|
PR PARTIAL EXCISION BONE TALUS/CALCANEUS
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 28120
|
| Min. Negotiated Rate |
$473.72 |
| Max. Negotiated Rate |
$828.10 |
| Rate for Payer: Aetna Commercial |
$634.78
|
| Rate for Payer: Aetna Medicare |
$473.72
|
| Rate for Payer: BCBS Complete |
$509.60
|
| Rate for Payer: BCBS MAPPO |
$473.72
|
| Rate for Payer: BCN Medicare Advantage |
$473.72
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$682.16
|
| Rate for Payer: Cofinity Commercial |
$634.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.72
|
| Rate for Payer: Healthscope Commercial |
$568.46
|
| Rate for Payer: Healthscope Whirlpool |
$568.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.41
|
| Rate for Payer: Nomi Health Commercial |
$568.46
|
| Rate for Payer: PACE SWMI |
$473.72
|
| Rate for Payer: PHP Medicare Advantage |
$473.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health Medicare |
$473.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$473.72
|
| Rate for Payer: UHC Medicare Advantage |
$473.72
|
| Rate for Payer: UHCCP DNSP |
$473.72
|
|
|
PR PARTIAL EXCISION BONE TIBIA
|
Professional
|
Both
|
$2,763.00
|
|
|
Service Code
|
HCPCS 27640
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$1,795.95 |
| Rate for Payer: Aetna Commercial |
$1,066.97
|
| Rate for Payer: Aetna Medicare |
$796.25
|
| Rate for Payer: BCBS Complete |
$1,105.20
|
| Rate for Payer: BCBS MAPPO |
$796.25
|
| Rate for Payer: BCN Medicare Advantage |
$796.25
|
| Rate for Payer: Cash Price |
$2,210.40
|
| Rate for Payer: Cash Price |
$2,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,146.60
|
| Rate for Payer: Cofinity Commercial |
$1,066.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.25
|
| Rate for Payer: Healthscope Commercial |
$955.50
|
| Rate for Payer: Healthscope Whirlpool |
$955.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.06
|
| Rate for Payer: Nomi Health Commercial |
$955.50
|
| Rate for Payer: PACE SWMI |
$796.25
|
| Rate for Payer: PHP Medicare Advantage |
$796.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,795.95
|
| Rate for Payer: Priority Health Medicare |
$796.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.25
|
| Rate for Payer: UHC Medicare Advantage |
$796.25
|
| Rate for Payer: UHCCP DNSP |
$796.25
|
|
|
PR PARTIAL EXCISION BONE ULNA
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 25150
|
| Min. Negotiated Rate |
$471.60 |
| Max. Negotiated Rate |
$792.99 |
| Rate for Payer: Aetna Commercial |
$737.92
|
| Rate for Payer: Aetna Medicare |
$550.69
|
| Rate for Payer: BCBS Complete |
$471.60
|
| Rate for Payer: BCBS MAPPO |
$550.69
|
| Rate for Payer: BCN Medicare Advantage |
$550.69
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$792.99
|
| Rate for Payer: Cofinity Commercial |
$737.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.69
|
| Rate for Payer: Healthscope Commercial |
$660.83
|
| Rate for Payer: Healthscope Whirlpool |
$660.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.22
|
| Rate for Payer: Nomi Health Commercial |
$660.83
|
| Rate for Payer: PACE SWMI |
$550.69
|
| Rate for Payer: PHP Medicare Advantage |
$550.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$766.35
|
| Rate for Payer: Priority Health Medicare |
$550.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.69
|
| Rate for Payer: UHC Medicare Advantage |
$550.69
|
| Rate for Payer: UHCCP DNSP |
$550.69
|
|
|
PR PARTIAL EXCISION DEEP PELVIS
|
Professional
|
Both
|
$3,227.00
|
|
|
Service Code
|
HCPCS 27071
|
| Min. Negotiated Rate |
$923.04 |
| Max. Negotiated Rate |
$2,097.55 |
| Rate for Payer: Aetna Commercial |
$1,236.87
|
| Rate for Payer: Aetna Medicare |
$923.04
|
| Rate for Payer: BCBS Complete |
$1,290.80
|
| Rate for Payer: BCBS MAPPO |
$923.04
|
| Rate for Payer: BCN Medicare Advantage |
$923.04
|
| Rate for Payer: Cash Price |
$2,581.60
|
| Rate for Payer: Cash Price |
$2,581.60
|
| Rate for Payer: Cofinity Commercial |
$1,329.18
|
| Rate for Payer: Cofinity Commercial |
$1,236.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.04
|
| Rate for Payer: Healthscope Commercial |
$1,107.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,107.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.19
|
| Rate for Payer: Nomi Health Commercial |
$1,107.65
|
| Rate for Payer: PACE SWMI |
$923.04
|
| Rate for Payer: PHP Medicare Advantage |
$923.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,097.55
|
| Rate for Payer: Priority Health Medicare |
$923.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.04
|
| Rate for Payer: UHC Medicare Advantage |
$923.04
|
| Rate for Payer: UHCCP DNSP |
$923.04
|
|
|
PR PARTIAL EXCISION DISTAL PHALANX FINGER
|
Professional
|
Both
|
$1,272.00
|
|
|
Service Code
|
HCPCS 26236
|
| Min. Negotiated Rate |
$428.45 |
| Max. Negotiated Rate |
$826.80 |
| Rate for Payer: Aetna Commercial |
$574.12
|
| Rate for Payer: Aetna Medicare |
$428.45
|
| Rate for Payer: BCBS Complete |
$508.80
|
| Rate for Payer: BCBS MAPPO |
$428.45
|
| Rate for Payer: BCN Medicare Advantage |
$428.45
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cofinity Commercial |
$616.97
|
| Rate for Payer: Cofinity Commercial |
$574.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.45
|
| Rate for Payer: Healthscope Commercial |
$514.14
|
| Rate for Payer: Healthscope Whirlpool |
$514.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.87
|
| Rate for Payer: Nomi Health Commercial |
$514.14
|
| Rate for Payer: PACE SWMI |
$428.45
|
| Rate for Payer: PHP Medicare Advantage |
$428.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.80
|
| Rate for Payer: Priority Health Medicare |
$428.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$428.45
|
| Rate for Payer: UHC Medicare Advantage |
$428.45
|
| Rate for Payer: UHCCP DNSP |
$428.45
|
|
|
PR PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 26235
|
| Min. Negotiated Rate |
$477.52 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Commercial |
$639.88
|
| Rate for Payer: Aetna Medicare |
$477.52
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$477.52
|
| Rate for Payer: BCN Medicare Advantage |
$477.52
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$687.63
|
| Rate for Payer: Cofinity Commercial |
$639.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.52
|
| Rate for Payer: Healthscope Commercial |
$573.02
|
| Rate for Payer: Healthscope Whirlpool |
$573.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.40
|
| Rate for Payer: Nomi Health Commercial |
$573.02
|
| Rate for Payer: PACE SWMI |
$477.52
|
| Rate for Payer: PHP Medicare Advantage |
$477.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$477.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.52
|
| Rate for Payer: UHC Medicare Advantage |
$477.52
|
| Rate for Payer: UHCCP DNSP |
$477.52
|
|
|
PR PARTIAL EXCISION SUPERFICIAL PELVIS
|
Professional
|
Both
|
$1,528.00
|
|
|
Service Code
|
HCPCS 27070
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$1,205.38 |
| Rate for Payer: Aetna Commercial |
$1,121.67
|
| Rate for Payer: Aetna Medicare |
$837.07
|
| Rate for Payer: BCBS Complete |
$611.20
|
| Rate for Payer: BCBS MAPPO |
$837.07
|
| Rate for Payer: BCN Medicare Advantage |
$837.07
|
| Rate for Payer: Cash Price |
$1,222.40
|
| Rate for Payer: Cash Price |
$1,222.40
|
| Rate for Payer: Cofinity Commercial |
$1,205.38
|
| Rate for Payer: Cofinity Commercial |
$1,121.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.07
|
| Rate for Payer: Healthscope Commercial |
$1,004.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,004.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$878.92
|
| Rate for Payer: Nomi Health Commercial |
$1,004.48
|
| Rate for Payer: PACE SWMI |
$837.07
|
| Rate for Payer: PHP Medicare Advantage |
$837.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$993.20
|
| Rate for Payer: Priority Health Medicare |
$837.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$837.07
|
| Rate for Payer: UHC Medicare Advantage |
$837.07
|
| Rate for Payer: UHCCP DNSP |
$837.07
|
|
|
PR PARTIAL HYMENECTOMY OR REVISION HYMENAL RING
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 56700
|
| Min. Negotiated Rate |
$193.26 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$258.97
|
| Rate for Payer: Aetna Medicare |
$193.26
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$193.26
|
| Rate for Payer: BCN Medicare Advantage |
$193.26
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$278.29
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.26
|
| Rate for Payer: Healthscope Commercial |
$231.91
|
| Rate for Payer: Healthscope Whirlpool |
$231.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.92
|
| Rate for Payer: Nomi Health Commercial |
$231.91
|
| Rate for Payer: PACE SWMI |
$193.26
|
| Rate for Payer: PHP Medicare Advantage |
$193.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$193.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.26
|
| Rate for Payer: UHC Medicare Advantage |
$193.26
|
| Rate for Payer: UHCCP DNSP |
$193.26
|
|
|
PR PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$914.00
|
|
|
Service Code
|
HCPCS 28124
|
| Min. Negotiated Rate |
$320.80 |
| Max. Negotiated Rate |
$594.10 |
| Rate for Payer: Aetna Commercial |
$429.87
|
| Rate for Payer: Aetna Medicare |
$320.80
|
| Rate for Payer: BCBS Complete |
$365.60
|
| Rate for Payer: BCBS MAPPO |
$320.80
|
| Rate for Payer: BCN Medicare Advantage |
$320.80
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cofinity Commercial |
$461.95
|
| Rate for Payer: Cofinity Commercial |
$429.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.80
|
| Rate for Payer: Healthscope Commercial |
$384.96
|
| Rate for Payer: Healthscope Whirlpool |
$384.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.84
|
| Rate for Payer: Nomi Health Commercial |
$384.96
|
| Rate for Payer: PACE SWMI |
$320.80
|
| Rate for Payer: PHP Medicare Advantage |
$320.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$594.10
|
| Rate for Payer: Priority Health Medicare |
$320.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.80
|
| Rate for Payer: UHC Medicare Advantage |
$320.80
|
| Rate for Payer: UHCCP DNSP |
$320.80
|
|
|
PR PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 27350
|
| Min. Negotiated Rate |
$632.86 |
| Max. Negotiated Rate |
$1,365.65 |
| Rate for Payer: Aetna Commercial |
$848.03
|
| Rate for Payer: Aetna Medicare |
$632.86
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: BCBS MAPPO |
$632.86
|
| Rate for Payer: BCN Medicare Advantage |
$632.86
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cofinity Commercial |
$911.32
|
| Rate for Payer: Cofinity Commercial |
$848.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.86
|
| Rate for Payer: Healthscope Commercial |
$759.43
|
| Rate for Payer: Healthscope Whirlpool |
$759.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.50
|
| Rate for Payer: Nomi Health Commercial |
$759.43
|
| Rate for Payer: PACE SWMI |
$632.86
|
| Rate for Payer: PHP Medicare Advantage |
$632.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.65
|
| Rate for Payer: Priority Health Medicare |
$632.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.86
|
| Rate for Payer: UHC Medicare Advantage |
$632.86
|
| Rate for Payer: UHCCP DNSP |
$632.86
|
|
|
PR PATIENT-INITIATED SPIROMETRIC RECORDING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 94015
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.02
|
| Rate for Payer: Aetna Medicare |
$28.37
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$28.37
|
| Rate for Payer: BCN Medicare Advantage |
$28.37
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$40.85
|
| Rate for Payer: Cofinity Commercial |
$38.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.37
|
| Rate for Payer: Healthscope Commercial |
$34.04
|
| Rate for Payer: Healthscope Whirlpool |
$34.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.79
|
| Rate for Payer: Nomi Health Commercial |
$34.04
|
| Rate for Payer: PACE SWMI |
$28.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$28.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.37
|
| Rate for Payer: UHC Medicare Advantage |
$28.37
|
| Rate for Payer: UHCCP DNSP |
$28.37
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 90670
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$371.51 |
| Rate for Payer: Aetna Commercial |
$345.71
|
| Rate for Payer: Aetna Medicare |
$257.99
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$257.99
|
| Rate for Payer: BCN Medicare Advantage |
$257.99
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$371.51
|
| Rate for Payer: Cofinity Commercial |
$345.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.99
|
| Rate for Payer: Healthscope Commercial |
$309.59
|
| Rate for Payer: Healthscope Whirlpool |
$309.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.89
|
| Rate for Payer: Nomi Health Commercial |
$309.59
|
| Rate for Payer: PACE SWMI |
$257.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$257.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.99
|
| Rate for Payer: UHC Medicare Advantage |
$257.99
|
| Rate for Payer: UHCCP DNSP |
$257.99
|
|
|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 90677
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$450.58 |
| Rate for Payer: Aetna Commercial |
$419.29
|
| Rate for Payer: Aetna Medicare |
$312.90
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$312.90
|
| Rate for Payer: BCN Medicare Advantage |
$312.90
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$450.58
|
| Rate for Payer: Cofinity Commercial |
$419.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.90
|
| Rate for Payer: Healthscope Commercial |
$375.48
|
| Rate for Payer: Healthscope Whirlpool |
$375.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.55
|
| Rate for Payer: Nomi Health Commercial |
$375.48
|
| Rate for Payer: PACE SWMI |
$312.90
|
| Rate for Payer: PHP Medicare Advantage |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$312.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.90
|
| Rate for Payer: UHC Medicare Advantage |
$312.90
|
| Rate for Payer: UHCCP DNSP |
$312.90
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 96573
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$281.45 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Medicare |
$195.45
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: BCBS MAPPO |
$195.45
|
| Rate for Payer: BCN Medicare Advantage |
$195.45
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Cofinity Commercial |
$261.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.45
|
| Rate for Payer: Healthscope Commercial |
$234.54
|
| Rate for Payer: Healthscope Whirlpool |
$234.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.22
|
| Rate for Payer: Nomi Health Commercial |
$234.54
|
| Rate for Payer: PACE SWMI |
$195.45
|
| Rate for Payer: PHP Medicare Advantage |
$195.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health Medicare |
$195.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.45
|
| Rate for Payer: UHC Medicare Advantage |
$195.45
|
| Rate for Payer: UHCCP DNSP |
$195.45
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 96567
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$167.73 |
| Rate for Payer: Aetna Commercial |
$156.08
|
| Rate for Payer: Aetna Medicare |
$116.48
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$116.48
|
| Rate for Payer: BCN Medicare Advantage |
$116.48
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$167.73
|
| Rate for Payer: Cofinity Commercial |
$156.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.48
|
| Rate for Payer: Healthscope Commercial |
$139.78
|
| Rate for Payer: Healthscope Whirlpool |
$139.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.30
|
| Rate for Payer: Nomi Health Commercial |
$139.78
|
| Rate for Payer: PACE SWMI |
$116.48
|
| Rate for Payer: PHP Medicare Advantage |
$116.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Medicare |
$116.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.48
|
| Rate for Payer: UHC Medicare Advantage |
$116.48
|
| Rate for Payer: UHCCP DNSP |
$116.48
|
|
|
PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 38770
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$1,112.44 |
| Rate for Payer: Aetna Commercial |
$1,035.19
|
| Rate for Payer: Aetna Medicare |
$772.53
|
| Rate for Payer: BCBS Complete |
$519.20
|
| Rate for Payer: BCBS MAPPO |
$772.53
|
| Rate for Payer: BCN Medicare Advantage |
$772.53
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cofinity Commercial |
$1,112.44
|
| Rate for Payer: Cofinity Commercial |
$1,035.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.53
|
| Rate for Payer: Healthscope Commercial |
$927.04
|
| Rate for Payer: Healthscope Whirlpool |
$927.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.16
|
| Rate for Payer: Nomi Health Commercial |
$927.04
|
| Rate for Payer: PACE SWMI |
$772.53
|
| Rate for Payer: PHP Medicare Advantage |
$772.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.70
|
| Rate for Payer: Priority Health Medicare |
$772.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.53
|
| Rate for Payer: UHC Medicare Advantage |
$772.53
|
| Rate for Payer: UHCCP DNSP |
$772.53
|
|
|
PR PELVIC EXAMINATION
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99459
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Medicare |
$18.86
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$18.86
|
| Rate for Payer: BCN Medicare Advantage |
$18.86
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$27.16
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Whirlpool |
$20.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.80
|
| Rate for Payer: Nomi Health Commercial |
$22.63
|
| Rate for Payer: PACE SWMI |
$18.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.86
|
| Rate for Payer: UHC Medicare Advantage |
$18.86
|
| Rate for Payer: UHCCP DNSP |
$18.86
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$4,806.44 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$190.12
|
| Rate for Payer: ASR Commercial |
$190.12
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$160.50
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$196.00
|
| Rate for Payer: Healthscope Whirlpool |
$190.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$176.40
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$160.72
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.74
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$137.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$101.41
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$101.41
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$146.03
|
| Rate for Payer: Cofinity Commercial |
$135.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.41
|
| Rate for Payer: Healthscope Commercial |
$121.69
|
| Rate for Payer: Healthscope Whirlpool |
$121.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Nomi Health Commercial |
$121.69
|
| Rate for Payer: PACE SWMI |
$101.41
|
| Rate for Payer: PHP Medicare Advantage |
$101.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UHCCP DNSP |
$101.41
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: ASR ASR |
$190.12
|
| Rate for Payer: ASR Commercial |
$190.12
|
| Rate for Payer: BCBS Trust/PPO |
$159.72
|
| Rate for Payer: BCN Commercial |
$151.96
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$196.00
|
| Rate for Payer: Healthscope Whirlpool |
$190.12
|
| Rate for Payer: Mclaren Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$160.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.48
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$101.41
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$101.41
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$146.03
|
| Rate for Payer: Cofinity Commercial |
$135.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.41
|
| Rate for Payer: Healthscope Commercial |
$121.69
|
| Rate for Payer: Healthscope Whirlpool |
$121.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Nomi Health Commercial |
$121.69
|
| Rate for Payer: PACE SWMI |
$101.41
|
| Rate for Payer: PHP Medicare Advantage |
$101.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UHCCP DNSP |
$101.41
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$349.78 |
| Max. Negotiated Rate |
$1,164.15 |
| Rate for Payer: Aetna Commercial |
$468.71
|
| Rate for Payer: Aetna Medicare |
$349.78
|
| Rate for Payer: BCBS Complete |
$716.40
|
| Rate for Payer: BCBS MAPPO |
$349.78
|
| Rate for Payer: BCN Medicare Advantage |
$349.78
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cofinity Commercial |
$503.68
|
| Rate for Payer: Cofinity Commercial |
$468.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.78
|
| Rate for Payer: Healthscope Commercial |
$419.74
|
| Rate for Payer: Healthscope Whirlpool |
$419.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.27
|
| Rate for Payer: Nomi Health Commercial |
$419.74
|
| Rate for Payer: PACE SWMI |
$349.78
|
| Rate for Payer: PHP Medicare Advantage |
$349.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.15
|
| Rate for Payer: Priority Health Medicare |
$349.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.78
|
| Rate for Payer: UHC Medicare Advantage |
$349.78
|
| Rate for Payer: UHCCP DNSP |
$349.78
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$1,026.10 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Commercial |
$1,374.97
|
| Rate for Payer: Aetna Medicare |
$1,026.10
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: BCBS MAPPO |
$1,026.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.10
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$1,477.58
|
| Rate for Payer: Cofinity Commercial |
$1,374.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.10
|
| Rate for Payer: Healthscope Commercial |
$1,231.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,231.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.40
|
| Rate for Payer: Nomi Health Commercial |
$1,231.32
|
| Rate for Payer: PACE SWMI |
$1,026.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health Medicare |
$1,026.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.10
|
| Rate for Payer: UHCCP DNSP |
$1,026.10
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$968.55 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,297.86
|
| Rate for Payer: Aetna Medicare |
$968.55
|
| Rate for Payer: BCBS Complete |
$1,253.60
|
| Rate for Payer: BCBS MAPPO |
$968.55
|
| Rate for Payer: BCN Medicare Advantage |
$968.55
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cofinity Commercial |
$1,394.71
|
| Rate for Payer: Cofinity Commercial |
$1,297.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.55
|
| Rate for Payer: Healthscope Commercial |
$1,162.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,162.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.98
|
| Rate for Payer: Nomi Health Commercial |
$1,162.26
|
| Rate for Payer: PACE SWMI |
$968.55
|
| Rate for Payer: PHP Medicare Advantage |
$968.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health Medicare |
$968.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.55
|
| Rate for Payer: UHC Medicare Advantage |
$968.55
|
| Rate for Payer: UHCCP DNSP |
$968.55
|
|
|
PR PENG BENZATHINE/PROCAINE INJ
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0558
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Aetna Commercial |
$26.16
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$28.11
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$23.42
|
| Rate for Payer: Healthscope Whirlpool |
$23.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.52
|
| Rate for Payer: UHCCP DNSP |
$19.52
|
|
