|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$1,031.53 |
| Rate for Payer: Aetna Commercial |
$959.90
|
| Rate for Payer: Aetna Medicare |
$716.34
|
| Rate for Payer: BCBS Complete |
$604.00
|
| Rate for Payer: BCBS MAPPO |
$716.34
|
| Rate for Payer: BCN Medicare Advantage |
$716.34
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cofinity Commercial |
$959.90
|
| Rate for Payer: Cofinity Commercial |
$1,031.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.34
|
| Rate for Payer: Healthscope Commercial |
$859.61
|
| Rate for Payer: Healthscope Whirlpool |
$859.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.16
|
| Rate for Payer: Nomi Health Commercial |
$859.61
|
| Rate for Payer: PACE SWMI |
$716.34
|
| Rate for Payer: PHP Medicare Advantage |
$716.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
| Rate for Payer: Priority Health Medicare |
$716.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.34
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
| Rate for Payer: UHCCP DNSP |
$716.34
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$933.54 |
| Rate for Payer: Aetna Commercial |
$868.71
|
| Rate for Payer: Aetna Medicare |
$648.29
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$648.29
|
| Rate for Payer: BCN Medicare Advantage |
$648.29
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$933.54
|
| Rate for Payer: Cofinity Commercial |
$868.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$648.29
|
| Rate for Payer: Healthscope Commercial |
$777.95
|
| Rate for Payer: Healthscope Whirlpool |
$777.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.70
|
| Rate for Payer: Nomi Health Commercial |
$777.95
|
| Rate for Payer: PACE SWMI |
$648.29
|
| Rate for Payer: PHP Medicare Advantage |
$648.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$648.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$648.29
|
| Rate for Payer: UHC Medicare Advantage |
$648.29
|
| Rate for Payer: UHCCP DNSP |
$648.29
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$1,258.88 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Aetna Medicare |
$874.22
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$874.22
|
| Rate for Payer: BCN Medicare Advantage |
$874.22
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.88
|
| Rate for Payer: Cofinity Commercial |
$1,171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.22
|
| Rate for Payer: Healthscope Commercial |
$1,049.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.93
|
| Rate for Payer: Nomi Health Commercial |
$1,049.06
|
| Rate for Payer: PACE SWMI |
$874.22
|
| Rate for Payer: PHP Medicare Advantage |
$874.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$874.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.22
|
| Rate for Payer: UHC Medicare Advantage |
$874.22
|
| Rate for Payer: UHCCP DNSP |
$874.22
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$253.38 |
| Max. Negotiated Rate |
$1,753.05 |
| Rate for Payer: Aetna Commercial |
$339.53
|
| Rate for Payer: Aetna Medicare |
$253.38
|
| Rate for Payer: BCBS Complete |
$1,078.80
|
| Rate for Payer: BCBS MAPPO |
$253.38
|
| Rate for Payer: BCN Medicare Advantage |
$253.38
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.38
|
| Rate for Payer: Healthscope Commercial |
$304.06
|
| Rate for Payer: Healthscope Whirlpool |
$304.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.05
|
| Rate for Payer: Nomi Health Commercial |
$304.06
|
| Rate for Payer: PACE SWMI |
$253.38
|
| Rate for Payer: PHP Medicare Advantage |
$253.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.05
|
| Rate for Payer: Priority Health Medicare |
$253.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.38
|
| Rate for Payer: UHC Medicare Advantage |
$253.38
|
| Rate for Payer: UHCCP DNSP |
$253.38
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$1,133.26 |
| Max. Negotiated Rate |
$1,948.05 |
| Rate for Payer: Aetna Commercial |
$1,518.57
|
| Rate for Payer: Aetna Medicare |
$1,133.26
|
| Rate for Payer: BCBS Complete |
$1,198.80
|
| Rate for Payer: BCBS MAPPO |
$1,133.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.26
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$1,631.89
|
| Rate for Payer: Cofinity Commercial |
$1,518.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.26
|
| Rate for Payer: Healthscope Commercial |
$1,359.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,359.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.92
|
| Rate for Payer: Nomi Health Commercial |
$1,359.91
|
| Rate for Payer: PACE SWMI |
$1,133.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health Medicare |
$1,133.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.26
|
| Rate for Payer: UHCCP DNSP |
$1,133.26
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$1,116.53 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,496.15
|
| Rate for Payer: Aetna Medicare |
$1,116.53
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$1,116.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.53
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,607.80
|
| Rate for Payer: Cofinity Commercial |
$1,496.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.53
|
| Rate for Payer: Healthscope Commercial |
$1,339.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,339.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.36
|
| Rate for Payer: Nomi Health Commercial |
$1,339.84
|
| Rate for Payer: PACE SWMI |
$1,116.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$1,116.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.53
|
| Rate for Payer: UHCCP DNSP |
$1,116.53
|
|
|
PR SPLINT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
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 |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$658.40
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Healthscope Commercial |
$790.08
|
| Rate for Payer: Healthscope Whirlpool |
$790.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UHCCP DNSP |
$658.40
|
|
|
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%
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,041.30 |
| Max. Negotiated Rate |
$5,534.23 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Medicare |
$3,570.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: ASR ASR |
$1,553.94
|
| Rate for Payer: ASR Commercial |
$1,553.94
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,311.88
|
| Rate for Payer: BCN Commercial |
$1,242.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$1,281.60
|
| 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: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$1,602.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,553.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,570.47
|
| Rate for Payer: Mclaren Commercial |
$1,441.80
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$1,313.64
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$3,927.52
|
| Rate for Payer: PHP Medicaid |
$1,913.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,403.67
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,123.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,409.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$5,534.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP DNSP |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
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 |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$658.40
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Healthscope Commercial |
$790.08
|
| Rate for Payer: Healthscope Whirlpool |
$790.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UHCCP DNSP |
$658.40
|
|
|
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 |
$125.12 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$167.66
|
| Rate for Payer: Aetna Medicare |
$125.12
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$125.12
|
| Rate for Payer: BCN Medicare Advantage |
$125.12
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$180.17
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.12
|
| Rate for Payer: Healthscope Commercial |
$150.14
|
| Rate for Payer: Healthscope Whirlpool |
$150.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: Nomi Health Commercial |
$150.14
|
| Rate for Payer: PACE SWMI |
$125.12
|
| Rate for Payer: PHP Medicare Advantage |
$125.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$125.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.12
|
| Rate for Payer: UHC Medicare Advantage |
$125.12
|
| Rate for Payer: UHCCP DNSP |
$125.12
|
|
|
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 |
$956.23 |
| Max. Negotiated Rate |
$2,765.22 |
| Rate for Payer: Aetna Commercial |
$1,936.80
|
| Rate for Payer: Aetna Medicare |
$1,784.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: ASR ASR |
$2,087.44
|
| Rate for Payer: ASR Commercial |
$2,087.44
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,762.27
|
| Rate for Payer: BCN Commercial |
$1,668.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| 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 |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$2,152.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,087.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,784.01
|
| Rate for Payer: Mclaren Commercial |
$1,936.80
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| 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 |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,962.41
|
| Rate for Payer: PHP Medicaid |
$956.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| 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 |
$1,784.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,893.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$2,765.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP DNSP |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
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 |
$683.63 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$683.63
|
| Rate for Payer: BCBS Complete |
$860.80
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Healthscope Commercial |
$820.36
|
| Rate for Payer: Healthscope Whirlpool |
$820.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UHCCP DNSP |
$683.63
|
|
|
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 |
$683.63 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$683.63
|
| Rate for Payer: BCBS Complete |
$860.80
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Healthscope Commercial |
$820.36
|
| Rate for Payer: Healthscope Whirlpool |
$820.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UHCCP DNSP |
$683.63
|
|
|
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 |
$105.79 |
| Max. Negotiated Rate |
$896.35 |
| Rate for Payer: Aetna Commercial |
$141.76
|
| Rate for Payer: Aetna Medicare |
$105.79
|
| Rate for Payer: BCBS Complete |
$551.60
|
| Rate for Payer: BCBS MAPPO |
$105.79
|
| Rate for Payer: BCN Medicare Advantage |
$105.79
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$141.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.79
|
| Rate for Payer: Healthscope Commercial |
$126.95
|
| Rate for Payer: Healthscope Whirlpool |
$126.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.08
|
| Rate for Payer: Nomi Health Commercial |
$126.95
|
| Rate for Payer: PACE SWMI |
$105.79
|
| Rate for Payer: PHP Medicare Advantage |
$105.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.35
|
| Rate for Payer: Priority Health Medicare |
$105.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.79
|
| Rate for Payer: UHC Medicare Advantage |
$105.79
|
| Rate for Payer: UHCCP DNSP |
$105.79
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$24.82
|
| Rate for Payer: Aetna Medicare |
$24.82
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Healthscope Commercial |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$29.78
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Healthscope Whirlpool |
$29.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: Nomi Health Commercial |
$29.78
|
| Rate for Payer: Nomi Health Commercial |
$29.78
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| 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 Medicare |
$24.82
|
| Rate for Payer: Priority Health Medicare |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.82
|
| Rate for Payer: UHCCP DNSP |
$24.82
|
| Rate for Payer: UHCCP DNSP |
$24.82
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna Medicare |
$23.42
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$23.42
|
| Rate for Payer: BCN Medicare Advantage |
$23.42
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.42
|
| Rate for Payer: Healthscope Commercial |
$28.10
|
| Rate for Payer: Healthscope Whirlpool |
$28.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.59
|
| Rate for Payer: Nomi Health Commercial |
$28.10
|
| Rate for Payer: PACE SWMI |
$23.42
|
| Rate for Payer: PHP Medicare Advantage |
$23.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$23.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.42
|
| Rate for Payer: UHC Medicare Advantage |
$23.42
|
| Rate for Payer: UHCCP DNSP |
$23.42
|
|
|
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 |
$257.45 |
| Max. Negotiated Rate |
$789.10 |
| Rate for Payer: Aetna Commercial |
$344.98
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: BCBS Complete |
$485.60
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cofinity Commercial |
$370.73
|
| Rate for Payer: Cofinity Commercial |
$344.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$308.94
|
| Rate for Payer: Healthscope Whirlpool |
$308.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Nomi Health Commercial |
$308.94
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.10
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$318.26 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$426.47
|
| Rate for Payer: Aetna Medicare |
$318.26
|
| Rate for Payer: BCBS Complete |
$500.00
|
| Rate for Payer: BCBS MAPPO |
$318.26
|
| Rate for Payer: BCN Medicare Advantage |
$318.26
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$458.29
|
| Rate for Payer: Cofinity Commercial |
$426.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.26
|
| Rate for Payer: Healthscope Commercial |
$381.91
|
| Rate for Payer: Healthscope Whirlpool |
$381.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.17
|
| Rate for Payer: Nomi Health Commercial |
$381.91
|
| Rate for Payer: PACE SWMI |
$318.26
|
| Rate for Payer: PHP Medicare Advantage |
$318.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health Medicare |
$318.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.26
|
| Rate for Payer: UHC Medicare Advantage |
$318.26
|
| Rate for Payer: UHCCP DNSP |
$318.26
|
|
|
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 |
$138.36 |
| Rate for Payer: Aetna Commercial |
$128.75
|
| Rate for Payer: Aetna Medicare |
$96.08
|
| Rate for Payer: BCBS Complete |
$74.80
|
| Rate for Payer: BCBS MAPPO |
$96.08
|
| Rate for Payer: BCN Medicare Advantage |
$96.08
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.08
|
| Rate for Payer: Healthscope Commercial |
$115.30
|
| Rate for Payer: Healthscope Whirlpool |
$115.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.88
|
| Rate for Payer: Nomi Health Commercial |
$115.30
|
| Rate for Payer: PACE SWMI |
$96.08
|
| Rate for Payer: PHP Medicare Advantage |
$96.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
| Rate for Payer: Priority Health Medicare |
$96.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.08
|
| Rate for Payer: UHC Medicare Advantage |
$96.08
|
| Rate for Payer: UHCCP DNSP |
$96.08
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$680.40 |
| Max. Negotiated Rate |
$1,247.49 |
| Rate for Payer: Aetna Commercial |
$1,160.86
|
| Rate for Payer: Aetna Medicare |
$866.31
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$866.31
|
| Rate for Payer: BCN Medicare Advantage |
$866.31
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,247.49
|
| Rate for Payer: Cofinity Commercial |
$1,160.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.31
|
| Rate for Payer: Healthscope Commercial |
$1,039.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,039.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.63
|
| Rate for Payer: Nomi Health Commercial |
$1,039.57
|
| Rate for Payer: PACE SWMI |
$866.31
|
| Rate for Payer: PHP Medicare Advantage |
$866.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$866.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.31
|
| Rate for Payer: UHC Medicare Advantage |
$866.31
|
| Rate for Payer: UHCCP DNSP |
$866.31
|
|
