|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$211.94 |
| Max. Negotiated Rate |
$1,249.50 |
| Rate for Payer: Aetna Commercial |
$433.20
|
| Rate for Payer: Aetna Medicare |
$323.28
|
| Rate for Payer: BCBS Complete |
$222.54
|
| Rate for Payer: BCBS MAPPO |
$323.28
|
| Rate for Payer: BCBS Trust/PPO |
$409.43
|
| Rate for Payer: BCN Commercial |
$1,003.26
|
| Rate for Payer: BCN Medicare Advantage |
$323.28
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cofinity Commercial |
$465.52
|
| Rate for Payer: Cofinity Commercial |
$433.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.28
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Healthscope Whirlpool |
$387.94
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$339.44
|
| Rate for Payer: PACE SWMI |
$323.28
|
| Rate for Payer: PHP Medicare Advantage |
$323.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.89
|
| Rate for Payer: Priority Health Medicare |
$323.28
|
| Rate for Payer: Priority Health Narrow Network |
$554.89
|
| Rate for Payer: UHC Medicare Advantage |
$332.98
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$1,486.00
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$178.57 |
| Max. Negotiated Rate |
$1,040.20 |
| Rate for Payer: Aetna Commercial |
$391.32
|
| Rate for Payer: Aetna Medicare |
$292.03
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$292.03
|
| Rate for Payer: BCBS Trust/PPO |
$178.57
|
| Rate for Payer: BCN Commercial |
$434.93
|
| Rate for Payer: BCN Medicare Advantage |
$292.03
|
| Rate for Payer: Cash Price |
$1,188.80
|
| Rate for Payer: Cash Price |
$1,188.80
|
| Rate for Payer: Cofinity Commercial |
$420.52
|
| Rate for Payer: Cofinity Commercial |
$391.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.03
|
| Rate for Payer: Healthscope Commercial |
$350.44
|
| Rate for Payer: Healthscope Whirlpool |
$350.44
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$306.63
|
| Rate for Payer: PACE SWMI |
$292.03
|
| Rate for Payer: PHP Medicare Advantage |
$292.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,040.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$503.95
|
| Rate for Payer: Priority Health Medicare |
$292.03
|
| Rate for Payer: Priority Health Narrow Network |
$503.95
|
| Rate for Payer: UHC Medicare Advantage |
$300.79
|
|
|
PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 26392
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$1,551.86 |
| Rate for Payer: Aetna Commercial |
$1,315.33
|
| Rate for Payer: Aetna Medicare |
$981.59
|
| Rate for Payer: BCBS Complete |
$679.00
|
| Rate for Payer: BCBS MAPPO |
$981.59
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$1,485.09
|
| Rate for Payer: BCN Medicare Advantage |
$981.59
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cofinity Commercial |
$1,413.49
|
| Rate for Payer: Cofinity Commercial |
$1,315.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.59
|
| Rate for Payer: Healthscope Commercial |
$1,177.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.91
|
| Rate for Payer: Meridian Medicaid |
$679.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,030.67
|
| Rate for Payer: PACE SWMI |
$981.59
|
| Rate for Payer: PHP Medicare Advantage |
$981.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$646.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,551.86
|
| Rate for Payer: Priority Health Medicare |
$981.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,551.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,011.04
|
|
|
PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 46754
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$512.14 |
| Rate for Payer: Aetna Commercial |
$314.24
|
| Rate for Payer: Aetna Medicare |
$234.51
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$234.51
|
| Rate for Payer: BCBS Trust/PPO |
$396.75
|
| Rate for Payer: BCN Commercial |
$512.14
|
| Rate for Payer: BCN Medicare Advantage |
$234.51
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cash Price |
$370.40
|
| Rate for Payer: Cofinity Commercial |
$337.69
|
| Rate for Payer: Cofinity Commercial |
$314.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.51
|
| Rate for Payer: Healthscope Commercial |
$281.41
|
| Rate for Payer: Healthscope Whirlpool |
$281.41
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.24
|
| Rate for Payer: PACE SWMI |
$234.51
|
| Rate for Payer: PHP Medicare Advantage |
$234.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$425.10
|
| Rate for Payer: Priority Health Medicare |
$234.51
|
| Rate for Payer: Priority Health Narrow Network |
$425.10
|
| Rate for Payer: UHC Medicare Advantage |
$241.55
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,206.11 |
| Rate for Payer: Aetna Commercial |
$836.91
|
| Rate for Payer: Aetna Medicare |
$624.56
|
| Rate for Payer: BCBS Complete |
$419.79
|
| Rate for Payer: BCBS MAPPO |
$624.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.11
|
| Rate for Payer: BCN Commercial |
$921.64
|
| Rate for Payer: BCN Medicare Advantage |
$624.56
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$899.37
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.56
|
| Rate for Payer: Healthscope Commercial |
$749.47
|
| Rate for Payer: Healthscope Whirlpool |
$749.47
|
| Rate for Payer: Meridian Medicaid |
$419.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$655.79
|
| Rate for Payer: PACE SWMI |
$624.56
|
| Rate for Payer: PHP Medicare Advantage |
$624.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,003.27
|
| Rate for Payer: Priority Health Medicare |
$624.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,003.27
|
| Rate for Payer: UHC Medicare Advantage |
$643.30
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$1,132.68 |
| Rate for Payer: Aetna Commercial |
$249.07
|
| Rate for Payer: Aetna Medicare |
$185.87
|
| Rate for Payer: BCBS Complete |
$125.70
|
| Rate for Payer: BCBS MAPPO |
$185.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.68
|
| Rate for Payer: BCN Commercial |
$325.95
|
| Rate for Payer: BCN Medicare Advantage |
$185.87
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$267.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.87
|
| Rate for Payer: Healthscope Commercial |
$223.04
|
| Rate for Payer: Healthscope Whirlpool |
$223.04
|
| Rate for Payer: Meridian Medicaid |
$125.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.16
|
| Rate for Payer: PACE SWMI |
$185.87
|
| Rate for Payer: PHP Medicare Advantage |
$185.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.97
|
| Rate for Payer: Priority Health Medicare |
$185.87
|
| Rate for Payer: Priority Health Narrow Network |
$298.97
|
| Rate for Payer: UHC Medicare Advantage |
$191.45
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: ASR ASR |
$680.94
|
| Rate for Payer: BCBS Trust/PPO |
$544.26
|
| Rate for Payer: BCN Commercial |
$544.26
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$659.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.60
|
| Rate for Payer: Healthscope Commercial |
$702.00
|
| Rate for Payer: Healthscope Whirlpool |
$680.94
|
| Rate for Payer: Mclaren Commercial |
$631.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$596.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.76
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$1,779.46 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Medicare |
$1,423.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: ASR ASR |
$680.94
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$544.26
|
| Rate for Payer: BCN Commercial |
$544.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$659.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Healthscope Commercial |
$702.00
|
| Rate for Payer: Healthscope Whirlpool |
$680.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,423.57
|
| Rate for Payer: Mclaren Commercial |
$631.80
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$596.70
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Commercial |
$1,565.93
|
| Rate for Payer: PHP Medicaid |
$778.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.82
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$498.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
36590
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$1,132.68 |
| Rate for Payer: Aetna Commercial |
$249.07
|
| Rate for Payer: Aetna Medicare |
$185.87
|
| Rate for Payer: BCBS Complete |
$125.70
|
| Rate for Payer: BCBS MAPPO |
$185.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.68
|
| Rate for Payer: BCN Commercial |
$325.95
|
| Rate for Payer: BCN Medicare Advantage |
$185.87
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$249.07
|
| Rate for Payer: Cofinity Commercial |
$267.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.87
|
| Rate for Payer: Healthscope Commercial |
$223.04
|
| Rate for Payer: Healthscope Whirlpool |
$223.04
|
| Rate for Payer: Meridian Medicaid |
$125.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$195.16
|
| Rate for Payer: PACE SWMI |
$185.87
|
| Rate for Payer: PHP Medicare Advantage |
$185.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.97
|
| Rate for Payer: Priority Health Medicare |
$185.87
|
| Rate for Payer: Priority Health Narrow Network |
$298.97
|
| Rate for Payer: UHC Medicare Advantage |
$191.45
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$1,048.15 |
| Rate for Payer: Aetna Commercial |
$178.89
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$133.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.15
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: BCN Medicare Advantage |
$133.50
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Cofinity Commercial |
$192.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.50
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.20
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.18
|
| Rate for Payer: PACE SWMI |
$133.50
|
| Rate for Payer: PHP Medicare Advantage |
$133.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.90
|
| Rate for Payer: Priority Health Medicare |
$133.50
|
| Rate for Payer: Priority Health Narrow Network |
$214.90
|
| Rate for Payer: UHC Medicare Advantage |
$137.50
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$698.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Medicare |
$558.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.00
|
| Rate for Payer: ASR ASR |
$408.37
|
| Rate for Payer: BCBS Complete |
$320.74
|
| Rate for Payer: BCBS MAPPO |
$558.40
|
| Rate for Payer: BCBS Trust/PPO |
$326.40
|
| Rate for Payer: BCN Commercial |
$326.40
|
| Rate for Payer: BCN Medicare Advantage |
$558.40
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$395.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.40
|
| Rate for Payer: Healthscope Commercial |
$421.00
|
| Rate for Payer: Healthscope Whirlpool |
$408.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.40
|
| Rate for Payer: Mclaren Commercial |
$378.90
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Mclaren Medicare |
$558.40
|
| Rate for Payer: Meridian Medicaid |
$320.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.85
|
| Rate for Payer: PACE Medicare |
$530.48
|
| Rate for Payer: PACE SWMI |
$558.40
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: PHP Medicaid |
$305.44
|
| Rate for Payer: PHP Medicare Advantage |
$558.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.11
|
| Rate for Payer: Priority Health Medicare |
$558.40
|
| Rate for Payer: Priority Health Narrow Network |
$298.91
|
| Rate for Payer: Railroad Medicare Medicare |
$558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.48
|
| Rate for Payer: UHC Medicare Advantage |
$575.15
|
| Rate for Payer: VA VA |
$558.40
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
36589
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: ASR ASR |
$408.37
|
| Rate for Payer: BCBS Trust/PPO |
$326.40
|
| Rate for Payer: BCN Commercial |
$326.40
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$395.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.80
|
| Rate for Payer: Healthscope Commercial |
$421.00
|
| Rate for Payer: Healthscope Whirlpool |
$408.37
|
| Rate for Payer: Mclaren Commercial |
$378.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.48
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$1,048.15 |
| Rate for Payer: Aetna Commercial |
$178.89
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$133.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.15
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: BCN Medicare Advantage |
$133.50
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cofinity Commercial |
$192.24
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.50
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.20
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.18
|
| Rate for Payer: PACE SWMI |
$133.50
|
| Rate for Payer: PHP Medicare Advantage |
$133.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.90
|
| Rate for Payer: Priority Health Medicare |
$133.50
|
| Rate for Payer: Priority Health Narrow Network |
$214.90
|
| Rate for Payer: UHC Medicare Advantage |
$137.50
|
|
|
PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 11983
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Commercial |
$137.67
|
| Rate for Payer: Aetna Medicare |
$102.74
|
| Rate for Payer: BCBS Complete |
$68.88
|
| Rate for Payer: BCBS MAPPO |
$102.74
|
| Rate for Payer: BCBS Trust/PPO |
$532.50
|
| Rate for Payer: BCN Commercial |
$208.18
|
| Rate for Payer: BCN Medicare Advantage |
$102.74
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$147.95
|
| Rate for Payer: Cofinity Commercial |
$137.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.74
|
| Rate for Payer: Healthscope Commercial |
$123.29
|
| Rate for Payer: Healthscope Whirlpool |
$123.29
|
| Rate for Payer: Meridian Medicaid |
$68.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.88
|
| Rate for Payer: PACE SWMI |
$102.74
|
| Rate for Payer: PHP Medicare Advantage |
$102.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.60
|
| Rate for Payer: Priority Health Medicare |
$102.74
|
| Rate for Payer: Priority Health Narrow Network |
$126.60
|
| Rate for Payer: UHC Medicare Advantage |
$105.82
|
|
|
PR RNL EXPL X NECESSITATING OTH SPEC PX
|
Professional
|
Both
|
$2,465.00
|
|
|
Service Code
|
HCPCS 50010
|
| Min. Negotiated Rate |
$449.64 |
| Max. Negotiated Rate |
$3,137.57 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna Medicare |
$733.72
|
| Rate for Payer: BCBS Complete |
$472.12
|
| Rate for Payer: BCBS MAPPO |
$733.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,137.57
|
| Rate for Payer: BCN Commercial |
$1,082.91
|
| Rate for Payer: BCN Medicare Advantage |
$733.72
|
| Rate for Payer: Cash Price |
$1,972.00
|
| Rate for Payer: Cash Price |
$1,972.00
|
| Rate for Payer: Cofinity Commercial |
$1,056.56
|
| Rate for Payer: Cofinity Commercial |
$983.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.72
|
| Rate for Payer: Healthscope Commercial |
$880.46
|
| Rate for Payer: Healthscope Whirlpool |
$880.46
|
| Rate for Payer: Meridian Medicaid |
$472.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$770.41
|
| Rate for Payer: PACE SWMI |
$733.72
|
| Rate for Payer: PHP Medicare Advantage |
$733.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,725.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,197.43
|
| Rate for Payer: Priority Health Medicare |
$733.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,197.43
|
| Rate for Payer: UHC Medicare Advantage |
$755.73
|
|
|
PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY
|
Professional
|
Both
|
$1,359.00
|
|
|
Service Code
|
HCPCS 50575
|
| Min. Negotiated Rate |
$446.66 |
| Max. Negotiated Rate |
$1,123.94 |
| Rate for Payer: Aetna Commercial |
$929.37
|
| Rate for Payer: Aetna Medicare |
$693.56
|
| Rate for Payer: BCBS Complete |
$468.99
|
| Rate for Payer: BCBS MAPPO |
$693.56
|
| Rate for Payer: BCBS Trust/PPO |
$838.41
|
| Rate for Payer: BCN Commercial |
$1,016.45
|
| Rate for Payer: BCN Medicare Advantage |
$693.56
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cash Price |
$1,087.20
|
| Rate for Payer: Cofinity Commercial |
$998.73
|
| Rate for Payer: Cofinity Commercial |
$929.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.56
|
| Rate for Payer: Healthscope Commercial |
$832.27
|
| Rate for Payer: Healthscope Whirlpool |
$832.27
|
| Rate for Payer: Meridian Medicaid |
$468.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$728.24
|
| Rate for Payer: PACE SWMI |
$693.56
|
| Rate for Payer: PHP Medicare Advantage |
$693.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$951.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,123.94
|
| Rate for Payer: Priority Health Medicare |
$693.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,123.94
|
| Rate for Payer: UHC Medicare Advantage |
$714.37
|
|
|
PR ROBOTIC SURGICAL SYSTEM
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS S2900
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$486.56 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
|
|
PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 95852
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$1,012.22 |
| Rate for Payer: Aetna Commercial |
$7.14
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS MAPPO |
$5.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$5.33
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.33
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Healthscope Whirlpool |
$6.40
|
| Rate for Payer: Meridian Medicaid |
$3.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.60
|
| Rate for Payer: PACE SWMI |
$5.33
|
| Rate for Payer: PHP Medicare Advantage |
$5.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.18
|
| Rate for Payer: Priority Health Medicare |
$5.33
|
| Rate for Payer: Priority Health Narrow Network |
$7.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.49
|
|
|
PR ROPIVACAINE HCL INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J2795
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: Aetna Medicare |
$0.07
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.07
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.07
|
| Rate for Payer: Healthscope Commercial |
$0.09
|
| Rate for Payer: Healthscope Whirlpool |
$0.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: PACE SWMI |
$0.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$0.07
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
|
|
PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 35700
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$1,875.47 |
| Rate for Payer: Aetna Commercial |
$200.42
|
| Rate for Payer: Aetna Medicare |
$149.57
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS MAPPO |
$149.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.47
|
| Rate for Payer: BCN Commercial |
$215.51
|
| Rate for Payer: BCN Medicare Advantage |
$149.57
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$200.42
|
| Rate for Payer: Cofinity Commercial |
$215.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.57
|
| Rate for Payer: Healthscope Commercial |
$179.48
|
| Rate for Payer: Healthscope Whirlpool |
$179.48
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.05
|
| Rate for Payer: PACE SWMI |
$149.57
|
| Rate for Payer: PHP Medicare Advantage |
$149.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.59
|
| Rate for Payer: Priority Health Medicare |
$149.57
|
| Rate for Payer: Priority Health Narrow Network |
$234.59
|
| Rate for Payer: UHC Medicare Advantage |
$154.06
|
|
|
PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 33530
|
| Min. Negotiated Rate |
$326.32 |
| Max. Negotiated Rate |
$1,169.00 |
| Rate for Payer: Aetna Commercial |
$692.36
|
| Rate for Payer: Aetna Medicare |
$516.69
|
| Rate for Payer: BCBS Complete |
$342.64
|
| Rate for Payer: BCBS MAPPO |
$516.69
|
| Rate for Payer: BCBS Trust/PPO |
$357.13
|
| Rate for Payer: BCN Commercial |
$748.66
|
| Rate for Payer: BCN Medicare Advantage |
$516.69
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cofinity Commercial |
$744.03
|
| Rate for Payer: Cofinity Commercial |
$692.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.69
|
| Rate for Payer: Healthscope Commercial |
$620.03
|
| Rate for Payer: Healthscope Whirlpool |
$620.03
|
| Rate for Payer: Meridian Medicaid |
$342.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$542.52
|
| Rate for Payer: PACE SWMI |
$516.69
|
| Rate for Payer: PHP Medicare Advantage |
$516.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,169.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.96
|
| Rate for Payer: Priority Health Medicare |
$516.69
|
| Rate for Payer: Priority Health Narrow Network |
$814.96
|
| Rate for Payer: UHC Medicare Advantage |
$532.19
|
|
|
PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 35390
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$601.21 |
| Rate for Payer: Aetna Commercial |
$209.63
|
| Rate for Payer: Aetna Medicare |
$156.44
|
| Rate for Payer: BCBS Complete |
$103.55
|
| Rate for Payer: BCBS MAPPO |
$156.44
|
| Rate for Payer: BCBS Trust/PPO |
$601.21
|
| Rate for Payer: BCN Commercial |
$225.76
|
| Rate for Payer: BCN Medicare Advantage |
$156.44
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$209.63
|
| Rate for Payer: Cofinity Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.44
|
| Rate for Payer: Healthscope Commercial |
$187.73
|
| Rate for Payer: Healthscope Whirlpool |
$187.73
|
| Rate for Payer: Meridian Medicaid |
$103.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$164.26
|
| Rate for Payer: PACE SWMI |
$156.44
|
| Rate for Payer: PHP Medicare Advantage |
$156.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Medicare |
$156.44
|
| Rate for Payer: Priority Health Narrow Network |
$245.77
|
| Rate for Payer: UHC Medicare Advantage |
$161.13
|
|
|
PR ROUT FOOT CARE PER VISIT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS S0390
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$31.70 |
| Rate for Payer: Aetna Commercial |
$25.38
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$31.70
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB
|
Professional
|
Both
|
$3,949.00
|
|
|
Service Code
|
HCPCS 59610
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$3,605.23 |
| Rate for Payer: Aetna Commercial |
$3,354.86
|
| Rate for Payer: Aetna Medicare |
$2,503.63
|
| Rate for Payer: BCBS Complete |
$2,459.93
|
| Rate for Payer: BCBS MAPPO |
$2,503.63
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCN Commercial |
$3,361.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,503.63
|
| Rate for Payer: Cash Price |
$3,159.20
|
| Rate for Payer: Cash Price |
$3,159.20
|
| Rate for Payer: Cofinity Commercial |
$3,605.23
|
| Rate for Payer: Cofinity Commercial |
$3,354.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,503.63
|
| Rate for Payer: Healthscope Commercial |
$3,004.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,004.36
|
| Rate for Payer: Meridian Medicaid |
$2,459.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,628.81
|
| Rate for Payer: PACE SWMI |
$2,503.63
|
| Rate for Payer: PHP Medicare Advantage |
$2,503.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,342.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,764.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,555.00
|
| Rate for Payer: Priority Health Medicare |
$2,503.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,555.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,578.74
|
|
|
PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC
|
Professional
|
Both
|
$4,238.00
|
|
|
Service Code
|
HCPCS 59618
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$3,849.32 |
| Rate for Payer: Aetna Commercial |
$3,582.01
|
| Rate for Payer: Aetna Medicare |
$2,673.14
|
| Rate for Payer: BCBS Complete |
$2,637.40
|
| Rate for Payer: BCBS MAPPO |
$2,673.14
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: BCN Commercial |
$3,361.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,673.14
|
| Rate for Payer: Cash Price |
$3,390.40
|
| Rate for Payer: Cash Price |
$3,390.40
|
| Rate for Payer: Cofinity Commercial |
$3,582.01
|
| Rate for Payer: Cofinity Commercial |
$3,849.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,673.14
|
| Rate for Payer: Healthscope Commercial |
$3,207.77
|
| Rate for Payer: Healthscope Whirlpool |
$3,207.77
|
| Rate for Payer: Meridian Medicaid |
$2,637.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,806.80
|
| Rate for Payer: PACE SWMI |
$2,673.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,673.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,511.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,966.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,795.33
|
| Rate for Payer: Priority Health Medicare |
$2,673.14
|
| Rate for Payer: Priority Health Narrow Network |
$3,795.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,753.33
|
|
