|
PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA
|
Professional
|
Both
|
$3,833.00
|
|
|
Service Code
|
HCPCS 61108
|
| Min. Negotiated Rate |
$590.86 |
| Max. Negotiated Rate |
$2,683.10 |
| Rate for Payer: Aetna Commercial |
$1,217.50
|
| Rate for Payer: Aetna Medicare |
$908.58
|
| Rate for Payer: BCBS Complete |
$620.40
|
| Rate for Payer: BCBS MAPPO |
$908.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: BCN Commercial |
$1,862.28
|
| Rate for Payer: BCN Medicare Advantage |
$908.58
|
| Rate for Payer: Cash Price |
$3,066.40
|
| Rate for Payer: Cash Price |
$3,066.40
|
| Rate for Payer: Cofinity Commercial |
$1,308.36
|
| Rate for Payer: Cofinity Commercial |
$1,217.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$908.58
|
| Rate for Payer: Healthscope Commercial |
$1,090.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,090.30
|
| Rate for Payer: Meridian Medicaid |
$620.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$954.01
|
| Rate for Payer: PACE SWMI |
$908.58
|
| Rate for Payer: PHP Medicare Advantage |
$908.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,683.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,555.41
|
| Rate for Payer: Priority Health Medicare |
$908.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,555.41
|
| Rate for Payer: UHC Medicare Advantage |
$935.84
|
|
|
PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 61107
|
| Min. Negotiated Rate |
$200.43 |
| Max. Negotiated Rate |
$1,701.00 |
| Rate for Payer: Aetna Commercial |
$421.71
|
| Rate for Payer: Aetna Medicare |
$314.71
|
| Rate for Payer: BCBS Complete |
$210.45
|
| Rate for Payer: BCBS MAPPO |
$314.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.60
|
| Rate for Payer: BCN Commercial |
$633.87
|
| Rate for Payer: BCN Medicare Advantage |
$314.71
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cofinity Commercial |
$453.18
|
| Rate for Payer: Cofinity Commercial |
$421.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.71
|
| Rate for Payer: Healthscope Commercial |
$377.65
|
| Rate for Payer: Healthscope Whirlpool |
$377.65
|
| Rate for Payer: Meridian Medicaid |
$210.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$330.45
|
| Rate for Payer: PACE SWMI |
$314.71
|
| Rate for Payer: PHP Medicare Advantage |
$314.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,701.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.43
|
| Rate for Payer: Priority Health Medicare |
$314.71
|
| Rate for Payer: Priority Health Narrow Network |
$529.43
|
| Rate for Payer: UHC Medicare Advantage |
$324.15
|
|
|
PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$2,107.00
|
|
|
Service Code
|
HCPCS 61105
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$1,474.90 |
| Rate for Payer: Aetna Commercial |
$622.85
|
| Rate for Payer: Aetna Medicare |
$464.81
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS MAPPO |
$464.81
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$957.24
|
| Rate for Payer: BCN Medicare Advantage |
$464.81
|
| Rate for Payer: Cash Price |
$1,685.60
|
| Rate for Payer: Cash Price |
$1,685.60
|
| Rate for Payer: Cofinity Commercial |
$622.85
|
| Rate for Payer: Cofinity Commercial |
$669.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.81
|
| Rate for Payer: Healthscope Commercial |
$557.77
|
| Rate for Payer: Healthscope Whirlpool |
$557.77
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$488.05
|
| Rate for Payer: PACE SWMI |
$464.81
|
| Rate for Payer: PHP Medicare Advantage |
$464.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,474.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$799.51
|
| Rate for Payer: Priority Health Medicare |
$464.81
|
| Rate for Payer: Priority Health Narrow Network |
$799.51
|
| Rate for Payer: UHC Medicare Advantage |
$478.75
|
|
|
PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 00528
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$1,890.00 |
| Rate for Payer: BCBS Complete |
$1,080.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,890.00
|
|
|
PR TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 46280
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$5,471.60 |
| Rate for Payer: Aetna Commercial |
$631.90
|
| Rate for Payer: Aetna Medicare |
$471.57
|
| Rate for Payer: BCBS Complete |
$324.96
|
| Rate for Payer: BCBS MAPPO |
$471.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,471.60
|
| Rate for Payer: BCN Commercial |
$706.14
|
| Rate for Payer: BCN Medicare Advantage |
$471.57
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cash Price |
$1,148.80
|
| Rate for Payer: Cofinity Commercial |
$631.90
|
| Rate for Payer: Cofinity Commercial |
$679.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.57
|
| Rate for Payer: Healthscope Commercial |
$565.88
|
| Rate for Payer: Healthscope Whirlpool |
$565.88
|
| Rate for Payer: Meridian Medicaid |
$324.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.15
|
| Rate for Payer: PACE SWMI |
$471.57
|
| Rate for Payer: PHP Medicare Advantage |
$471.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.62
|
| Rate for Payer: Priority Health Medicare |
$471.57
|
| Rate for Payer: Priority Health Narrow Network |
$849.62
|
| Rate for Payer: UHC Medicare Advantage |
$485.72
|
|
|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$318.04 |
| Max. Negotiated Rate |
$1,397.13 |
| Rate for Payer: Aetna Commercial |
$1,277.44
|
| Rate for Payer: Aetna Medicare |
$953.31
|
| Rate for Payer: BCBS Complete |
$642.55
|
| Rate for Payer: BCBS MAPPO |
$953.31
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$1,397.13
|
| Rate for Payer: BCN Medicare Advantage |
$953.31
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,372.77
|
| Rate for Payer: Cofinity Commercial |
$1,277.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.31
|
| Rate for Payer: Healthscope Commercial |
$1,143.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.97
|
| Rate for Payer: Meridian Medicaid |
$642.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,000.98
|
| Rate for Payer: PACE SWMI |
$953.31
|
| Rate for Payer: PHP Medicare Advantage |
$953.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$611.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,349.95
|
| Rate for Payer: Priority Health Medicare |
$953.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.95
|
| Rate for Payer: UHC Medicare Advantage |
$981.91
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,695.00
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$1,203.12 |
| Rate for Payer: Aetna Commercial |
$1,098.00
|
| Rate for Payer: Aetna Medicare |
$819.40
|
| Rate for Payer: BCBS Complete |
$553.76
|
| Rate for Payer: BCBS MAPPO |
$819.40
|
| Rate for Payer: BCBS Trust/PPO |
$51.77
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: BCN Medicare Advantage |
$819.40
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cofinity Commercial |
$1,179.94
|
| Rate for Payer: Cofinity Commercial |
$1,098.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.40
|
| Rate for Payer: Healthscope Commercial |
$983.28
|
| Rate for Payer: Healthscope Whirlpool |
$983.28
|
| Rate for Payer: Meridian Medicaid |
$553.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$860.37
|
| Rate for Payer: PACE SWMI |
$819.40
|
| Rate for Payer: PHP Medicare Advantage |
$819.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,162.49
|
| Rate for Payer: Priority Health Medicare |
$819.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,162.49
|
| Rate for Payer: UHC Medicare Advantage |
$843.98
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,781.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,210.90
|
| Rate for Payer: Aetna Medicare |
$903.66
|
| Rate for Payer: BCBS Complete |
$609.67
|
| Rate for Payer: BCBS MAPPO |
$903.66
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$1,324.80
|
| Rate for Payer: BCN Medicare Advantage |
$903.66
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cash Price |
$1,424.80
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Cofinity Commercial |
$1,301.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.66
|
| Rate for Payer: Healthscope Commercial |
$1,084.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,084.39
|
| Rate for Payer: Meridian Medicaid |
$609.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$948.84
|
| Rate for Payer: PACE SWMI |
$903.66
|
| Rate for Payer: PHP Medicare Advantage |
$903.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$580.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,280.06
|
| Rate for Payer: Priority Health Medicare |
$903.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,280.06
|
| Rate for Payer: UHC Medicare Advantage |
$930.77
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,438.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$286.34 |
| Max. Negotiated Rate |
$1,203.12 |
| Rate for Payer: Aetna Commercial |
$1,098.28
|
| Rate for Payer: Aetna Medicare |
$819.61
|
| Rate for Payer: BCBS Complete |
$553.98
|
| Rate for Payer: BCBS MAPPO |
$819.61
|
| Rate for Payer: BCBS Trust/PPO |
$286.34
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: BCN Medicare Advantage |
$819.61
|
| Rate for Payer: Cash Price |
$1,150.40
|
| Rate for Payer: Cash Price |
$1,150.40
|
| Rate for Payer: Cofinity Commercial |
$1,180.24
|
| Rate for Payer: Cofinity Commercial |
$1,098.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.61
|
| Rate for Payer: Healthscope Commercial |
$983.53
|
| Rate for Payer: Healthscope Whirlpool |
$983.53
|
| Rate for Payer: Meridian Medicaid |
$553.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$860.59
|
| Rate for Payer: PACE SWMI |
$819.61
|
| Rate for Payer: PHP Medicare Advantage |
$819.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,162.49
|
| Rate for Payer: Priority Health Medicare |
$819.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,162.49
|
| Rate for Payer: UHC Medicare Advantage |
$844.20
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,445.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$2,411.50 |
| Rate for Payer: Aetna Commercial |
$1,136.75
|
| Rate for Payer: Aetna Medicare |
$848.32
|
| Rate for Payer: BCBS Complete |
$582.16
|
| Rate for Payer: BCBS MAPPO |
$848.32
|
| Rate for Payer: BCBS Trust/PPO |
$345.51
|
| Rate for Payer: BCN Commercial |
$1,263.24
|
| Rate for Payer: BCN Medicare Advantage |
$848.32
|
| Rate for Payer: Cash Price |
$2,756.00
|
| Rate for Payer: Cash Price |
$2,756.00
|
| Rate for Payer: Cofinity Commercial |
$1,136.75
|
| Rate for Payer: Cofinity Commercial |
$1,221.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$848.32
|
| Rate for Payer: Healthscope Commercial |
$1,017.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,017.98
|
| Rate for Payer: Meridian Medicaid |
$582.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$890.74
|
| Rate for Payer: PACE SWMI |
$848.32
|
| Rate for Payer: PHP Medicare Advantage |
$848.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,411.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,320.02
|
| Rate for Payer: Priority Health Medicare |
$848.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,320.02
|
| Rate for Payer: UHC Medicare Advantage |
$873.77
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$1,118.94 |
| Rate for Payer: Aetna Commercial |
$411.17
|
| Rate for Payer: Aetna Medicare |
$306.84
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$306.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.94
|
| Rate for Payer: BCN Commercial |
$536.56
|
| Rate for Payer: BCN Medicare Advantage |
$306.84
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$441.85
|
| Rate for Payer: Cofinity Commercial |
$411.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.84
|
| Rate for Payer: Healthscope Commercial |
$368.21
|
| Rate for Payer: Healthscope Whirlpool |
$368.21
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$322.18
|
| Rate for Payer: PACE SWMI |
$306.84
|
| Rate for Payer: PHP Medicare Advantage |
$306.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.70
|
| Rate for Payer: Priority Health Medicare |
$306.84
|
| Rate for Payer: Priority Health Narrow Network |
$437.70
|
| Rate for Payer: UHC Medicare Advantage |
$316.05
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,025.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$787.04 |
| Max. Negotiated Rate |
$2,817.50 |
| Rate for Payer: Aetna Commercial |
$1,618.21
|
| Rate for Payer: Aetna Medicare |
$1,207.62
|
| Rate for Payer: BCBS Complete |
$826.39
|
| Rate for Payer: BCBS MAPPO |
$1,207.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,447.01
|
| Rate for Payer: BCN Commercial |
$1,792.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,207.62
|
| Rate for Payer: Cash Price |
$3,220.00
|
| Rate for Payer: Cash Price |
$3,220.00
|
| Rate for Payer: Cofinity Commercial |
$1,738.97
|
| Rate for Payer: Cofinity Commercial |
$1,618.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,207.62
|
| Rate for Payer: Healthscope Commercial |
$1,449.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,449.14
|
| Rate for Payer: Meridian Medicaid |
$826.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,268.00
|
| Rate for Payer: PACE SWMI |
$1,207.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,207.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$787.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,817.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,873.57
|
| Rate for Payer: Priority Health Medicare |
$1,207.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,873.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,243.85
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,403.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$788.10 |
| Max. Negotiated Rate |
$2,382.10 |
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: Aetna Medicare |
$1,209.03
|
| Rate for Payer: BCBS Complete |
$827.50
|
| Rate for Payer: BCBS MAPPO |
$1,209.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.73
|
| Rate for Payer: BCN Commercial |
$1,976.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,209.03
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cofinity Commercial |
$1,741.00
|
| Rate for Payer: Cofinity Commercial |
$1,620.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,209.03
|
| Rate for Payer: Healthscope Commercial |
$1,450.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,450.84
|
| Rate for Payer: Meridian Medicaid |
$827.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,269.48
|
| Rate for Payer: PACE SWMI |
$1,209.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,209.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,382.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,875.62
|
| Rate for Payer: Priority Health Medicare |
$1,209.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,875.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,245.30
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$1,022.79 |
| Rate for Payer: Aetna Commercial |
$513.11
|
| Rate for Payer: Aetna Medicare |
$382.92
|
| Rate for Payer: BCBS Complete |
$263.24
|
| Rate for Payer: BCBS MAPPO |
$382.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.79
|
| Rate for Payer: BCN Commercial |
$650.43
|
| Rate for Payer: BCN Medicare Advantage |
$382.92
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cofinity Commercial |
$551.40
|
| Rate for Payer: Cofinity Commercial |
$513.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.92
|
| Rate for Payer: Healthscope Commercial |
$459.50
|
| Rate for Payer: Healthscope Whirlpool |
$459.50
|
| Rate for Payer: Meridian Medicaid |
$263.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.07
|
| Rate for Payer: PACE SWMI |
$382.92
|
| Rate for Payer: PHP Medicare Advantage |
$382.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$551.02
|
| Rate for Payer: Priority Health Medicare |
$382.92
|
| Rate for Payer: Priority Health Narrow Network |
$551.02
|
| Rate for Payer: UHC Medicare Advantage |
$394.41
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$244.95 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$504.04
|
| Rate for Payer: Aetna Medicare |
$376.15
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS MAPPO |
$376.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: BCN Commercial |
$641.15
|
| Rate for Payer: BCN Medicare Advantage |
$376.15
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cofinity Commercial |
$541.66
|
| Rate for Payer: Cofinity Commercial |
$504.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.15
|
| Rate for Payer: Healthscope Commercial |
$451.38
|
| Rate for Payer: Healthscope Whirlpool |
$451.38
|
| Rate for Payer: Meridian Medicaid |
$257.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$394.96
|
| Rate for Payer: PACE SWMI |
$376.15
|
| Rate for Payer: PHP Medicare Advantage |
$376.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.75
|
| Rate for Payer: Priority Health Medicare |
$376.15
|
| Rate for Payer: Priority Health Narrow Network |
$538.75
|
| Rate for Payer: UHC Medicare Advantage |
$387.43
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$1,182.86 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Medicare |
$233.30
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS MAPPO |
$233.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$547.32
|
| Rate for Payer: BCN Medicare Advantage |
$233.30
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cofinity Commercial |
$335.95
|
| Rate for Payer: Cofinity Commercial |
$312.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.30
|
| Rate for Payer: Healthscope Commercial |
$279.96
|
| Rate for Payer: Healthscope Whirlpool |
$279.96
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$244.96
|
| Rate for Payer: PACE SWMI |
$233.30
|
| Rate for Payer: PHP Medicare Advantage |
$233.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.62
|
| Rate for Payer: Priority Health Medicare |
$233.30
|
| Rate for Payer: Priority Health Narrow Network |
$365.62
|
| Rate for Payer: UHC Medicare Advantage |
$240.30
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$609.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$920.30 |
| Rate for Payer: Aetna Commercial |
$372.39
|
| Rate for Payer: Aetna Medicare |
$277.90
|
| Rate for Payer: BCBS Complete |
$193.01
|
| Rate for Payer: BCBS MAPPO |
$277.90
|
| Rate for Payer: BCBS Trust/PPO |
$920.30
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: BCN Medicare Advantage |
$277.90
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cofinity Commercial |
$372.39
|
| Rate for Payer: Cofinity Commercial |
$400.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.90
|
| Rate for Payer: Healthscope Commercial |
$333.48
|
| Rate for Payer: Healthscope Whirlpool |
$333.48
|
| Rate for Payer: Meridian Medicaid |
$193.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$291.80
|
| Rate for Payer: PACE SWMI |
$277.90
|
| Rate for Payer: PHP Medicare Advantage |
$277.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.05
|
| Rate for Payer: Priority Health Medicare |
$277.90
|
| Rate for Payer: Priority Health Narrow Network |
$434.05
|
| Rate for Payer: UHC Medicare Advantage |
$286.24
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$1,227.77 |
| Rate for Payer: Aetna Commercial |
$621.77
|
| Rate for Payer: Aetna Medicare |
$464.01
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS MAPPO |
$464.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.77
|
| Rate for Payer: BCN Commercial |
$685.61
|
| Rate for Payer: BCN Medicare Advantage |
$464.01
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cofinity Commercial |
$668.17
|
| Rate for Payer: Cofinity Commercial |
$621.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.01
|
| Rate for Payer: Healthscope Commercial |
$556.81
|
| Rate for Payer: Healthscope Whirlpool |
$556.81
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$487.21
|
| Rate for Payer: PACE SWMI |
$464.01
|
| Rate for Payer: PHP Medicare Advantage |
$464.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$662.46
|
| Rate for Payer: Priority Health Medicare |
$464.01
|
| Rate for Payer: Priority Health Narrow Network |
$662.46
|
| Rate for Payer: UHC Medicare Advantage |
$477.93
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,328.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$595.12 |
| Max. Negotiated Rate |
$4,429.60 |
| Rate for Payer: Aetna Commercial |
$1,218.89
|
| Rate for Payer: Aetna Medicare |
$909.62
|
| Rate for Payer: BCBS Complete |
$624.88
|
| Rate for Payer: BCBS MAPPO |
$909.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.66
|
| Rate for Payer: BCN Commercial |
$1,355.11
|
| Rate for Payer: BCN Medicare Advantage |
$909.62
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cash Price |
$5,062.40
|
| Rate for Payer: Cofinity Commercial |
$1,218.89
|
| Rate for Payer: Cofinity Commercial |
$1,309.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.62
|
| Rate for Payer: Healthscope Commercial |
$1,091.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.54
|
| Rate for Payer: Meridian Medicaid |
$624.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$955.10
|
| Rate for Payer: PACE SWMI |
$909.62
|
| Rate for Payer: PHP Medicare Advantage |
$909.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,429.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.03
|
| Rate for Payer: Priority Health Medicare |
$909.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.03
|
| Rate for Payer: UHC Medicare Advantage |
$936.91
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$2,684.82 |
| Rate for Payer: Aetna Commercial |
$477.43
|
| Rate for Payer: Aetna Medicare |
$356.29
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS MAPPO |
$356.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,684.82
|
| Rate for Payer: BCN Commercial |
$528.75
|
| Rate for Payer: BCN Medicare Advantage |
$356.29
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$513.06
|
| Rate for Payer: Cofinity Commercial |
$477.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.29
|
| Rate for Payer: Healthscope Commercial |
$427.55
|
| Rate for Payer: Healthscope Whirlpool |
$427.55
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.10
|
| Rate for Payer: PACE SWMI |
$356.29
|
| Rate for Payer: PHP Medicare Advantage |
$356.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.52
|
| Rate for Payer: Priority Health Medicare |
$356.29
|
| Rate for Payer: Priority Health Narrow Network |
$552.52
|
| Rate for Payer: UHC Medicare Advantage |
$366.98
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: ASR ASR |
$447.17
|
| Rate for Payer: BCBS Trust/PPO |
$357.41
|
| Rate for Payer: BCN Commercial |
$357.41
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$433.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.80
|
| Rate for Payer: Healthscope Commercial |
$461.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.17
|
| Rate for Payer: Mclaren Commercial |
$414.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.68
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$305.37 |
| Max. Negotiated Rate |
$697.82 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Aetna Medicare |
$558.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: ASR ASR |
$447.17
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$357.41
|
| Rate for Payer: BCN Commercial |
$357.41
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$433.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Healthscope Commercial |
$461.00
|
| Rate for Payer: Healthscope Whirlpool |
$447.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.26
|
| Rate for Payer: Mclaren Commercial |
$414.90
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.85
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Commercial |
$614.09
|
| Rate for Payer: PHP Medicaid |
$305.37
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.73
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$524.58
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.68
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$441.27 |
| Rate for Payer: Aetna Commercial |
$246.49
|
| Rate for Payer: Aetna Medicare |
$183.95
|
| Rate for Payer: BCBS Complete |
$126.59
|
| Rate for Payer: BCBS MAPPO |
$183.95
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: BCN Medicare Advantage |
$183.95
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$264.89
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.95
|
| Rate for Payer: Healthscope Commercial |
$220.74
|
| Rate for Payer: Healthscope Whirlpool |
$220.74
|
| Rate for Payer: Meridian Medicaid |
$126.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$193.15
|
| Rate for Payer: PACE SWMI |
$183.95
|
| Rate for Payer: PHP Medicare Advantage |
$183.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.01
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: Priority Health Narrow Network |
$231.01
|
| Rate for Payer: UHC Medicare Advantage |
$189.47
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$441.27 |
| Rate for Payer: Aetna Commercial |
$246.49
|
| Rate for Payer: Aetna Medicare |
$183.95
|
| Rate for Payer: BCBS Complete |
$126.59
|
| Rate for Payer: BCBS MAPPO |
$183.95
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: BCN Medicare Advantage |
$183.95
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$264.89
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.95
|
| Rate for Payer: Healthscope Commercial |
$220.74
|
| Rate for Payer: Healthscope Whirlpool |
$220.74
|
| Rate for Payer: Meridian Medicaid |
$126.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$193.15
|
| Rate for Payer: PACE SWMI |
$183.95
|
| Rate for Payer: PHP Medicare Advantage |
$183.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.01
|
| Rate for Payer: Priority Health Medicare |
$183.95
|
| Rate for Payer: Priority Health Narrow Network |
$231.01
|
| Rate for Payer: UHC Medicare Advantage |
$189.47
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$259.98 |
| Rate for Payer: Aetna Commercial |
$184.05
|
| Rate for Payer: Aetna Medicare |
$137.35
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS MAPPO |
$137.35
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$259.98
|
| Rate for Payer: BCN Medicare Advantage |
$137.35
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$197.78
|
| Rate for Payer: Cofinity Commercial |
$184.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.35
|
| Rate for Payer: Healthscope Commercial |
$164.82
|
| Rate for Payer: Healthscope Whirlpool |
$164.82
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.22
|
| Rate for Payer: PACE SWMI |
$137.35
|
| Rate for Payer: PHP Medicare Advantage |
$137.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.05
|
| Rate for Payer: Priority Health Medicare |
$137.35
|
| Rate for Payer: Priority Health Narrow Network |
$173.05
|
| Rate for Payer: UHC Medicare Advantage |
$141.47
|
|
