|
PR SCREENING PROCTOSCOPY
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS S0601
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$105.70 |
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$67.02
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.70
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$1,709.05 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.05
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.17
|
| Rate for Payer: Priority Health Narrow Network |
$16.17
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$1,121.05 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.05
|
| Rate for Payer: BCN Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.04
|
| Rate for Payer: Priority Health Narrow Network |
$4.04
|
|
|
PR SCR MAMMO BI INCL CAD
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS G0202
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$142.10 |
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
|
|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$2,153.88 |
| Rate for Payer: Aetna Commercial |
$508.05
|
| Rate for Payer: Aetna Medicare |
$379.14
|
| Rate for Payer: BCBS Complete |
$261.45
|
| Rate for Payer: BCBS MAPPO |
$379.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.88
|
| Rate for Payer: BCN Commercial |
$562.96
|
| Rate for Payer: BCN Medicare Advantage |
$379.14
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cofinity Commercial |
$545.96
|
| Rate for Payer: Cofinity Commercial |
$508.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.14
|
| Rate for Payer: Healthscope Commercial |
$454.97
|
| Rate for Payer: Healthscope Whirlpool |
$454.97
|
| Rate for Payer: Meridian Medicaid |
$261.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$398.10
|
| Rate for Payer: PACE SWMI |
$379.14
|
| Rate for Payer: PHP Medicare Advantage |
$379.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.49
|
| Rate for Payer: Priority Health Medicare |
$379.14
|
| Rate for Payer: Priority Health Narrow Network |
$622.49
|
| Rate for Payer: UHC Medicare Advantage |
$390.51
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$439.63 |
| Max. Negotiated Rate |
$1,956.82 |
| Rate for Payer: Aetna Commercial |
$902.18
|
| Rate for Payer: Aetna Medicare |
$673.27
|
| Rate for Payer: BCBS Complete |
$461.61
|
| Rate for Payer: BCBS MAPPO |
$673.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.82
|
| Rate for Payer: BCN Commercial |
$996.41
|
| Rate for Payer: BCN Medicare Advantage |
$673.27
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cofinity Commercial |
$969.51
|
| Rate for Payer: Cofinity Commercial |
$902.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$673.27
|
| Rate for Payer: Healthscope Commercial |
$807.92
|
| Rate for Payer: Healthscope Whirlpool |
$807.92
|
| Rate for Payer: Meridian Medicaid |
$461.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$706.93
|
| Rate for Payer: PACE SWMI |
$673.27
|
| Rate for Payer: PHP Medicare Advantage |
$673.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$439.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.79
|
| Rate for Payer: Priority Health Medicare |
$673.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,101.79
|
| Rate for Payer: UHC Medicare Advantage |
$693.47
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$234.30 |
| Max. Negotiated Rate |
$1,287.47 |
| Rate for Payer: Aetna Commercial |
$478.03
|
| Rate for Payer: Aetna Medicare |
$356.74
|
| Rate for Payer: BCBS Complete |
$246.02
|
| Rate for Payer: BCBS MAPPO |
$356.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.47
|
| Rate for Payer: BCN Commercial |
$530.22
|
| Rate for Payer: BCN Medicare Advantage |
$356.74
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$513.71
|
| Rate for Payer: Cofinity Commercial |
$478.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.74
|
| Rate for Payer: Healthscope Commercial |
$428.09
|
| Rate for Payer: Healthscope Whirlpool |
$428.09
|
| Rate for Payer: Meridian Medicaid |
$246.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.58
|
| Rate for Payer: PACE SWMI |
$356.74
|
| Rate for Payer: PHP Medicare Advantage |
$356.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.29
|
| Rate for Payer: Priority Health Medicare |
$356.74
|
| Rate for Payer: Priority Health Narrow Network |
$586.29
|
| Rate for Payer: UHC Medicare Advantage |
$367.44
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$529.31 |
| Max. Negotiated Rate |
$4,854.55 |
| Rate for Payer: Aetna Commercial |
$1,087.99
|
| Rate for Payer: Aetna Medicare |
$811.93
|
| Rate for Payer: BCBS Complete |
$555.78
|
| Rate for Payer: BCBS MAPPO |
$811.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,854.55
|
| Rate for Payer: BCN Commercial |
$1,200.68
|
| Rate for Payer: BCN Medicare Advantage |
$811.93
|
| Rate for Payer: Cash Price |
$1,840.00
|
| Rate for Payer: Cash Price |
$1,840.00
|
| Rate for Payer: Cofinity Commercial |
$1,169.18
|
| Rate for Payer: Cofinity Commercial |
$1,087.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.93
|
| Rate for Payer: Healthscope Commercial |
$974.32
|
| Rate for Payer: Healthscope Whirlpool |
$974.32
|
| Rate for Payer: Meridian Medicaid |
$555.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$852.53
|
| Rate for Payer: PACE SWMI |
$811.93
|
| Rate for Payer: PHP Medicare Advantage |
$811.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,444.65
|
| Rate for Payer: Priority Health Medicare |
$811.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,444.65
|
| Rate for Payer: UHC Medicare Advantage |
$836.29
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC
|
Professional
|
Both
|
$1,757.00
|
|
|
Service Code
|
HCPCS 13160
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$1,229.90 |
| Rate for Payer: Aetna Commercial |
$1,046.50
|
| Rate for Payer: Aetna Medicare |
$780.97
|
| Rate for Payer: BCBS Complete |
$534.30
|
| Rate for Payer: BCBS MAPPO |
$780.97
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: BCN Medicare Advantage |
$780.97
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cofinity Commercial |
$1,124.60
|
| Rate for Payer: Cofinity Commercial |
$1,046.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.97
|
| Rate for Payer: Healthscope Commercial |
$937.16
|
| Rate for Payer: Healthscope Whirlpool |
$937.16
|
| Rate for Payer: Meridian Medicaid |
$534.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$820.02
|
| Rate for Payer: PACE SWMI |
$780.97
|
| Rate for Payer: PHP Medicare Advantage |
$780.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$976.22
|
| Rate for Payer: Priority Health Medicare |
$780.97
|
| Rate for Payer: Priority Health Narrow Network |
$976.22
|
| Rate for Payer: UHC Medicare Advantage |
$804.40
|
|
|
PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ
|
Professional
|
Both
|
$4,480.00
|
|
|
Service Code
|
HCPCS 21275
|
| Min. Negotiated Rate |
$540.38 |
| Max. Negotiated Rate |
$3,205.12 |
| Rate for Payer: Aetna Commercial |
$1,109.02
|
| Rate for Payer: Aetna Medicare |
$827.63
|
| Rate for Payer: BCBS Complete |
$567.40
|
| Rate for Payer: BCBS MAPPO |
$827.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$1,235.37
|
| Rate for Payer: BCN Medicare Advantage |
$827.63
|
| Rate for Payer: Cash Price |
$3,584.00
|
| Rate for Payer: Cash Price |
$3,584.00
|
| Rate for Payer: Cofinity Commercial |
$1,109.02
|
| Rate for Payer: Cofinity Commercial |
$1,191.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.63
|
| Rate for Payer: Healthscope Commercial |
$993.16
|
| Rate for Payer: Healthscope Whirlpool |
$993.16
|
| Rate for Payer: Meridian Medicaid |
$567.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$869.01
|
| Rate for Payer: PACE SWMI |
$827.63
|
| Rate for Payer: PHP Medicare Advantage |
$827.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$540.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,136.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,290.93
|
| Rate for Payer: Priority Health Medicare |
$827.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,290.93
|
| Rate for Payer: UHC Medicare Advantage |
$852.46
|
|
|
PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT
|
Professional
|
Both
|
$6,167.00
|
|
|
Service Code
|
HCPCS 61618
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$4,316.90 |
| Rate for Payer: Aetna Commercial |
$1,729.69
|
| Rate for Payer: Aetna Medicare |
$1,290.81
|
| Rate for Payer: BCBS Complete |
$873.80
|
| Rate for Payer: BCBS MAPPO |
$1,290.81
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$2,635.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,290.81
|
| Rate for Payer: Cash Price |
$4,933.60
|
| Rate for Payer: Cash Price |
$4,933.60
|
| Rate for Payer: Cofinity Commercial |
$1,729.69
|
| Rate for Payer: Cofinity Commercial |
$1,858.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,290.81
|
| Rate for Payer: Healthscope Commercial |
$1,548.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,548.97
|
| Rate for Payer: Meridian Medicaid |
$873.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,355.35
|
| Rate for Payer: PACE SWMI |
$1,290.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,290.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$832.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,316.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,201.47
|
| Rate for Payer: Priority Health Medicare |
$1,290.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,201.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.53
|
|
|
PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Professional
|
Both
|
$2,516.84
|
|
|
Service Code
|
HCPCS 37186
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$1,761.79 |
| Rate for Payer: Aetna Commercial |
$319.55
|
| Rate for Payer: Aetna Medicare |
$238.47
|
| Rate for Payer: BCBS Complete |
$158.79
|
| Rate for Payer: BCBS MAPPO |
$238.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.73
|
| Rate for Payer: BCN Commercial |
$1,745.07
|
| Rate for Payer: BCN Medicare Advantage |
$238.47
|
| Rate for Payer: Cash Price |
$2,013.47
|
| Rate for Payer: Cash Price |
$2,013.47
|
| Rate for Payer: Cofinity Commercial |
$319.55
|
| Rate for Payer: Cofinity Commercial |
$343.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.47
|
| Rate for Payer: Healthscope Commercial |
$286.16
|
| Rate for Payer: Healthscope Whirlpool |
$286.16
|
| Rate for Payer: Meridian Medicaid |
$158.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.39
|
| Rate for Payer: PACE SWMI |
$238.47
|
| Rate for Payer: PHP Medicare Advantage |
$238.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,761.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.09
|
| Rate for Payer: Priority Health Medicare |
$238.47
|
| Rate for Payer: Priority Health Narrow Network |
$376.09
|
| Rate for Payer: UHC Medicare Advantage |
$245.62
|
|
|
PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP
|
Professional
|
Both
|
$9,744.00
|
|
|
Service Code
|
HCPCS 61619
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$6,820.80 |
| Rate for Payer: Aetna Commercial |
$1,913.18
|
| Rate for Payer: Aetna Medicare |
$1,427.75
|
| Rate for Payer: BCBS Complete |
$969.30
|
| Rate for Payer: BCBS MAPPO |
$1,427.75
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$2,915.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,427.75
|
| Rate for Payer: Cash Price |
$7,795.20
|
| Rate for Payer: Cash Price |
$7,795.20
|
| Rate for Payer: Cofinity Commercial |
$2,055.96
|
| Rate for Payer: Cofinity Commercial |
$1,913.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,427.75
|
| Rate for Payer: Healthscope Commercial |
$1,713.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,713.30
|
| Rate for Payer: Meridian Medicaid |
$969.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,499.14
|
| Rate for Payer: PACE SWMI |
$1,427.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,427.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,435.33
|
| Rate for Payer: Priority Health Medicare |
$1,427.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,435.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,470.58
|
|
|
PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 97535
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$88.75 |
| Rate for Payer: Aetna Commercial |
$42.44
|
| Rate for Payer: Aetna Medicare |
$31.67
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$31.67
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: BCN Commercial |
$31.97
|
| Rate for Payer: BCN Medicare Advantage |
$31.67
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.67
|
| Rate for Payer: Healthscope Commercial |
$38.00
|
| Rate for Payer: Healthscope Whirlpool |
$38.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.25
|
| Rate for Payer: PACE SWMI |
$31.67
|
| Rate for Payer: PHP Medicare Advantage |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$31.67
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$32.62
|
|
|
PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 92060
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$970.49 |
| Rate for Payer: Aetna Commercial |
$80.71
|
| Rate for Payer: Aetna Medicare |
$60.23
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$60.23
|
| Rate for Payer: BCBS Trust/PPO |
$970.49
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: BCN Medicare Advantage |
$60.23
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$80.71
|
| Rate for Payer: Cofinity Commercial |
$86.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.23
|
| Rate for Payer: Healthscope Commercial |
$72.28
|
| Rate for Payer: Healthscope Whirlpool |
$72.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.24
|
| Rate for Payer: PACE SWMI |
$60.23
|
| Rate for Payer: PHP Medicare Advantage |
$60.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.48
|
| Rate for Payer: Priority Health Medicare |
$60.23
|
| Rate for Payer: Priority Health Narrow Network |
$75.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.04
|
|
|
PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 30520
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna Commercial |
$882.20
|
| Rate for Payer: Aetna Commercial |
$882.20
|
| Rate for Payer: Aetna Medicare |
$658.36
|
| Rate for Payer: Aetna Medicare |
$658.36
|
| Rate for Payer: BCBS Complete |
$456.92
|
| Rate for Payer: BCBS Complete |
$456.92
|
| Rate for Payer: BCBS MAPPO |
$658.36
|
| Rate for Payer: BCBS MAPPO |
$658.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCN Commercial |
$999.83
|
| Rate for Payer: BCN Commercial |
$999.83
|
| Rate for Payer: BCN Medicare Advantage |
$658.36
|
| Rate for Payer: BCN Medicare Advantage |
$658.36
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$1,427.20
|
| Rate for Payer: Cash Price |
$1,427.20
|
| Rate for Payer: Cofinity Commercial |
$948.04
|
| Rate for Payer: Cofinity Commercial |
$882.20
|
| Rate for Payer: Cofinity Commercial |
$882.20
|
| Rate for Payer: Cofinity Commercial |
$948.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.36
|
| Rate for Payer: Healthscope Commercial |
$790.03
|
| Rate for Payer: Healthscope Commercial |
$790.03
|
| Rate for Payer: Healthscope Whirlpool |
$790.03
|
| Rate for Payer: Healthscope Whirlpool |
$790.03
|
| Rate for Payer: Meridian Medicaid |
$456.92
|
| Rate for Payer: Meridian Medicaid |
$456.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$691.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$691.28
|
| Rate for Payer: PACE SWMI |
$658.36
|
| Rate for Payer: PACE SWMI |
$658.36
|
| Rate for Payer: PHP Medicare Advantage |
$658.36
|
| Rate for Payer: PHP Medicare Advantage |
$658.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.39
|
| Rate for Payer: Priority Health Medicare |
$658.36
|
| Rate for Payer: Priority Health Medicare |
$658.36
|
| Rate for Payer: Priority Health Narrow Network |
$947.39
|
| Rate for Payer: Priority Health Narrow Network |
$947.39
|
| Rate for Payer: UHC Medicare Advantage |
$678.11
|
| Rate for Payer: UHC Medicare Advantage |
$678.11
|
|
|
PR SEQUESTRECTOMY FOREARM &/WRIST
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 25145
|
| Min. Negotiated Rate |
$334.94 |
| Max. Negotiated Rate |
$1,549.10 |
| Rate for Payer: Aetna Commercial |
$690.26
|
| Rate for Payer: Aetna Medicare |
$515.12
|
| Rate for Payer: BCBS Complete |
$357.62
|
| Rate for Payer: BCBS MAPPO |
$515.12
|
| Rate for Payer: BCBS Trust/PPO |
$334.94
|
| Rate for Payer: BCN Commercial |
$772.60
|
| Rate for Payer: BCN Medicare Advantage |
$515.12
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$741.77
|
| Rate for Payer: Cofinity Commercial |
$690.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.12
|
| Rate for Payer: Healthscope Commercial |
$618.14
|
| Rate for Payer: Healthscope Whirlpool |
$618.14
|
| Rate for Payer: Meridian Medicaid |
$357.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$540.88
|
| Rate for Payer: PACE SWMI |
$515.12
|
| Rate for Payer: PHP Medicare Advantage |
$515.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,549.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$807.34
|
| Rate for Payer: Priority Health Medicare |
$515.12
|
| Rate for Payer: Priority Health Narrow Network |
$807.34
|
| Rate for Payer: UHC Medicare Advantage |
$530.57
|
|
|
PR SEQUESTRECTOMY SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 24134
|
| Min. Negotiated Rate |
$175.92 |
| Max. Negotiated Rate |
$1,523.20 |
| Rate for Payer: Aetna Commercial |
$989.50
|
| Rate for Payer: Aetna Medicare |
$738.43
|
| Rate for Payer: BCBS Complete |
$508.81
|
| Rate for Payer: BCBS MAPPO |
$738.43
|
| Rate for Payer: BCBS Trust/PPO |
$175.92
|
| Rate for Payer: BCN Commercial |
$1,101.97
|
| Rate for Payer: BCN Medicare Advantage |
$738.43
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$989.50
|
| Rate for Payer: Cofinity Commercial |
$1,063.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.43
|
| Rate for Payer: Healthscope Commercial |
$886.12
|
| Rate for Payer: Healthscope Whirlpool |
$886.12
|
| Rate for Payer: Meridian Medicaid |
$508.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$775.35
|
| Rate for Payer: PACE SWMI |
$738.43
|
| Rate for Payer: PHP Medicare Advantage |
$738.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,151.52
|
| Rate for Payer: Priority Health Medicare |
$738.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,151.52
|
| Rate for Payer: UHC Medicare Advantage |
$760.58
|
|
|
PR SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 99050
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$608.60 |
| Rate for Payer: Aetna Commercial |
$23.50
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$608.60
|
| Rate for Payer: BCN Commercial |
$20.16
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.25
|
| Rate for Payer: Priority Health Narrow Network |
$24.25
|
|
|
PR SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 28315
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$427.37
|
| Rate for Payer: Aetna Medicare |
$318.93
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS MAPPO |
$318.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.96
|
| Rate for Payer: BCN Commercial |
$697.34
|
| Rate for Payer: BCN Medicare Advantage |
$318.93
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$459.26
|
| Rate for Payer: Cofinity Commercial |
$427.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.93
|
| Rate for Payer: Healthscope Commercial |
$382.72
|
| Rate for Payer: Healthscope Whirlpool |
$382.72
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$334.88
|
| Rate for Payer: PACE SWMI |
$318.93
|
| Rate for Payer: PHP Medicare Advantage |
$318.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.88
|
| Rate for Payer: Priority Health Medicare |
$318.93
|
| Rate for Payer: Priority Health Narrow Network |
$497.88
|
| Rate for Payer: UHC Medicare Advantage |
$328.50
|
|
|
PR SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 26185
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$1,152.90 |
| Rate for Payer: Aetna Commercial |
$735.27
|
| Rate for Payer: Aetna Medicare |
$548.71
|
| Rate for Payer: BCBS Complete |
$383.11
|
| Rate for Payer: BCBS MAPPO |
$548.71
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$825.87
|
| Rate for Payer: BCN Medicare Advantage |
$548.71
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$735.27
|
| Rate for Payer: Cofinity Commercial |
$790.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.71
|
| Rate for Payer: Healthscope Commercial |
$658.45
|
| Rate for Payer: Healthscope Whirlpool |
$658.45
|
| Rate for Payer: Meridian Medicaid |
$383.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$576.15
|
| Rate for Payer: PACE SWMI |
$548.71
|
| Rate for Payer: PHP Medicare Advantage |
$548.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.99
|
| Rate for Payer: Priority Health Medicare |
$548.71
|
| Rate for Payer: Priority Health Narrow Network |
$862.99
|
| Rate for Payer: UHC Medicare Advantage |
$565.17
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: Aetna Commercial |
$573.30
|
| Rate for Payer: ASR ASR |
$617.89
|
| Rate for Payer: BCBS Trust/PPO |
$493.87
|
| Rate for Payer: BCN Commercial |
$493.87
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$598.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.60
|
| Rate for Payer: Healthscope Commercial |
$637.00
|
| Rate for Payer: Healthscope Whirlpool |
$617.89
|
| Rate for Payer: Mclaren Commercial |
$573.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$560.56
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
HCPCS 45335
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna Commercial |
$86.75
|
| Rate for Payer: Aetna Medicare |
$64.74
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$64.74
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$430.03
|
| Rate for Payer: BCN Medicare Advantage |
$64.74
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$93.23
|
| Rate for Payer: Cofinity Commercial |
$86.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.74
|
| Rate for Payer: Healthscope Commercial |
$77.69
|
| Rate for Payer: Healthscope Whirlpool |
$77.69
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.98
|
| Rate for Payer: PACE SWMI |
$64.74
|
| Rate for Payer: PHP Medicare Advantage |
$64.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.83
|
| Rate for Payer: Priority Health Medicare |
$64.74
|
| Rate for Payer: Priority Health Narrow Network |
$115.83
|
| Rate for Payer: UHC Medicare Advantage |
$66.68
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$1,015.50 |
| Rate for Payer: Aetna Commercial |
$573.30
|
| Rate for Payer: Aetna Medicare |
$812.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: ASR ASR |
$617.89
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$493.87
|
| Rate for Payer: BCN Commercial |
$493.87
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$598.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$637.00
|
| Rate for Payer: Healthscope Whirlpool |
$617.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$573.30
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.45
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$893.64
|
| Rate for Payer: PHP Medicaid |
$444.38
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$579.67
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$452.27
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$560.56
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
HCPCS 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna Commercial |
$86.75
|
| Rate for Payer: Aetna Medicare |
$64.74
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$64.74
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$430.03
|
| Rate for Payer: BCN Medicare Advantage |
$64.74
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$93.23
|
| Rate for Payer: Cofinity Commercial |
$86.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.74
|
| Rate for Payer: Healthscope Commercial |
$77.69
|
| Rate for Payer: Healthscope Whirlpool |
$77.69
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.98
|
| Rate for Payer: PACE SWMI |
$64.74
|
| Rate for Payer: PHP Medicare Advantage |
$64.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.83
|
| Rate for Payer: Priority Health Medicare |
$64.74
|
| Rate for Payer: Priority Health Narrow Network |
$115.83
|
| Rate for Payer: UHC Medicare Advantage |
$66.68
|
|
