|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,041.30 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: ASR ASR |
$1,553.94
|
| Rate for Payer: ASR Commercial |
$1,553.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.47
|
| Rate for Payer: BCN Commercial |
$1,242.03
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,505.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Healthscope Commercial |
$1,602.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,553.94
|
| Rate for Payer: Mclaren Commercial |
$1,441.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$1,313.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,409.76
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$743.74
|
| Rate for Payer: Aetna Medicare |
$801.00
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.99
|
| Rate for Payer: Priority Health Narrow Network |
$935.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.69
|
| Rate for Payer: UHC Exchange |
$830.69
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,237.82 |
| Rate for Payer: Aetna Commercial |
$743.74
|
| Rate for Payer: Aetna Medicare |
$801.00
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.99
|
| Rate for Payer: Priority Health Narrow Network |
$935.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.69
|
| Rate for Payer: UHC Exchange |
$830.69
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$147.37
|
| Rate for Payer: Aetna Medicare |
$250.00
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.00
|
| Rate for Payer: Priority Health Narrow Network |
$177.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.07
|
| Rate for Payer: UHC Exchange |
$183.07
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$1,936.80
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$2,087.44
|
| Rate for Payer: ASR Commercial |
$2,087.44
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,762.27
|
| Rate for Payer: BCN Commercial |
$1,668.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$2,022.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$2,152.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,087.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$1,936.80
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$1,764.64
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.58
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,893.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,398.80 |
| Max. Negotiated Rate |
$2,152.00 |
| Rate for Payer: Aetna Commercial |
$1,936.80
|
| Rate for Payer: ASR ASR |
$2,087.44
|
| Rate for Payer: ASR Commercial |
$2,087.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.66
|
| Rate for Payer: BCN Commercial |
$1,668.45
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$2,022.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Healthscope Commercial |
$2,152.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,087.44
|
| Rate for Payer: Mclaren Commercial |
$1,936.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$1,764.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,893.76
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$770.92
|
| Rate for Payer: Aetna Medicare |
$1,076.00
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.21
|
| Rate for Payer: Priority Health Narrow Network |
$971.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.05
|
| Rate for Payer: UHC Exchange |
$755.05
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$770.92
|
| Rate for Payer: Aetna Medicare |
$1,076.00
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.21
|
| Rate for Payer: Priority Health Narrow Network |
$971.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.05
|
| Rate for Payer: UHC Exchange |
$755.05
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
|
|
PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$896.35 |
| Rate for Payer: Aetna Commercial |
$122.15
|
| Rate for Payer: Aetna Medicare |
$689.50
|
| Rate for Payer: BCBS Complete |
$74.02
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Meridian Medicaid |
$74.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.00
|
| Rate for Payer: Priority Health Narrow Network |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.37
|
| Rate for Payer: UHC Exchange |
$119.37
|
| Rate for Payer: UHCCP Medicaid |
$70.50
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$1,259.47 |
| Rate for Payer: Aetna Commercial |
$31.26
|
| Rate for Payer: Aetna Commercial |
$31.26
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,259.47
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Meridian Medicaid |
$5.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.86
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.86
|
| Rate for Payer: UHC Exchange |
$33.86
|
| Rate for Payer: UHC Exchange |
$33.86
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$1,875.99 |
| Rate for Payer: Aetna Commercial |
$27.79
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.99
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.05
|
| Rate for Payer: Priority Health Narrow Network |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.08
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
|
|
PR SPORTS PHYSICAL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$789.10 |
| Rate for Payer: Aetna Commercial |
$362.87
|
| Rate for Payer: Aetna Medicare |
$607.00
|
| Rate for Payer: BCBS Complete |
$178.03
|
| Rate for Payer: BCBS Trust/PPO |
$463.85
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Meridian Medicaid |
$178.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.39
|
| Rate for Payer: Priority Health Narrow Network |
$424.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$591.45
|
| Rate for Payer: UHC Exchange |
$591.45
|
| Rate for Payer: UHCCP Medicaid |
$169.55
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$444.13
|
| Rate for Payer: Aetna Medicare |
$625.00
|
| Rate for Payer: BCBS Complete |
$219.63
|
| Rate for Payer: BCBS Trust/PPO |
$327.02
|
| Rate for Payer: BCN Commercial |
$725.69
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Meridian Medicaid |
$219.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$520.12
|
| Rate for Payer: Priority Health Narrow Network |
$520.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.19
|
| Rate for Payer: UHC Exchange |
$726.19
|
| Rate for Payer: UHCCP Medicaid |
$209.17
|
|
|
PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA
|
Professional
|
Both
|
$1,743.00
|
|
|
Service Code
|
HCPCS 49220
|
| Min. Negotiated Rate |
$697.20 |
| Max. Negotiated Rate |
$1,132.95 |
| Rate for Payer: Aetna Medicare |
$871.50
|
| Rate for Payer: BCBS Complete |
$697.20
|
| Rate for Payer: Cash Price |
$1,394.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.95
|
|
|
PR STANDARDIZED COGNITIVE PERFORMANCE TESTING
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 96125
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$115.45
|
| Rate for Payer: Aetna Medicare |
$93.50
|
| Rate for Payer: BCBS Complete |
$74.80
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$149.05
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.86
|
| Rate for Payer: Priority Health Narrow Network |
$138.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.67
|
| Rate for Payer: UHC Exchange |
$84.67
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$590.44 |
| Max. Negotiated Rate |
$1,545.81 |
| Rate for Payer: Aetna Commercial |
$1,052.44
|
| Rate for Payer: Aetna Medicare |
$850.50
|
| Rate for Payer: BCBS Complete |
$619.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.81
|
| Rate for Payer: BCN Commercial |
$1,365.86
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Meridian Medicaid |
$619.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,356.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,356.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,025.87
|
| Rate for Payer: UHC Exchange |
$1,025.87
|
| Rate for Payer: UHCCP Medicaid |
$590.44
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT
|
Professional
|
Both
|
$2,433.00
|
|
|
Service Code
|
HCPCS 69661
|
| Min. Negotiated Rate |
$768.93 |
| Max. Negotiated Rate |
$1,935.16 |
| Rate for Payer: Aetna Commercial |
$1,372.29
|
| Rate for Payer: Aetna Medicare |
$1,216.50
|
| Rate for Payer: BCBS Complete |
$807.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.16
|
| Rate for Payer: BCN Commercial |
$1,778.78
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Meridian Medicaid |
$807.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$768.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,581.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,766.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,766.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,339.37
|
| Rate for Payer: UHC Exchange |
$1,339.37
|
| Rate for Payer: UHCCP Medicaid |
$768.93
|
|
|
PR STAPES MOBILIZATION
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 69650
|
| Min. Negotiated Rate |
$512.90 |
| Max. Negotiated Rate |
$1,315.47 |
| Rate for Payer: Aetna Commercial |
$913.46
|
| Rate for Payer: Aetna Medicare |
$727.00
|
| Rate for Payer: BCBS Complete |
$538.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.47
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Meridian Medicaid |
$538.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,180.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,180.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$874.70
|
| Rate for Payer: UHC Exchange |
$874.70
|
| Rate for Payer: UHCCP Medicaid |
$512.90
|
|
|
PR STENGER TEST PURE TONE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92565
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$1,644.60 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.60
|
| Rate for Payer: BCN Commercial |
$29.32
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.49
|
| Rate for Payer: Priority Health Narrow Network |
$28.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.34
|
| Rate for Payer: UHC Exchange |
$12.34
|
|
|
PR STENGER TEST SPEECH
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92577
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$2,026.03 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,026.03
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.85
|
| Rate for Payer: Priority Health Narrow Network |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.32
|
| Rate for Payer: UHC Exchange |
$15.32
|
|
|
PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 36908
|
| Min. Negotiated Rate |
$129.29 |
| Max. Negotiated Rate |
$2,085.19 |
| Rate for Payer: Aetna Commercial |
$278.21
|
| Rate for Payer: Aetna Medicare |
$288.00
|
| Rate for Payer: BCBS Complete |
$135.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.07
|
| Rate for Payer: BCN Commercial |
$2,085.19
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Meridian Medicaid |
$135.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.68
|
| Rate for Payer: Priority Health Narrow Network |
$320.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.86
|
| Rate for Payer: UHC Exchange |
$249.86
|
| Rate for Payer: UHCCP Medicaid |
$129.29
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS G6002
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$85.81
|
| Rate for Payer: Aetna Commercial |
$85.81
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$108.97
|
| Rate for Payer: BCN Commercial |
$108.97
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Narrow Network |
$31.32
|
| Rate for Payer: Priority Health Narrow Network |
$31.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.09
|
| Rate for Payer: UHC Exchange |
$143.09
|
| Rate for Payer: UHC Exchange |
$143.09
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
|
|
PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES
|
Professional
|
Both
|
$2,976.00
|
|
|
Service Code
|
HCPCS 61750
|
| Min. Negotiated Rate |
$662.49 |
| Max. Negotiated Rate |
$2,885.28 |
| Rate for Payer: Aetna Commercial |
$1,819.17
|
| Rate for Payer: Aetna Medicare |
$1,488.00
|
| Rate for Payer: BCBS Complete |
$967.06
|
| Rate for Payer: BCBS Trust/PPO |
$662.49
|
| Rate for Payer: BCN Commercial |
$2,885.28
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Meridian Medicaid |
$967.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$921.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,934.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,443.20
|
| Rate for Payer: Priority Health Narrow Network |
$2,443.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,623.73
|
| Rate for Payer: UHC Exchange |
$1,623.73
|
| Rate for Payer: UHCCP Medicaid |
$921.01
|
|
|
PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61783
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$707.92 |
| Rate for Payer: Aetna Commercial |
$300.82
|
| Rate for Payer: Aetna Medicare |
$371.50
|
| Rate for Payer: BCBS Complete |
$155.88
|
| Rate for Payer: BCBS Trust/PPO |
$707.92
|
| Rate for Payer: BCN Commercial |
$337.68
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Meridian Medicaid |
$155.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.12
|
| Rate for Payer: Priority Health Narrow Network |
$394.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.49
|
| Rate for Payer: UHC Exchange |
$316.49
|
| Rate for Payer: UHCCP Medicaid |
$148.46
|
|
