|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: Aetna Medicare |
$65.54
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: BCBS Trust/PPO |
$107.35
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.86
|
| Rate for Payer: Priority Health Narrow Network |
$91.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$116.71
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.86 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Aetna Commercial |
$105.04
|
| Rate for Payer: ASR ASR |
$113.21
|
| Rate for Payer: ASR Commercial |
$113.21
|
| Rate for Payer: BCBS Trust/PPO |
$95.11
|
| Rate for Payer: BCN Commercial |
$90.49
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$109.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$116.71
|
| Rate for Payer: Healthscope Whirlpool |
$113.21
|
| Rate for Payer: Mclaren Commercial |
$105.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.20
|
| Rate for Payer: Nomi Health Commercial |
$95.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.70
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,527.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$775.11 |
| Max. Negotiated Rate |
$4,748.36 |
| Rate for Payer: Aetna Commercial |
$1,561.74
|
| Rate for Payer: Aetna Medicare |
$1,263.50
|
| Rate for Payer: BCBS Complete |
$813.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,748.36
|
| Rate for Payer: BCN Commercial |
$1,748.49
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Meridian Medicaid |
$813.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$775.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,642.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,926.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,926.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,479.50
|
| Rate for Payer: UHC Exchange |
$1,479.50
|
| Rate for Payer: UHCCP Medicaid |
$775.11
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$289.47 |
| Max. Negotiated Rate |
$900.10 |
| Rate for Payer: Aetna Commercial |
$551.41
|
| Rate for Payer: Aetna Medicare |
$450.50
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: BCBS Trust/PPO |
$662.49
|
| Rate for Payer: BCN Commercial |
$654.83
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Meridian Medicaid |
$303.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.10
|
| Rate for Payer: Priority Health Narrow Network |
$900.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.31
|
| Rate for Payer: UHC Exchange |
$531.31
|
| Rate for Payer: UHCCP Medicaid |
$289.47
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$289.47 |
| Max. Negotiated Rate |
$900.10 |
| Rate for Payer: Aetna Commercial |
$551.41
|
| Rate for Payer: Aetna Medicare |
$450.50
|
| Rate for Payer: BCBS Complete |
$303.94
|
| Rate for Payer: BCBS Trust/PPO |
$662.49
|
| Rate for Payer: BCN Commercial |
$654.83
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Meridian Medicaid |
$303.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.10
|
| Rate for Payer: Priority Health Narrow Network |
$900.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.31
|
| Rate for Payer: UHC Exchange |
$531.31
|
| Rate for Payer: UHCCP Medicaid |
$289.47
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$5,815.37 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Medicare |
$3,751.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: ASR ASR |
$873.97
|
| Rate for Payer: ASR Commercial |
$873.97
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$737.83
|
| Rate for Payer: BCN Commercial |
$698.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$846.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$901.00
|
| Rate for Payer: Healthscope Whirlpool |
$873.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,751.85
|
| Rate for Payer: Mclaren Commercial |
$810.90
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: Nomi Health Commercial |
$738.82
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$4,127.04
|
| Rate for Payer: PHP Medicaid |
$2,010.99
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,224.05
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,579.24
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,815.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP DNSP |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$901.00 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: ASR ASR |
$873.97
|
| Rate for Payer: ASR Commercial |
$873.97
|
| Rate for Payer: BCBS Trust/PPO |
$734.22
|
| Rate for Payer: BCN Commercial |
$698.55
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$846.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Healthscope Commercial |
$901.00
|
| Rate for Payer: Healthscope Whirlpool |
$873.97
|
| Rate for Payer: Mclaren Commercial |
$810.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: Nomi Health Commercial |
$738.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.88
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,782.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,282.18 |
| Max. Negotiated Rate |
$4,031.10 |
| Rate for Payer: Aetna Commercial |
$3,626.68
|
| Rate for Payer: Aetna Medicare |
$2,391.00
|
| Rate for Payer: BCBS Complete |
$1,853.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,282.18
|
| Rate for Payer: BCN Commercial |
$4,031.10
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Meridian Medicaid |
$1,853.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,764.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,108.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,829.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,829.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,279.12
|
| Rate for Payer: UHC Exchange |
$3,279.12
|
| Rate for Payer: UHCCP Medicaid |
$1,764.92
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM
|
Professional
|
Both
|
$4,070.00
|
|
|
Service Code
|
HCPCS 49188
|
| Min. Negotiated Rate |
$1,284.82 |
| Max. Negotiated Rate |
$2,645.50 |
| Rate for Payer: Aetna Medicare |
$2,035.00
|
| Rate for Payer: BCBS Complete |
$1,349.06
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Meridian Medicaid |
$1,349.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,284.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,645.50
|
| Rate for Payer: UHCCP Medicaid |
$1,284.82
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,694.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$841.35 |
| Max. Negotiated Rate |
$1,751.10 |
| Rate for Payer: Aetna Medicare |
$1,347.00
|
| Rate for Payer: BCBS Complete |
$883.42
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Meridian Medicaid |
$883.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$841.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.10
|
| Rate for Payer: UHCCP Medicaid |
$841.35
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$1,077.73 |
| Rate for Payer: Aetna Commercial |
$345.32
|
| Rate for Payer: Aetna Medicare |
$643.50
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.73
|
| Rate for Payer: BCN Commercial |
$264.86
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.31
|
| Rate for Payer: Priority Health Narrow Network |
$289.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.66
|
| Rate for Payer: UHC Exchange |
$345.66
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$390.86 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$795.28
|
| Rate for Payer: Aetna Medicare |
$969.00
|
| Rate for Payer: BCBS Complete |
$410.40
|
| Rate for Payer: BCBS Trust/PPO |
$462.79
|
| Rate for Payer: BCN Commercial |
$879.62
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Meridian Medicaid |
$410.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.90
|
| Rate for Payer: UHC Exchange |
$825.90
|
| Rate for Payer: UHCCP Medicaid |
$390.86
|
|
|
PR OPEN IMPLANTATION NEA PERIPHERAL NERVE
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 64575
|
| Min. Negotiated Rate |
$202.99 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$428.44
|
| Rate for Payer: Aetna Medicare |
$497.50
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$447.63
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.15
|
| Rate for Payer: Priority Health Narrow Network |
$539.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.43
|
| Rate for Payer: UHC Exchange |
$322.43
|
| Rate for Payer: UHCCP Medicaid |
$202.99
|
|
|
PR OPEN IMPLANTATION NEA SACRAL NERVE
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 64581
|
| Min. Negotiated Rate |
$338.11 |
| Max. Negotiated Rate |
$1,115.82 |
| Rate for Payer: Aetna Commercial |
$851.71
|
| Rate for Payer: Aetna Medicare |
$758.50
|
| Rate for Payer: BCBS Complete |
$441.04
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$950.47
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Meridian Medicaid |
$441.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.49
|
| Rate for Payer: UHC Exchange |
$961.49
|
| Rate for Payer: UHCCP Medicaid |
$420.04
|
|
|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$368.23 |
| Max. Negotiated Rate |
$1,429.17 |
| Rate for Payer: Aetna Commercial |
$1,116.01
|
| Rate for Payer: Aetna Medicare |
$875.50
|
| Rate for Payer: BCBS Complete |
$564.05
|
| Rate for Payer: BCBS Trust/PPO |
$368.23
|
| Rate for Payer: BCN Commercial |
$1,258.34
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Meridian Medicaid |
$564.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$537.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,429.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,429.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.62
|
| Rate for Payer: UHC Exchange |
$1,130.62
|
| Rate for Payer: UHCCP Medicaid |
$537.19
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$320.00
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.39
|
| Rate for Payer: BCN Commercial |
$2,525.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.94
|
| Rate for Payer: Priority Health Narrow Network |
$232.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.98
|
| Rate for Payer: UHC Exchange |
$202.98
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$1,902.42 |
| Rate for Payer: Aetna Commercial |
$283.76
|
| Rate for Payer: Aetna Medicare |
$254.00
|
| Rate for Payer: BCBS Complete |
$137.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,781.43
|
| Rate for Payer: BCN Commercial |
$1,902.42
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Meridian Medicaid |
$137.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.08
|
| Rate for Payer: Priority Health Narrow Network |
$327.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.80
|
| Rate for Payer: UHC Exchange |
$290.80
|
| Rate for Payer: UHCCP Medicaid |
$131.42
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
HCPCS 37236
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$4,048.21 |
| Rate for Payer: Aetna Commercial |
$595.20
|
| Rate for Payer: Aetna Medicare |
$605.50
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.84
|
| Rate for Payer: BCN Commercial |
$4,048.21
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.86
|
| Rate for Payer: Priority Health Narrow Network |
$682.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$621.61
|
| Rate for Payer: UHC Exchange |
$621.61
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 37238
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$5,084.69 |
| Rate for Payer: Aetna Commercial |
$412.29
|
| Rate for Payer: Aetna Medicare |
$642.50
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.33
|
| Rate for Payer: BCN Commercial |
$5,084.69
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Meridian Medicaid |
$200.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.45
|
| Rate for Payer: Priority Health Narrow Network |
$475.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.44
|
| Rate for Payer: UHC Exchange |
$435.44
|
| Rate for Payer: UHCCP Medicaid |
$191.27
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$2,616.00
|
|
|
Service Code
|
HCPCS 23410
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$1,700.40 |
| Rate for Payer: Aetna Commercial |
$1,094.22
|
| Rate for Payer: Aetna Medicare |
$1,308.00
|
| Rate for Payer: BCBS Complete |
$560.69
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$1,206.54
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Meridian Medicaid |
$560.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$533.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,265.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,265.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$945.18
|
| Rate for Payer: UHC Exchange |
$945.18
|
| Rate for Payer: UHCCP Medicaid |
$533.99
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$3,119.00
|
|
|
Service Code
|
HCPCS 23412
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$2,027.35 |
| Rate for Payer: Aetna Commercial |
$1,137.14
|
| Rate for Payer: Aetna Medicare |
$1,559.50
|
| Rate for Payer: BCBS Complete |
$582.61
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$1,379.62
|
| Rate for Payer: Cash Price |
$2,495.20
|
| Rate for Payer: Cash Price |
$2,495.20
|
| Rate for Payer: Meridian Medicaid |
$582.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,314.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,314.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$985.20
|
| Rate for Payer: UHC Exchange |
$985.20
|
| Rate for Payer: UHCCP Medicaid |
$554.87
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$496.93 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$1,021.13
|
| Rate for Payer: Aetna Medicare |
$1,502.50
|
| Rate for Payer: BCBS Complete |
$521.78
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$1,124.94
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Meridian Medicaid |
$521.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,180.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,180.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$886.57
|
| Rate for Payer: UHC Exchange |
$886.57
|
| Rate for Payer: UHCCP Medicaid |
$496.93
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Facility
|
OP
|
$3,005.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$1,953.25 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$2,704.50
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$2,914.85
|
| Rate for Payer: ASR Commercial |
$2,914.85
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,460.79
|
| Rate for Payer: BCN Commercial |
$2,329.78
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$2,824.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,404.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$3,005.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,914.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$2,704.50
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,554.25
|
| Rate for Payer: Nomi Health Commercial |
$2,464.10
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,632.98
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,106.50
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,644.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Facility
|
IP
|
$3,005.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$1,953.25 |
| Max. Negotiated Rate |
$3,005.00 |
| Rate for Payer: Aetna Commercial |
$2,704.50
|
| Rate for Payer: ASR ASR |
$2,914.85
|
| Rate for Payer: ASR Commercial |
$2,914.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,448.77
|
| Rate for Payer: BCN Commercial |
$2,329.78
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$2,824.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,404.00
|
| Rate for Payer: Healthscope Commercial |
$3,005.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,914.85
|
| Rate for Payer: Mclaren Commercial |
$2,704.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,554.25
|
| Rate for Payer: Nomi Health Commercial |
$2,464.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,644.40
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27814
|
| Min. Negotiated Rate |
$496.93 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$1,021.13
|
| Rate for Payer: Aetna Medicare |
$1,502.50
|
| Rate for Payer: BCBS Complete |
$521.78
|
| Rate for Payer: BCBS Trust/PPO |
$761.81
|
| Rate for Payer: BCN Commercial |
$1,124.94
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Meridian Medicaid |
$521.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,180.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,180.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$886.57
|
| Rate for Payer: UHC Exchange |
$886.57
|
| Rate for Payer: UHCCP Medicaid |
$496.93
|
|
