|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$662.40
|
| Rate for Payer: ASR ASR |
$713.92
|
| Rate for Payer: BCBS Trust/PPO |
$570.62
|
| Rate for Payer: BCN Commercial |
$570.62
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$691.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.80
|
| Rate for Payer: Healthscope Commercial |
$736.00
|
| Rate for Payer: Healthscope Whirlpool |
$713.92
|
| Rate for Payer: Mclaren Commercial |
$662.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$647.68
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 45333
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$122.17
|
| Rate for Payer: Aetna Medicare |
$91.17
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$91.17
|
| Rate for Payer: BCBS Trust/PPO |
$297.83
|
| Rate for Payer: BCN Commercial |
$485.26
|
| Rate for Payer: BCN Medicare Advantage |
$91.17
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$131.28
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$109.40
|
| Rate for Payer: Healthscope Whirlpool |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.73
|
| Rate for Payer: PACE SWMI |
$91.17
|
| Rate for Payer: PHP Medicare Advantage |
$91.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$91.17
|
| Rate for Payer: Priority Health Narrow Network |
$162.28
|
| Rate for Payer: UHC Medicare Advantage |
$93.91
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$1,015.50 |
| Rate for Payer: Aetna Commercial |
$662.40
|
| 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 |
$713.92
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$570.62
|
| Rate for Payer: BCN Commercial |
$570.62
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$691.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$736.00
|
| Rate for Payer: Healthscope Whirlpool |
$713.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$662.40
|
| 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 |
$625.60
|
| 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 |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$669.76
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$522.56
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$647.68
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 45333
|
| Hospital Charge Code |
45333
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$122.17
|
| Rate for Payer: Aetna Medicare |
$91.17
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$91.17
|
| Rate for Payer: BCBS Trust/PPO |
$297.83
|
| Rate for Payer: BCN Commercial |
$485.26
|
| Rate for Payer: BCN Medicare Advantage |
$91.17
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Cofinity Commercial |
$131.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$109.40
|
| Rate for Payer: Healthscope Whirlpool |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.73
|
| Rate for Payer: PACE SWMI |
$91.17
|
| Rate for Payer: PHP Medicare Advantage |
$91.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.28
|
| Rate for Payer: Priority Health Medicare |
$91.17
|
| Rate for Payer: Priority Health Narrow Network |
$162.28
|
| Rate for Payer: UHC Medicare Advantage |
$93.91
|
|
|
PR SIGMOIDOSCOPY,TRANSENDOSCOPIC STENT
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 45345
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
|
|
PR SIGMOIDOSCOPY W/STENT
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS G6023
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
|
|
PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 93278
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$981.33 |
| Rate for Payer: Aetna Commercial |
$36.74
|
| Rate for Payer: Aetna Medicare |
$27.42
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$27.42
|
| Rate for Payer: BCBS Trust/PPO |
$981.33
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$27.42
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.42
|
| Rate for Payer: Healthscope Commercial |
$32.90
|
| Rate for Payer: Healthscope Whirlpool |
$32.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.79
|
| Rate for Payer: PACE SWMI |
$27.42
|
| Rate for Payer: PHP Medicare Advantage |
$27.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.66
|
| Rate for Payer: Priority Health Medicare |
$27.42
|
| Rate for Payer: Priority Health Narrow Network |
$40.66
|
| Rate for Payer: UHC Medicare Advantage |
$28.24
|
|
|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 51725
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$642.41 |
| Rate for Payer: Aetna Commercial |
$291.30
|
| Rate for Payer: Aetna Medicare |
$217.39
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$217.39
|
| Rate for Payer: BCBS Trust/PPO |
$642.41
|
| Rate for Payer: BCN Commercial |
$335.23
|
| Rate for Payer: BCN Medicare Advantage |
$217.39
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Cofinity Commercial |
$291.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.39
|
| Rate for Payer: Healthscope Commercial |
$260.87
|
| Rate for Payer: Healthscope Whirlpool |
$260.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.26
|
| Rate for Payer: PACE SWMI |
$217.39
|
| Rate for Payer: PHP Medicare Advantage |
$217.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.69
|
| Rate for Payer: Priority Health Medicare |
$217.39
|
| Rate for Payer: Priority Health Narrow Network |
$370.69
|
| Rate for Payer: UHC Medicare Advantage |
$223.91
|
|
|
PR SIMPLE IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 00522
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$9,538.00
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$1,257.35 |
| Max. Negotiated Rate |
$6,912.88 |
| Rate for Payer: Aetna Commercial |
$4,571.24
|
| Rate for Payer: Aetna Medicare |
$3,411.37
|
| Rate for Payer: BCBS Complete |
$2,313.43
|
| Rate for Payer: BCBS MAPPO |
$3,411.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,257.35
|
| Rate for Payer: BCN Commercial |
$6,912.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,411.37
|
| Rate for Payer: Cash Price |
$7,630.40
|
| Rate for Payer: Cash Price |
$7,630.40
|
| Rate for Payer: Cofinity Commercial |
$4,912.37
|
| Rate for Payer: Cofinity Commercial |
$4,571.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,411.37
|
| Rate for Payer: Healthscope Commercial |
$4,093.64
|
| Rate for Payer: Healthscope Whirlpool |
$4,093.64
|
| Rate for Payer: Meridian Medicaid |
$2,313.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,581.94
|
| Rate for Payer: PACE SWMI |
$3,411.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,411.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,203.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,676.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,773.78
|
| Rate for Payer: Priority Health Medicare |
$3,411.37
|
| Rate for Payer: Priority Health Narrow Network |
$5,773.78
|
| Rate for Payer: UHC Medicare Advantage |
$3,513.71
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$8,499.00
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$1,072.45 |
| Max. Negotiated Rate |
$8,192.82 |
| Rate for Payer: Aetna Commercial |
$5,424.12
|
| Rate for Payer: Aetna Medicare |
$4,047.85
|
| Rate for Payer: BCBS Complete |
$2,722.04
|
| Rate for Payer: BCBS MAPPO |
$4,047.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$8,192.82
|
| Rate for Payer: BCN Medicare Advantage |
$4,047.85
|
| Rate for Payer: Cash Price |
$6,799.20
|
| Rate for Payer: Cash Price |
$6,799.20
|
| Rate for Payer: Cofinity Commercial |
$5,828.90
|
| Rate for Payer: Cofinity Commercial |
$5,424.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,047.85
|
| Rate for Payer: Healthscope Commercial |
$4,857.42
|
| Rate for Payer: Healthscope Whirlpool |
$4,857.42
|
| Rate for Payer: Meridian Medicaid |
$2,722.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,250.24
|
| Rate for Payer: PACE SWMI |
$4,047.85
|
| Rate for Payer: PHP Medicare Advantage |
$4,047.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,949.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,842.81
|
| Rate for Payer: Priority Health Medicare |
$4,047.85
|
| Rate for Payer: Priority Health Narrow Network |
$6,842.81
|
| Rate for Payer: UHC Medicare Advantage |
$4,169.29
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$171.86
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS MAPPO |
$128.25
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$322.53
|
| Rate for Payer: BCN Medicare Advantage |
$128.25
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cofinity Commercial |
$171.86
|
| Rate for Payer: Cofinity Commercial |
$184.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.25
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Healthscope Whirlpool |
$153.90
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.66
|
| Rate for Payer: PACE SWMI |
$128.25
|
| Rate for Payer: PHP Medicare Advantage |
$128.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.19
|
| Rate for Payer: Priority Health Medicare |
$128.25
|
| Rate for Payer: Priority Health Narrow Network |
$156.19
|
| Rate for Payer: UHC Medicare Advantage |
$132.10
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$223.32 |
| Rate for Payer: Aetna Commercial |
$206.84
|
| Rate for Payer: Aetna Medicare |
$154.36
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$154.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$223.32
|
| Rate for Payer: BCN Medicare Advantage |
$154.36
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Cofinity Commercial |
$206.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.36
|
| Rate for Payer: Healthscope Commercial |
$185.23
|
| Rate for Payer: Healthscope Whirlpool |
$185.23
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$162.08
|
| Rate for Payer: PACE SWMI |
$154.36
|
| Rate for Payer: PHP Medicare Advantage |
$154.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.84
|
| Rate for Payer: Priority Health Medicare |
$154.36
|
| Rate for Payer: Priority Health Narrow Network |
$187.84
|
| Rate for Payer: UHC Medicare Advantage |
$158.99
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$73.66
|
| Rate for Payer: Aetna Medicare |
$54.97
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS MAPPO |
$54.97
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: BCN Medicare Advantage |
$54.97
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$79.16
|
| Rate for Payer: Cofinity Commercial |
$73.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.97
|
| Rate for Payer: Healthscope Commercial |
$65.96
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.72
|
| Rate for Payer: PACE SWMI |
$54.97
|
| Rate for Payer: PHP Medicare Advantage |
$54.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.42
|
| Rate for Payer: Priority Health Medicare |
$54.97
|
| Rate for Payer: Priority Health Narrow Network |
$67.42
|
| Rate for Payer: UHC Medicare Advantage |
$56.62
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$351.25 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna Medicare |
$58.79
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$58.79
|
| Rate for Payer: BCBS Trust/PPO |
$351.25
|
| Rate for Payer: BCN Commercial |
$172.99
|
| Rate for Payer: BCN Medicare Advantage |
$58.79
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cofinity Commercial |
$84.66
|
| Rate for Payer: Cofinity Commercial |
$78.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.79
|
| Rate for Payer: Healthscope Commercial |
$70.55
|
| Rate for Payer: Healthscope Whirlpool |
$70.55
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.73
|
| Rate for Payer: PACE SWMI |
$58.79
|
| Rate for Payer: PHP Medicare Advantage |
$58.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.52
|
| Rate for Payer: Priority Health Medicare |
$58.79
|
| Rate for Payer: Priority Health Narrow Network |
$71.52
|
| Rate for Payer: UHC Medicare Advantage |
$60.55
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$933.10 |
| Rate for Payer: Aetna Commercial |
$233.67
|
| Rate for Payer: Aetna Medicare |
$174.38
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS MAPPO |
$174.38
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$252.16
|
| Rate for Payer: BCN Medicare Advantage |
$174.38
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$233.67
|
| Rate for Payer: Cofinity Commercial |
$251.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.38
|
| Rate for Payer: Healthscope Commercial |
$209.26
|
| Rate for Payer: Healthscope Whirlpool |
$209.26
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$183.10
|
| Rate for Payer: PACE SWMI |
$174.38
|
| Rate for Payer: PHP Medicare Advantage |
$174.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.10
|
| Rate for Payer: Priority Health Medicare |
$174.38
|
| Rate for Payer: Priority Health Narrow Network |
$212.10
|
| Rate for Payer: UHC Medicare Advantage |
$179.61
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$336.70 |
| Rate for Payer: Aetna Commercial |
$100.43
|
| Rate for Payer: Aetna Medicare |
$74.95
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS MAPPO |
$74.95
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$74.95
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cofinity Commercial |
$100.43
|
| Rate for Payer: Cofinity Commercial |
$107.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.95
|
| Rate for Payer: Healthscope Commercial |
$89.94
|
| Rate for Payer: Healthscope Whirlpool |
$89.94
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.70
|
| Rate for Payer: PACE SWMI |
$74.95
|
| Rate for Payer: PHP Medicare Advantage |
$74.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.25
|
| Rate for Payer: Priority Health Medicare |
$74.95
|
| Rate for Payer: Priority Health Narrow Network |
$91.25
|
| Rate for Payer: UHC Medicare Advantage |
$77.20
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$435.40 |
| Rate for Payer: Aetna Commercial |
$126.68
|
| Rate for Payer: Aetna Medicare |
$94.54
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS MAPPO |
$94.54
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$253.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.54
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cofinity Commercial |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$126.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.54
|
| Rate for Payer: Healthscope Commercial |
$113.45
|
| Rate for Payer: Healthscope Whirlpool |
$113.45
|
| Rate for Payer: Meridian Medicaid |
$62.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.27
|
| Rate for Payer: PACE SWMI |
$94.54
|
| Rate for Payer: PHP Medicare Advantage |
$94.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.09
|
| Rate for Payer: Priority Health Medicare |
$94.54
|
| Rate for Payer: Priority Health Narrow Network |
$115.09
|
| Rate for Payer: UHC Medicare Advantage |
$97.38
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$556.23 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Aetna Medicare |
$44.85
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$44.85
|
| Rate for Payer: BCBS Trust/PPO |
$556.23
|
| Rate for Payer: BCN Commercial |
$138.30
|
| Rate for Payer: BCN Medicare Advantage |
$44.85
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$64.58
|
| Rate for Payer: Cofinity Commercial |
$60.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.85
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: Healthscope Whirlpool |
$53.82
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.09
|
| Rate for Payer: PACE SWMI |
$44.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.08
|
| Rate for Payer: Priority Health Medicare |
$44.85
|
| Rate for Payer: Priority Health Narrow Network |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$46.20
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$193.79
|
| Rate for Payer: Aetna Medicare |
$144.62
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCBS MAPPO |
$144.62
|
| Rate for Payer: BCBS Trust/PPO |
$305.57
|
| Rate for Payer: BCN Commercial |
$339.63
|
| Rate for Payer: BCN Medicare Advantage |
$144.62
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cofinity Commercial |
$193.79
|
| Rate for Payer: Cofinity Commercial |
$208.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.62
|
| Rate for Payer: Healthscope Commercial |
$173.54
|
| Rate for Payer: Healthscope Whirlpool |
$173.54
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.85
|
| Rate for Payer: PACE SWMI |
$144.62
|
| Rate for Payer: PHP Medicare Advantage |
$144.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.74
|
| Rate for Payer: Priority Health Medicare |
$144.62
|
| Rate for Payer: Priority Health Narrow Network |
$176.74
|
| Rate for Payer: UHC Medicare Advantage |
$148.96
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$260.40 |
| Rate for Payer: Aetna Commercial |
$97.61
|
| Rate for Payer: Aetna Medicare |
$72.84
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$72.84
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$194.01
|
| Rate for Payer: BCN Medicare Advantage |
$72.84
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$97.61
|
| Rate for Payer: Cofinity Commercial |
$104.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.84
|
| Rate for Payer: Healthscope Commercial |
$87.41
|
| Rate for Payer: Healthscope Whirlpool |
$87.41
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.48
|
| Rate for Payer: PACE SWMI |
$72.84
|
| Rate for Payer: PHP Medicare Advantage |
$72.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.20
|
| Rate for Payer: Priority Health Medicare |
$72.84
|
| Rate for Payer: Priority Health Narrow Network |
$89.20
|
| Rate for Payer: UHC Medicare Advantage |
$75.03
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$3,043.01 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$12.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,043.01
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.97
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.97
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Whirlpool |
$15.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.62
|
| Rate for Payer: PACE SWMI |
$12.97
|
| Rate for Payer: PHP Medicare Advantage |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.61
|
| Rate for Payer: Priority Health Medicare |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$21.61
|
| Rate for Payer: UHC Medicare Advantage |
$13.36
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 31087
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$1,656.13 |
| Rate for Payer: Aetna Commercial |
$1,476.41
|
| Rate for Payer: Aetna Medicare |
$1,101.80
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,101.80
|
| Rate for Payer: BCBS Trust/PPO |
$896.53
|
| Rate for Payer: BCN Commercial |
$1,656.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,101.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.41
|
| Rate for Payer: Cofinity Commercial |
$1,586.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,101.80
|
| Rate for Payer: Healthscope Commercial |
$1,322.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.16
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,156.89
|
| Rate for Payer: PACE SWMI |
$1,101.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,101.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,470.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,569.26
|
| Rate for Payer: Priority Health Medicare |
$1,101.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,569.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,134.85
|
|
|
PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 31081
|
| Min. Negotiated Rate |
$750.83 |
| Max. Negotiated Rate |
$1,727.96 |
| Rate for Payer: Aetna Commercial |
$1,535.16
|
| Rate for Payer: Aetna Medicare |
$1,145.64
|
| Rate for Payer: BCBS Complete |
$788.37
|
| Rate for Payer: BCBS MAPPO |
$1,145.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.07
|
| Rate for Payer: BCN Commercial |
$1,727.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,145.64
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cash Price |
$1,635.20
|
| Rate for Payer: Cofinity Commercial |
$1,535.16
|
| Rate for Payer: Cofinity Commercial |
$1,649.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,145.64
|
| Rate for Payer: Healthscope Commercial |
$1,374.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,374.77
|
| Rate for Payer: Meridian Medicaid |
$788.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,202.92
|
| Rate for Payer: PACE SWMI |
$1,145.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,145.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$750.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,637.33
|
| Rate for Payer: Priority Health Medicare |
$1,145.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,637.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,180.01
|
|
|
PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC
|
Professional
|
Both
|
$2,615.00
|
|
|
Service Code
|
HCPCS 31085
|
| Min. Negotiated Rate |
$792.45 |
| Max. Negotiated Rate |
$1,843.29 |
| Rate for Payer: Aetna Commercial |
$1,640.37
|
| Rate for Payer: Aetna Medicare |
$1,224.16
|
| Rate for Payer: BCBS Complete |
$840.47
|
| Rate for Payer: BCBS MAPPO |
$1,224.16
|
| Rate for Payer: BCBS Trust/PPO |
$792.45
|
| Rate for Payer: BCN Commercial |
$1,843.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,224.16
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Cash Price |
$2,092.00
|
| Rate for Payer: Cofinity Commercial |
$1,762.79
|
| Rate for Payer: Cofinity Commercial |
$1,640.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,224.16
|
| Rate for Payer: Healthscope Commercial |
$1,468.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,468.99
|
| Rate for Payer: Meridian Medicaid |
$840.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,224.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,224.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$800.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,830.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,746.61
|
| Rate for Payer: Priority Health Medicare |
$1,224.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,746.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,260.88
|
|
