|
PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM
|
Professional
|
Both
|
$2,134.00
|
|
|
Service Code
|
HCPCS 22904
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$1,605.45 |
| Rate for Payer: Aetna Commercial |
$1,401.18
|
| Rate for Payer: Aetna Medicare |
$1,067.00
|
| Rate for Payer: BCBS Complete |
$706.51
|
| Rate for Payer: BCBS Trust/PPO |
$288.98
|
| Rate for Payer: BCN Commercial |
$1,533.96
|
| Rate for Payer: Cash Price |
$1,707.20
|
| Rate for Payer: Cash Price |
$1,707.20
|
| Rate for Payer: Meridian Medicaid |
$706.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$672.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,387.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,605.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,605.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.25
|
| Rate for Payer: UHC Exchange |
$1,243.25
|
| Rate for Payer: UHCCP Medicaid |
$672.87
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM
|
Professional
|
Both
|
$2,940.00
|
|
|
Service Code
|
HCPCS 21935
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$1,374.99
|
| Rate for Payer: Aetna Medicare |
$1,470.00
|
| Rate for Payer: BCBS Complete |
$689.51
|
| Rate for Payer: BCBS Trust/PPO |
$124.38
|
| Rate for Payer: BCN Commercial |
$1,491.44
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Cash Price |
$2,352.00
|
| Rate for Payer: Meridian Medicaid |
$689.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$656.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,911.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,566.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,566.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,208.35
|
| Rate for Payer: UHC Exchange |
$1,208.35
|
| Rate for Payer: UHCCP Medicaid |
$656.68
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>
|
Professional
|
Both
|
$2,598.00
|
|
|
Service Code
|
HCPCS 21936
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$2,164.69 |
| Rate for Payer: Aetna Commercial |
$1,897.26
|
| Rate for Payer: Aetna Medicare |
$1,299.00
|
| Rate for Payer: BCBS Complete |
$954.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.98
|
| Rate for Payer: BCN Commercial |
$2,064.17
|
| Rate for Payer: Cash Price |
$2,078.40
|
| Rate for Payer: Cash Price |
$2,078.40
|
| Rate for Payer: Meridian Medicaid |
$954.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$908.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,688.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,164.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,164.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,719.92
|
| Rate for Payer: UHC Exchange |
$1,719.92
|
| Rate for Payer: UHCCP Medicaid |
$908.87
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27616
|
| Min. Negotiated Rate |
$804.71 |
| Max. Negotiated Rate |
$1,928.07 |
| Rate for Payer: Aetna Commercial |
$1,701.80
|
| Rate for Payer: Aetna Medicare |
$1,156.50
|
| Rate for Payer: BCBS Complete |
$844.95
|
| Rate for Payer: BCBS Trust/PPO |
$928.75
|
| Rate for Payer: BCN Commercial |
$1,853.06
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Meridian Medicaid |
$844.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$804.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,928.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,928.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,531.37
|
| Rate for Payer: UHC Exchange |
$1,531.37
|
| Rate for Payer: UHCCP Medicaid |
$804.71
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM
|
Professional
|
Both
|
$2,051.00
|
|
|
Service Code
|
HCPCS 23077
|
| Min. Negotiated Rate |
$240.38 |
| Max. Negotiated Rate |
$1,732.67 |
| Rate for Payer: Aetna Commercial |
$1,518.73
|
| Rate for Payer: Aetna Medicare |
$1,025.50
|
| Rate for Payer: BCBS Complete |
$766.90
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: BCN Commercial |
$1,650.26
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Meridian Medicaid |
$766.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$730.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,732.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,732.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,351.88
|
| Rate for Payer: UHC Exchange |
$1,351.88
|
| Rate for Payer: UHCCP Medicaid |
$730.38
|
|
|
PR RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>
|
Professional
|
Both
|
$6,657.00
|
|
|
Service Code
|
HCPCS 27364
|
| Min. Negotiated Rate |
$1,008.98 |
| Max. Negotiated Rate |
$4,327.05 |
| Rate for Payer: Aetna Commercial |
$2,093.77
|
| Rate for Payer: Aetna Medicare |
$3,328.50
|
| Rate for Payer: BCBS Complete |
$1,059.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.03
|
| Rate for Payer: BCN Commercial |
$2,283.59
|
| Rate for Payer: Cash Price |
$5,325.60
|
| Rate for Payer: Cash Price |
$5,325.60
|
| Rate for Payer: Meridian Medicaid |
$1,059.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,008.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,327.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,390.11
|
| Rate for Payer: Priority Health Narrow Network |
$2,390.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,878.72
|
| Rate for Payer: UHC Exchange |
$1,878.72
|
| Rate for Payer: UHCCP Medicaid |
$1,008.98
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Facility
|
IP
|
$2,876.00
|
|
|
Service Code
|
CPT 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$1,869.40 |
| Max. Negotiated Rate |
$2,876.00 |
| Rate for Payer: Aetna Commercial |
$2,588.40
|
| Rate for Payer: ASR ASR |
$2,789.72
|
| Rate for Payer: ASR Commercial |
$2,789.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,343.65
|
| Rate for Payer: BCN Commercial |
$2,229.76
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cofinity Commercial |
$2,703.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,300.80
|
| Rate for Payer: Healthscope Commercial |
$2,876.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,789.72
|
| Rate for Payer: Mclaren Commercial |
$2,588.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,444.60
|
| Rate for Payer: Nomi Health Commercial |
$2,358.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,869.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,530.88
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Professional
|
Both
|
$2,876.00
|
|
|
Service Code
|
HCPCS 25077
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$1,869.40 |
| Rate for Payer: Aetna Commercial |
$1,186.63
|
| Rate for Payer: Aetna Medicare |
$1,438.00
|
| Rate for Payer: BCBS Complete |
$584.62
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$1,300.37
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Meridian Medicaid |
$584.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,321.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,321.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,014.02
|
| Rate for Payer: UHC Exchange |
$1,014.02
|
| Rate for Payer: UHCCP Medicaid |
$556.78
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Facility
|
OP
|
$2,876.00
|
|
|
Service Code
|
CPT 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$1,503.04 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$2,588.40
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$2,789.72
|
| Rate for Payer: ASR Commercial |
$2,789.72
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,355.16
|
| Rate for Payer: BCN Commercial |
$2,229.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cofinity Commercial |
$2,703.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,300.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$2,876.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,789.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$2,588.40
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,444.60
|
| Rate for Payer: Nomi Health Commercial |
$2,358.32
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.95
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$2,016.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,530.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Professional
|
Both
|
$2,876.00
|
|
|
Service Code
|
HCPCS 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$1,869.40 |
| Rate for Payer: Aetna Commercial |
$1,186.63
|
| Rate for Payer: Aetna Medicare |
$1,438.00
|
| Rate for Payer: BCBS Complete |
$584.62
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$1,300.37
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Meridian Medicaid |
$584.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,321.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,321.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,014.02
|
| Rate for Payer: UHC Exchange |
$1,014.02
|
| Rate for Payer: UHCCP Medicaid |
$556.78
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 21557
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$1,469.59 |
| Rate for Payer: Aetna Commercial |
$1,274.88
|
| Rate for Payer: Aetna Medicare |
$838.50
|
| Rate for Payer: BCBS Complete |
$645.46
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$1,396.64
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Meridian Medicaid |
$645.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,469.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,469.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,012.67
|
| Rate for Payer: UHC Exchange |
$1,012.67
|
| Rate for Payer: UHCCP Medicaid |
$614.72
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>
|
Professional
|
Both
|
$3,418.00
|
|
|
Service Code
|
HCPCS 21558
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$2,221.70 |
| Rate for Payer: Aetna Commercial |
$1,800.42
|
| Rate for Payer: Aetna Medicare |
$1,709.00
|
| Rate for Payer: BCBS Complete |
$904.67
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$1,962.53
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Meridian Medicaid |
$904.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$861.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,048.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,048.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,649.42
|
| Rate for Payer: UHC Exchange |
$1,649.42
|
| Rate for Payer: UHCCP Medicaid |
$861.59
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26117
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$984.86
|
| Rate for Payer: Aetna Medicare |
$1,180.50
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS Trust/PPO |
$171.92
|
| Rate for Payer: BCN Commercial |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$817.74
|
| Rate for Payer: UHC Exchange |
$817.74
|
| Rate for Payer: UHCCP Medicaid |
$488.20
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 27049
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$4,326.25 |
| Rate for Payer: Aetna Commercial |
$1,808.92
|
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$966.62
|
| Rate for Payer: BCBS Trust/PPO |
$4,326.25
|
| Rate for Payer: BCN Commercial |
$1,956.17
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Meridian Medicaid |
$966.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$920.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,182.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,512.00
|
| Rate for Payer: UHC Exchange |
$1,512.00
|
| Rate for Payer: UHCCP Medicaid |
$920.59
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 27329
|
| Min. Negotiated Rate |
$673.08 |
| Max. Negotiated Rate |
$2,195.70 |
| Rate for Payer: Aetna Commercial |
$1,391.29
|
| Rate for Payer: Aetna Medicare |
$1,689.00
|
| Rate for Payer: BCBS Complete |
$706.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: BCN Commercial |
$1,523.21
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Meridian Medicaid |
$706.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,596.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,206.12
|
| Rate for Payer: UHC Exchange |
$1,206.12
|
| Rate for Payer: UHCCP Medicaid |
$673.08
|
|
|
PR RAPID DESENSITIZATION PROCEDURE EACH HOUR
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 95180
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$430.04 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: Aetna Medicare |
$126.50
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCBS Trust/PPO |
$430.04
|
| Rate for Payer: BCN Commercial |
$198.89
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.75
|
| Rate for Payer: Priority Health Narrow Network |
$138.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.67
|
| Rate for Payer: UHC Exchange |
$117.67
|
| Rate for Payer: UHCCP Medicaid |
$64.97
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$553.15 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$825.47
|
| Rate for Payer: ASR Commercial |
$825.47
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$696.88
|
| Rate for Payer: BCN Commercial |
$659.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$799.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Healthscope Whirlpool |
$825.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$765.90
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$697.82
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.65
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$596.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$553.15 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: ASR ASR |
$825.47
|
| Rate for Payer: ASR Commercial |
$825.47
|
| Rate for Payer: BCBS Trust/PPO |
$693.48
|
| Rate for Payer: BCN Commercial |
$659.78
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$799.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Healthscope Whirlpool |
$825.47
|
| Rate for Payer: Mclaren Commercial |
$765.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$697.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.88
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$1,777.73 |
| Rate for Payer: Aetna Commercial |
$475.12
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.73
|
| Rate for Payer: Priority Health Narrow Network |
$558.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
| Rate for Payer: UHC Exchange |
$427.68
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$1,777.73 |
| Rate for Payer: Aetna Commercial |
$475.12
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.73
|
| Rate for Payer: Priority Health Narrow Network |
$558.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
| Rate for Payer: UHC Exchange |
$427.68
|
|
|
PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 21175
|
| Min. Negotiated Rate |
$377.57 |
| Max. Negotiated Rate |
$4,677.40 |
| Rate for Payer: Aetna Commercial |
$2,954.27
|
| Rate for Payer: Aetna Medicare |
$3,598.00
|
| Rate for Payer: BCBS Complete |
$1,485.71
|
| Rate for Payer: BCBS Trust/PPO |
$377.57
|
| Rate for Payer: BCN Commercial |
$3,551.28
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Meridian Medicaid |
$1,485.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,677.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,358.99
|
| Rate for Payer: Priority Health Narrow Network |
$3,358.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,707.09
|
| Rate for Payer: UHC Exchange |
$2,707.09
|
| Rate for Payer: UHCCP Medicaid |
$1,414.96
|
|
|
PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 26545
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$1,137.81 |
| Rate for Payer: Aetna Commercial |
$969.02
|
| Rate for Payer: Aetna Medicare |
$608.00
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$1,090.73
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$767.80
|
| Rate for Payer: UHC Exchange |
$767.80
|
| Rate for Payer: UHCCP Medicaid |
$473.50
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
|
Professional
|
Both
|
$3,566.00
|
|
|
Service Code
|
HCPCS 26542
|
| Min. Negotiated Rate |
$466.90 |
| Max. Negotiated Rate |
$2,317.90 |
| Rate for Payer: Aetna Commercial |
$954.95
|
| Rate for Payer: Aetna Medicare |
$1,783.00
|
| Rate for Payer: BCBS Complete |
$490.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.54
|
| Rate for Payer: BCN Commercial |
$1,073.63
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Meridian Medicaid |
$490.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,317.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$750.88
|
| Rate for Payer: UHC Exchange |
$750.88
|
| Rate for Payer: UHCCP Medicaid |
$466.90
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$540.81 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,106.28
|
| Rate for Payer: Aetna Medicare |
$1,190.00
|
| Rate for Payer: BCBS Complete |
$567.85
|
| Rate for Payer: BCBS Trust/PPO |
$544.15
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Meridian Medicaid |
$567.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$540.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,292.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.71
|
| Rate for Payer: UHC Exchange |
$891.71
|
| Rate for Payer: UHCCP Medicaid |
$540.81
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$1,159.19 |
| Rate for Payer: Aetna Commercial |
$999.14
|
| Rate for Payer: Aetna Medicare |
$759.50
|
| Rate for Payer: BCBS Complete |
$514.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.81
|
| Rate for Payer: BCN Commercial |
$1,103.92
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Meridian Medicaid |
$514.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,159.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.14
|
| Rate for Payer: UHC Exchange |
$852.14
|
| Rate for Payer: UHCCP Medicaid |
$489.90
|
|
