Commercial |
$2,425.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,425.51
|
| Rate for Payer: Meridian Medicaid |
$1,375.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,122.32
|
| Rate for Payer: PACE SWMI |
$2,021.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,021.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,309.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,782.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,122.62
|
| Rate for Payer: Priority Health Medicare |
$2,021.26
|
| Rate for Payer: Priority Health Narrow Network |
$3,122.62
|
| Rate for Payer: UHC Medicare Advantage |
$2,081.90
|
|
|
PR RADICAL RESECTION TUMOR METACARPAL
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 26250
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: Aetna Commercial |
$1,406.09
|
| Rate for Payer: Aetna Medicare |
$1,049.32
|
| Rate for Payer: BCBS Complete |
$720.82
|
| Rate for Payer: BCBS MAPPO |
$1,049.32
|
| Rate for Payer: BCBS Trust/PPO |
$120.98
|
| Rate for Payer: BCN Commercial |
$1,561.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,049.32
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Cofinity Commercial |
$1,511.02
|
| Rate for Payer: Cofinity Commercial |
$1,406.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,049.32
|
| Rate for Payer: Healthscope Commercial |
$1,259.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,259.18
|
| Rate for Payer: Meridian Medicaid |
$720.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.79
|
| Rate for Payer: PACE SWMI |
$1,049.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,049.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$686.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,079.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,631.53
|
| Rate for Payer: Priority Health Medicare |
$1,049.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.80
|
|
|
PR RADICAL RESECTION TUMOR METATARSAL
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 28173
|
| Min. Negotiated Rate |
$463.28 |
| Max. Negotiated Rate |
$1,110.49 |
| Rate for Payer: Aetna Commercial |
$954.12
|
| Rate for Payer: Aetna Medicare |
$712.03
|
| Rate for Payer: BCBS Complete |
$486.44
|
| Rate for Payer: BCBS MAPPO |
$712.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.49
|
| Rate for Payer: BCN Commercial |
$1,049.68
|
| Rate for Payer: BCN Medicare Advantage |
$712.03
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cofinity Commercial |
$1,025.32
|
| Rate for Payer: Cofinity Commercial |
$954.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.03
|
| Rate for Payer: Healthscope Commercial |
$854.44
|
| Rate for Payer: Healthscope Whirlpool |
$854.44
|
| Rate for Payer: Meridian Medicaid |
$486.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.63
|
| Rate for Payer: PACE SWMI |
$712.03
|
| Rate for Payer: PHP Medicare Advantage |
$712.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,096.88
|
| Rate for Payer: Priority Health Medicare |
$712.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.88
|
| Rate for Payer: UHC Medicare Advantage |
$733.39
|
|
|
PR RADICAL RESECTION TUMOR RADIUS OR ULNA
|
Professional
|
Both
|
$2,544.00
|
|
|
Service Code
|
HCPCS 25170
|
| Min. Negotiated Rate |
$542.04 |
| Max. Negotiated Rate |
$2,239.71 |
| Rate for Payer: Aetna Commercial |
$1,937.63
|
| Rate for Payer: Aetna Medicare |
$1,445.99
|
| Rate for Payer: BCBS Complete |
$987.19
|
| Rate for Payer: BCBS MAPPO |
$1,445.99
|
| Rate for Payer: BCBS Trust/PPO |
$542.04
|
| Rate for Payer: BCN Commercial |
$2,143.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,445.99
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cofinity Commercial |
$1,937.63
|
| Rate for Payer: Cofinity Commercial |
$2,082.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,445.99
|
| Rate for Payer: Healthscope Commercial |
$1,735.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,735.19
|
| Rate for Payer: Meridian Medicaid |
$987.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,518.29
|
| Rate for Payer: PACE SWMI |
$1,445.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,445.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$940.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,239.71
|
| Rate for Payer: Priority Health Medicare |
$1,445.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,239.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,489.37
|
|
|
PR RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$2,269.00
|
|
|
Service Code
|
HCPCS 24150
|
| Min. Negotiated Rate |
$145.81 |
| Max. Negotiated Rate |
$2,355.12 |
| Rate for Payer: Aetna Commercial |
$2,037.97
|
| Rate for Payer: Aetna Medicare |
$1,520.87
|
| Rate for Payer: BCBS Complete |
$1,038.41
|
| Rate for Payer: BCBS MAPPO |
$1,520.87
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: BCN Commercial |
$2,253.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,520.87
|
| Rate for Payer: Cash Price |
$1,815.20
|
| Rate for Payer: Cash Price |
$1,815.20
|
| Rate for Payer: Cofinity Commercial |
$2,190.05
|
| Rate for Payer: Cofinity Commercial |
$2,037.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,520.87
|
| Rate for Payer: Healthscope Commercial |
$1,825.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,825.04
|
| Rate for Payer: Meridian Medicaid |
$1,038.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,596.91
|
| Rate for Payer: PACE SWMI |
$1,520.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,520.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,355.12
|
| Rate for Payer: Priority Health Medicare |
$1,520.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,355.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,566.50
|
|
|
PR RADICAL STYLOIDECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 25230
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$573.02
|
| Rate for Payer: Aetna Medicare |
$427.63
|
| Rate for Payer: BCBS Complete |
$297.68
|
| Rate for Payer: BCBS MAPPO |
$427.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: BCN Commercial |
$642.61
|
| Rate for Payer: BCN Medicare Advantage |
$427.63
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cofinity Commercial |
$573.02
|
| Rate for Payer: Cofinity Commercial |
$615.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.63
|
| Rate for Payer: Healthscope Commercial |
$513.16
|
| Rate for Payer: Healthscope Whirlpool |
$513.16
|
| Rate for Payer: Meridian Medicaid |
$297.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$449.01
|
| Rate for Payer: PACE SWMI |
$427.63
|
| Rate for Payer: PHP Medicare Advantage |
$427.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$671.51
|
| Rate for Payer: Priority Health Medicare |
$427.63
|
| Rate for Payer: Priority Health Narrow Network |
$671.51
|
| Rate for Payer: UHC Medicare Advantage |
$440.46
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 64625
|
| Min. Negotiated Rate |
$124.39 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Aetna Commercial |
$253.81
|
| Rate for Payer: Aetna Medicare |
$189.41
|
| Rate for Payer: BCBS Complete |
$130.61
|
| Rate for Payer: BCBS MAPPO |
$189.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,208.22
|
| Rate for Payer: BCN Commercial |
$690.50
|
| Rate for Payer: BCN Medicare Advantage |
$189.41
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$272.75
|
| Rate for Payer: Cofinity Commercial |
$253.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.41
|
| Rate for Payer: Healthscope Commercial |
$227.29
|
| Rate for Payer: Healthscope Whirlpool |
$227.29
|
| Rate for Payer: Meridian Medicaid |
$130.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.88
|
| Rate for Payer: PACE SWMI |
$189.41
|
| Rate for Payer: PHP Medicare Advantage |
$189.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.58
|
| Rate for Payer: Priority Health Medicare |
$189.41
|
| Rate for Payer: Priority Health Narrow Network |
$325.58
|
| Rate for Payer: UHC Medicare Advantage |
$195.09
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$641.20 |
| Max. Negotiated Rate |
$2,145.29 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Aetna Medicare |
$1,716.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: ASR ASR |
$888.52
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$710.17
|
| Rate for Payer: BCN Commercial |
$710.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$861.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$916.00
|
| Rate for Payer: Healthscope Whirlpool |
$888.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,716.23
|
| Rate for Payer: Mclaren Commercial |
$824.40
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.60
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$1,887.85
|
| Rate for Payer: PHP Medicaid |
$938.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.50
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,471.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$124.39 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Aetna Commercial |
$253.81
|
| Rate for Payer: Aetna Medicare |
$189.41
|
| Rate for Payer: BCBS Complete |
$130.61
|
| Rate for Payer: BCBS MAPPO |
$189.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,208.22
|
| Rate for Payer: BCN Commercial |
$690.50
|
| Rate for Payer: BCN Medicare Advantage |
$189.41
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$272.75
|
| Rate for Payer: Cofinity Commercial |
$253.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.41
|
| Rate for Payer: Healthscope Commercial |
$227.29
|
| Rate for Payer: Healthscope Whirlpool |
$227.29
|
| Rate for Payer: Meridian Medicaid |
$130.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.88
|
| Rate for Payer: PACE SWMI |
$189.41
|
| Rate for Payer: PHP Medicare Advantage |
$189.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.58
|
| Rate for Payer: Priority Health Medicare |
$189.41
|
| Rate for Payer: Priority Health Narrow Network |
$325.58
|
| Rate for Payer: UHC Medicare Advantage |
$195.09
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$641.20 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: ASR ASR |
$888.52
|
| Rate for Payer: BCBS Trust/PPO |
$710.17
|
| Rate for Payer: BCN Commercial |
$710.17
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$861.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.80
|
| Rate for Payer: Healthscope Commercial |
$916.00
|
| Rate for Payer: Healthscope Whirlpool |
$888.52
|
| Rate for Payer: Mclaren Commercial |
$824.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$806.08
|
|
|
PR RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS
|
Professional
|
Both
|
$2,616.00
|
|
|
Service Code
|
HCPCS 24149
|
| Min. Negotiated Rate |
$762.11 |
| Max. Negotiated Rate |
$1,831.20 |
| Rate for Payer: Aetna Commercial |
$1,555.67
|
| Rate for Payer: Aetna Medicare |
$1,160.95
|
| Rate for Payer: BCBS Complete |
$800.22
|
| Rate for Payer: BCBS MAPPO |
$1,160.95
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: BCN Commercial |
$1,732.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.95
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Cofinity Commercial |
$1,671.77
|
| Rate for Payer: Cofinity Commercial |
$1,555.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.95
|
| Rate for Payer: Healthscope Commercial |
$1,393.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,393.14
|
| Rate for Payer: Meridian Medicaid |
$800.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,219.00
|
| Rate for Payer: PACE SWMI |
$1,160.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,831.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,810.76
|
| Rate for Payer: Priority Health Medicare |
$1,160.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,810.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,195.78
|
|
|
PR RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW <5CM
|
Professional
|
Both
|
$1,811.00
|
|
|
Service Code
|
HCPCS 24077
|
| Min. Negotiated Rate |
$659.87 |
| Max. Negotiated Rate |
$1,580.46 |
| Rate for Payer: Aetna Commercial |
$1,369.63
|
| Rate for Payer: Aetna Medicare |
$1,022.11
|
| Rate for Payer: BCBS Complete |
$692.86
|
| Rate for Payer: BCBS MAPPO |
$1,022.11
|
| Rate for Payer: BCBS Trust/PPO |
$712.15
|
| Rate for Payer: BCN Commercial |
$1,512.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,022.11
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cofinity Commercial |
$1,369.63
|
| Rate for Payer: Cofinity Commercial |
$1,471.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,022.11
|
| Rate for Payer: Healthscope Commercial |
$1,226.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,226.53
|
| Rate for Payer: Meridian Medicaid |
$692.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,073.22
|
| Rate for Payer: PACE SWMI |
$1,022.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,022.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,580.46
|
| Rate for Payer: Priority Health Medicare |
$1,022.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,052.77
|
|
|
PR RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW 5CM+
|
Professional
|
Both
|
$3,056.00
|
|
|
Service Code
|
HCPCS 24079
|
| Min. Negotiated Rate |
$849.66 |
| Max. Negotiated Rate |
$2,139.20 |
| Rate for Payer: Aetna Commercial |
$1,756.40
|
| Rate for Payer: Aetna Medicare |
$1,310.75
|
| Rate for Payer: BCBS Complete |
$892.14
|
| Rate for Payer: BCBS MAPPO |
$1,310.75
|
| Rate for Payer: BCBS Trust/PPO |
$918.19
|
| Rate for Payer: BCN Commercial |
$1,935.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,310.75
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Cofinity Commercial |
$1,887.48
|
| Rate for Payer: Cofinity Commercial |
$1,756.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,310.75
|
| Rate for Payer: Healthscope Commercial |
$1,572.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,572.90
|
| Rate for Payer: Meridian Medicaid |
$892.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,376.29
|
| Rate for Payer: PACE SWMI |
$1,310.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,310.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$849.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,022.68
|
| Rate for Payer: Priority Health Medicare |
$1,310.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,022.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,350.07
|
|
|
PR RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>
|
Professional
|
Both
|
$3,863.00
|
|
|
Service Code
|
HCPCS 25078
|
| Min. Negotiated Rate |
$748.91 |
| Max. Negotiated Rate |
$2,704.10 |
| Rate for Payer: Aetna Commercial |
$1,545.45
|
| Rate for Payer: Aetna Medicare |
$1,153.32
|
| Rate for Payer: BCBS Complete |
$786.36
|
| Rate for Payer: BCBS MAPPO |
$1,153.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: BCN Commercial |
$1,706.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,153.32
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Cofinity Commercial |
$1,660.78
|
| Rate for Payer: Cofinity Commercial |
$1,545.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,153.32
|
| Rate for Payer: Healthscope Commercial |
$1,383.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,383.98
|
| Rate for Payer: Meridian Medicaid |
$786.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,210.99
|
| Rate for Payer: PACE SWMI |
$1,153.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,153.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$748.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,704.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,783.70
|
| Rate for Payer: Priority Health Medicare |
$1,153.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,783.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.92
|
|
