|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,938.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$566.87 |
| Max. Negotiated Rate |
$2,516.36 |
| Rate for Payer: Aetna Commercial |
$1,552.90
|
| Rate for Payer: Aetna Medicare |
$1,158.88
|
| Rate for Payer: BCBS Complete |
$780.32
|
| Rate for Payer: BCBS MAPPO |
$1,158.88
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$1,697.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,158.88
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,668.79
|
| Rate for Payer: Cofinity Commercial |
$1,552.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,158.88
|
| Rate for Payer: Healthscope Commercial |
$1,390.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,390.66
|
| Rate for Payer: Meridian Medicaid |
$780.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,216.82
|
| Rate for Payer: PACE SWMI |
$1,158.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,158.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$743.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,516.36
|
| Rate for Payer: Priority Health Medicare |
$1,158.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,516.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.65
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,639.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$482.87 |
| Max. Negotiated Rate |
$3,247.30 |
| Rate for Payer: Aetna Commercial |
$1,533.28
|
| Rate for Payer: Aetna Medicare |
$1,144.24
|
| Rate for Payer: BCBS Complete |
$770.48
|
| Rate for Payer: BCBS MAPPO |
$1,144.24
|
| Rate for Payer: BCBS Trust/PPO |
$482.87
|
| Rate for Payer: BCN Commercial |
$1,677.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.24
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$1,647.71
|
| Rate for Payer: Cofinity Commercial |
$1,533.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.24
|
| Rate for Payer: Healthscope Commercial |
$1,373.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,373.09
|
| Rate for Payer: Meridian Medicaid |
$770.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,201.45
|
| Rate for Payer: PACE SWMI |
$1,144.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,485.94
|
| Rate for Payer: Priority Health Medicare |
$1,144.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,485.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,178.57
|
|
|
PR SPLINT
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$903.75
|
| Rate for Payer: Aetna Medicare |
$674.44
|
| Rate for Payer: BCBS Complete |
$463.63
|
| Rate for Payer: BCBS MAPPO |
$674.44
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$674.44
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$971.19
|
| Rate for Payer: Cofinity Commercial |
$903.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$674.44
|
| Rate for Payer: Healthscope Commercial |
$809.33
|
| Rate for Payer: Healthscope Whirlpool |
$809.33
|
| Rate for Payer: Meridian Medicaid |
$463.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$708.16
|
| Rate for Payer: PACE SWMI |
$674.44
|
| Rate for Payer: PHP Medicare Advantage |
$674.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.09
|
| Rate for Payer: Priority Health Medicare |
$674.44
|
| Rate for Payer: Priority Health Narrow Network |
$845.09
|
| Rate for Payer: UHC Medicare Advantage |
$694.67
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$903.75
|
| Rate for Payer: Aetna Medicare |
$674.44
|
| Rate for Payer: BCBS Complete |
$463.63
|
| Rate for Payer: BCBS MAPPO |
$674.44
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$674.44
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$903.75
|
| Rate for Payer: Cofinity Commercial |
$971.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$674.44
|
| Rate for Payer: Healthscope Commercial |
$809.33
|
| Rate for Payer: Healthscope Whirlpool |
$809.33
|
| Rate for Payer: Meridian Medicaid |
$463.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$708.16
|
| Rate for Payer: PACE SWMI |
$674.44
|
| Rate for Payer: PHP Medicare Advantage |
$674.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.09
|
| Rate for Payer: Priority Health Medicare |
$674.44
|
| Rate for Payer: Priority Health Narrow Network |
$845.09
|
| Rate for Payer: UHC Medicare Advantage |
$694.67
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,099.70 |
| Max. Negotiated Rate |
$1,571.00 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: ASR ASR |
$1,523.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.00
|
| Rate for Payer: BCN Commercial |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.80
|
| Rate for Payer: Healthscope Commercial |
$1,571.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,523.87
|
| Rate for Payer: Mclaren Commercial |
$1,413.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,335.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,382.48
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,099.70 |
| Max. Negotiated Rate |
$3,986.20 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Medicare |
$3,188.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: ASR ASR |
$1,523.87
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.00
|
| Rate for Payer: BCN Commercial |
$1,218.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Healthscope Commercial |
$1,571.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,523.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,188.96
|
| Rate for Payer: Mclaren Commercial |
$1,413.90
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,335.35
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Commercial |
$3,507.86
|
| Rate for Payer: PHP Medicaid |
$1,744.36
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,429.61
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,382.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
PR SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna Commercial |
$175.31
|
| Rate for Payer: Aetna Medicare |
$130.83
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$130.83
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: BCN Medicare Advantage |
$130.83
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$188.40
|
| Rate for Payer: Cofinity Commercial |
$175.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.83
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Whirlpool |
$157.00
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.37
|
| Rate for Payer: PACE SWMI |
$130.83
|
| Rate for Payer: PHP Medicare Advantage |
$130.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.18
|
| Rate for Payer: Priority Health Medicare |
$130.83
|
| Rate for Payer: Priority Health Narrow Network |
$163.18
|
| Rate for Payer: UHC Medicare Advantage |
$134.75
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Aetna Commercial |
$938.68
|
| Rate for Payer: Aetna Medicare |
$700.51
|
| Rate for Payer: BCBS Complete |
$481.07
|
| Rate for Payer: BCBS MAPPO |
$700.51
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$700.51
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$938.68
|
| Rate for Payer: Cofinity Commercial |
$1,008.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.51
|
| Rate for Payer: Healthscope Commercial |
$840.61
|
| Rate for Payer: Healthscope Whirlpool |
$840.61
|
| Rate for Payer: Meridian Medicaid |
$481.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.54
|
| Rate for Payer: PACE SWMI |
$700.51
|
| Rate for Payer: PHP Medicare Advantage |
$700.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.80
|
| Rate for Payer: Priority Health Medicare |
$700.51
|
| Rate for Payer: Priority Health Narrow Network |
$878.80
|
| Rate for Payer: UHC Medicare Advantage |
$721.53
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Aetna Commercial |
$938.68
|
| Rate for Payer: Aetna Medicare |
$700.51
|
| Rate for Payer: BCBS Complete |
$481.07
|
| Rate for Payer: BCBS MAPPO |
$700.51
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$700.51
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$938.68
|
| Rate for Payer: Cofinity Commercial |
$1,008.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.51
|
| Rate for Payer: Healthscope Commercial |
$840.61
|
| Rate for Payer: Healthscope Whirlpool |
$840.61
|
| Rate for Payer: Meridian Medicaid |
$481.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.54
|
| Rate for Payer: PACE SWMI |
$700.51
|
| Rate for Payer: PHP Medicare Advantage |
$700.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.80
|
| Rate for Payer: Priority Health Medicare |
$700.51
|
| Rate for Payer: Priority Health Narrow Network |
$878.80
|
| Rate for Payer: UHC Medicare Advantage |
$721.53
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,477.00 |
| Max. Negotiated Rate |
$2,110.00 |
| Rate for Payer: Aetna Commercial |
$1,899.00
|
| Rate for Payer: ASR ASR |
$2,046.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,635.88
|
| Rate for Payer: BCN Commercial |
$1,635.88
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,983.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.00
|
| Rate for Payer: Healthscope Commercial |
$2,110.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,046.70
|
| Rate for Payer: Mclaren Commercial |
$1,899.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,793.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,856.80
|
|
|
PR SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,110.00 |
| Rate for Payer: Aetna Commercial |
$1,899.00
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$2,046.70
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,635.88
|
| Rate for Payer: BCN Commercial |
$1,635.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,983.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$2,110.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,046.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$1,899.00
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,793.50
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.10
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,498.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,856.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
PR SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$946.40 |
| Rate for Payer: Aetna Commercial |
$145.75
|
| Rate for Payer: Aetna Medicare |
$108.77
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS MAPPO |
$108.77
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$108.77
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cofinity Commercial |
$145.75
|
| Rate for Payer: Cofinity Commercial |
$156.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.77
|
| Rate for Payer: Healthscope Commercial |
$130.52
|
| Rate for Payer: Healthscope Whirlpool |
$130.52
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.21
|
| Rate for Payer: PACE SWMI |
$108.77
|
| Rate for Payer: PHP Medicare Advantage |
$108.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.23
|
| Rate for Payer: Priority Health Medicare |
$108.77
|
| Rate for Payer: Priority Health Narrow Network |
$135.23
|
| Rate for Payer: UHC Medicare Advantage |
$112.03
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$1,259.47 |
| Rate for Payer: Aetna Commercial |
$33.93
|
| Rate for Payer: Aetna Commercial |
$33.93
|
| Rate for Payer: Aetna Medicare |
$25.32
|
| Rate for Payer: Aetna Medicare |
$25.32
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$25.32
|
| Rate for Payer: BCBS MAPPO |
$25.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.47
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: BCN Medicare Advantage |
$25.32
|
| Rate for Payer: BCN Medicare Advantage |
$25.32
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Cofinity Commercial |
$33.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.32
|
| Rate for Payer: Healthscope Commercial |
$30.38
|
| Rate for Payer: Healthscope Commercial |
$30.38
|
| Rate for Payer: Healthscope Whirlpool |
$30.38
|
| Rate for Payer: Healthscope Whirlpool |
$30.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.59
|
| Rate for Payer: PACE SWMI |
$25.32
|
| Rate for Payer: PACE SWMI |
$25.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.93
|
| Rate for Payer: Priority Health Medicare |
$25.32
|
| Rate for Payer: Priority Health Medicare |
$25.32
|
| Rate for Payer: Priority Health Narrow Network |
$35.93
|
| Rate for Payer: Priority Health Narrow Network |
$35.93
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
| Rate for Payer: UHC Medicare Advantage |
$26.08
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$1,875.99 |
| Rate for Payer: Aetna Commercial |
$32.79
|
| Rate for Payer: Aetna Medicare |
$24.47
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.99
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: BCN Medicare Advantage |
$24.47
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$32.79
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$29.36
|
| Rate for Payer: Healthscope Whirlpool |
$29.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.69
|
| Rate for Payer: PACE SWMI |
$24.47
|
| Rate for Payer: PHP Medicare Advantage |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.69
|
| Rate for Payer: Priority Health Medicare |
$24.47
|
| Rate for Payer: Priority Health Narrow Network |
$33.69
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
|
|
PR SPORTS PHYSICAL
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$169.97 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Aetna Commercial |
$356.63
|
| Rate for Payer: Aetna Medicare |
$266.14
|
| Rate for Payer: BCBS Complete |
$178.47
|
| Rate for Payer: BCBS MAPPO |
$266.14
|
| Rate for Payer: BCBS Trust/PPO |
$463.85
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: BCN Medicare Advantage |
$266.14
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cofinity Commercial |
$356.63
|
| Rate for Payer: Cofinity Commercial |
$383.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.14
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Healthscope Whirlpool |
$319.37
|
| Rate for Payer: Meridian Medicaid |
$178.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$279.45
|
| Rate for Payer: PACE SWMI |
$266.14
|
| Rate for Payer: PHP Medicare Advantage |
$266.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.43
|
| Rate for Payer: Priority Health Medicare |
$266.14
|
| Rate for Payer: Priority Health Narrow Network |
$423.43
|
| Rate for Payer: UHC Medicare Advantage |
$274.12
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$208.31 |
| Max. Negotiated Rate |
$857.50 |
| Rate for Payer: Aetna Commercial |
$436.83
|
| Rate for Payer: Aetna Medicare |
$325.99
|
| Rate for Payer: BCBS Complete |
$218.73
|
| Rate for Payer: BCBS MAPPO |
$325.99
|
| Rate for Payer: BCBS Trust/PPO |
$327.02
|
| Rate for Payer: BCN Commercial |
$725.69
|
| Rate for Payer: BCN Medicare Advantage |
$325.99
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$469.43
|
| Rate for Payer: Cofinity Commercial |
$436.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.99
|
| Rate for Payer: Healthscope Commercial |
$391.19
|
| Rate for Payer: Healthscope Whirlpool |
$391.19
|
| Rate for Payer: Meridian Medicaid |
$218.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.29
|
| Rate for Payer: PACE SWMI |
$325.99
|
| Rate for Payer: PHP Medicare Advantage |
$325.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.12
|
| Rate for Payer: Priority Health Medicare |
$325.99
|
| Rate for Payer: Priority Health Narrow Network |
$518.12
|
| Rate for Payer: UHC Medicare Advantage |
$335.77
|
|
|
PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
HCPCS 49220
|
| Min. Negotiated Rate |
$683.60 |
| Max. Negotiated Rate |
$1,196.30 |
| Rate for Payer: BCBS Complete |
$683.60
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,196.30
|
|
|
PR STANDARDIZED COGNITIVE PERFORMANCE TESTING
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 96125
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$133.49
|
| Rate for Payer: Aetna Medicare |
$99.62
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$99.62
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$149.05
|
| Rate for Payer: BCN Medicare Advantage |
$99.62
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$143.45
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.62
|
| Rate for Payer: Healthscope Commercial |
$119.54
|
| Rate for Payer: Healthscope Whirlpool |
$119.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$104.60
|
| Rate for Payer: PACE SWMI |
$99.62
|
| Rate for Payer: PHP Medicare Advantage |
$99.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.99
|
| Rate for Payer: Priority Health Medicare |
$99.62
|
| Rate for Payer: Priority Health Narrow Network |
$136.99
|
| Rate for Payer: UHC Medicare Advantage |
$102.61
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$593.84 |
| Max. Negotiated Rate |
$1,545.81 |
| Rate for Payer: Aetna Commercial |
$1,217.87
|
| Rate for Payer: Aetna Medicare |
$908.86
|
| Rate for Payer: BCBS Complete |
$623.53
|
| Rate for Payer: BCBS MAPPO |
$908.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.81
|
| Rate for Payer: BCN Commercial |
$1,365.86
|
| Rate for Payer: BCN Medicare Advantage |
$908.86
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,308.76
|
| Rate for Payer: Cofinity Commercial |
$1,217.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$908.86
|
| Rate for Payer: Healthscope Commercial |
$1,090.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,090.63
|
| Rate for Payer: Meridian Medicaid |
$623.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$954.30
|
| Rate for Payer: PACE SWMI |
$908.86
|
| Rate for Payer: PHP Medicare Advantage |
$908.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$593.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,317.73
|
| Rate for Payer: Priority Health Medicare |
$908.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,317.73
|
| Rate for Payer: UHC Medicare Advantage |
$936.13
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT
|
Professional
|
Both
|
$2,385.00
|
|
|
Service Code
|
HCPCS 69661
|
| Min. Negotiated Rate |
$773.40 |
| Max. Negotiated Rate |
$1,935.16 |
| Rate for Payer: Aetna Commercial |
$1,587.20
|
| Rate for Payer: Aetna Medicare |
$1,184.48
|
| Rate for Payer: BCBS Complete |
$812.07
|
| Rate for Payer: BCBS MAPPO |
$1,184.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.16
|
| Rate for Payer: BCN Commercial |
$1,778.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,184.48
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cofinity Commercial |
$1,587.20
|
| Rate for Payer: Cofinity Commercial |
$1,705.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,184.48
|
| Rate for Payer: Healthscope Commercial |
$1,421.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,421.38
|
| Rate for Payer: Meridian Medicaid |
$812.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,243.70
|
| Rate for Payer: PACE SWMI |
$1,184.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,184.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,669.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,716.11
|
| Rate for Payer: Priority Health Medicare |
$1,184.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,716.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,220.01
|
|
|
PR STAPES MOBILIZATION
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 69650
|
| Min. Negotiated Rate |
$516.95 |
| Max. Negotiated Rate |
$1,315.47 |
| Rate for Payer: Aetna Commercial |
$1,054.75
|
| Rate for Payer: Aetna Medicare |
$787.13
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS MAPPO |
$787.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.47
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$787.13
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.47
|
| Rate for Payer: Cofinity Commercial |
$1,054.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.13
|
| Rate for Payer: Healthscope Commercial |
$944.56
|
| Rate for Payer: Healthscope Whirlpool |
$944.56
|
| Rate for Payer: Meridian Medicaid |
$542.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$826.49
|
| Rate for Payer: PACE SWMI |
$787.13
|
| Rate for Payer: PHP Medicare Advantage |
$787.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.17
|
| Rate for Payer: Priority Health Medicare |
$787.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,145.17
|
| Rate for Payer: UHC Medicare Advantage |
$810.74
|
|
|
PR STENGER TEST PURE TONE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 92565
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$1,644.60 |
| Rate for Payer: Aetna Commercial |
$24.90
|
| Rate for Payer: Aetna Medicare |
$18.58
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$18.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.60
|
| Rate for Payer: BCN Commercial |
$29.32
|
| Rate for Payer: BCN Medicare Advantage |
$18.58
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$24.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Whirlpool |
$22.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.51
|
| Rate for Payer: PACE SWMI |
$18.58
|
| Rate for Payer: PHP Medicare Advantage |
$18.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.95
|
| Rate for Payer: Priority Health Medicare |
$18.58
|
| Rate for Payer: Priority Health Narrow Network |
$26.95
|
| Rate for Payer: UHC Medicare Advantage |
$19.14
|
|
|
PR STENGER TEST SPEECH
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92577
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$25.31
|
| Rate for Payer: Aetna Medicare |
$18.89
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$18.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$18.89
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$22.67
|
| Rate for Payer: Healthscope Whirlpool |
$22.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.83
|
| Rate for Payer: PACE SWMI |
$18.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.40
|
| Rate for Payer: Priority Health Medicare |
$18.89
|
| Rate for Payer: Priority Health Narrow Network |
$27.40
|
| Rate for Payer: UHC Medicare Advantage |
$19.46
|
|
