|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
|
|
PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99375
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$925.11 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna Commercial |
$1,239.65
|
| Rate for Payer: Aetna Medicare |
$925.11
|
| Rate for Payer: BCBS Complete |
$1,296.00
|
| Rate for Payer: BCBS MAPPO |
$925.11
|
| Rate for Payer: BCN Medicare Advantage |
$925.11
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,332.16
|
| Rate for Payer: Cofinity Commercial |
$1,239.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.11
|
| Rate for Payer: Healthscope Commercial |
$1,110.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,110.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$971.37
|
| Rate for Payer: Nomi Health Commercial |
$1,110.13
|
| Rate for Payer: PACE SWMI |
$925.11
|
| Rate for Payer: PHP Medicare Advantage |
$925.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health Medicare |
$925.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.11
|
| Rate for Payer: UHC Medicare Advantage |
$925.11
|
| Rate for Payer: UHCCP DNSP |
$925.11
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$584.00 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Aetna Commercial |
$1,034.59
|
| Rate for Payer: Aetna Medicare |
$772.08
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$772.08
|
| Rate for Payer: BCN Medicare Advantage |
$772.08
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$1,111.80
|
| Rate for Payer: Cofinity Commercial |
$1,034.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.08
|
| Rate for Payer: Healthscope Commercial |
$926.50
|
| Rate for Payer: Healthscope Whirlpool |
$926.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.68
|
| Rate for Payer: Nomi Health Commercial |
$926.50
|
| Rate for Payer: PACE SWMI |
$772.08
|
| Rate for Payer: PHP Medicare Advantage |
$772.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health Medicare |
$772.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.08
|
| Rate for Payer: UHC Medicare Advantage |
$772.08
|
| Rate for Payer: UHCCP DNSP |
$772.08
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$479.82 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare |
$333.21
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$333.21
|
| Rate for Payer: BCN Medicare Advantage |
$333.21
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$479.82
|
| Rate for Payer: Cofinity Commercial |
$446.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.21
|
| Rate for Payer: Healthscope Commercial |
$399.85
|
| Rate for Payer: Healthscope Whirlpool |
$399.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.87
|
| Rate for Payer: Nomi Health Commercial |
$399.85
|
| Rate for Payer: PACE SWMI |
$333.21
|
| Rate for Payer: PHP Medicare Advantage |
$333.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$333.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.21
|
| Rate for Payer: UHC Medicare Advantage |
$333.21
|
| Rate for Payer: UHCCP DNSP |
$333.21
|
|
|
PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99374
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 31820
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$477.10 |
| Rate for Payer: Aetna Commercial |
$421.56
|
| Rate for Payer: Aetna Medicare |
$314.60
|
| Rate for Payer: BCBS Complete |
$293.60
|
| Rate for Payer: BCBS MAPPO |
$314.60
|
| Rate for Payer: BCN Medicare Advantage |
$314.60
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$453.02
|
| Rate for Payer: Cofinity Commercial |
$421.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.60
|
| Rate for Payer: Healthscope Commercial |
$377.52
|
| Rate for Payer: Healthscope Whirlpool |
$377.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.33
|
| Rate for Payer: Nomi Health Commercial |
$377.52
|
| Rate for Payer: PACE SWMI |
$314.60
|
| Rate for Payer: PHP Medicare Advantage |
$314.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health Medicare |
$314.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.60
|
| Rate for Payer: UHC Medicare Advantage |
$314.60
|
| Rate for Payer: UHCCP DNSP |
$314.60
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 31825
|
| Min. Negotiated Rate |
$412.40 |
| Max. Negotiated Rate |
$670.15 |
| Rate for Payer: Aetna Commercial |
$619.66
|
| Rate for Payer: Aetna Medicare |
$462.43
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$462.43
|
| Rate for Payer: BCN Medicare Advantage |
$462.43
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$665.90
|
| Rate for Payer: Cofinity Commercial |
$619.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.43
|
| Rate for Payer: Healthscope Commercial |
$554.92
|
| Rate for Payer: Healthscope Whirlpool |
$554.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$485.55
|
| Rate for Payer: Nomi Health Commercial |
$554.92
|
| Rate for Payer: PACE SWMI |
$462.43
|
| Rate for Payer: PHP Medicare Advantage |
$462.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$462.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.43
|
| Rate for Payer: UHC Medicare Advantage |
$462.43
|
| Rate for Payer: UHCCP DNSP |
$462.43
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$2,977.00
|
|
|
Service Code
|
HCPCS 29828
|
| Min. Negotiated Rate |
$881.73 |
| Max. Negotiated Rate |
$1,935.05 |
| Rate for Payer: Aetna Commercial |
$1,181.52
|
| Rate for Payer: Aetna Medicare |
$881.73
|
| Rate for Payer: BCBS Complete |
$1,190.80
|
| Rate for Payer: BCBS MAPPO |
$881.73
|
| Rate for Payer: BCN Medicare Advantage |
$881.73
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,269.69
|
| Rate for Payer: Cofinity Commercial |
$1,181.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.73
|
| Rate for Payer: Healthscope Commercial |
$1,058.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.82
|
| Rate for Payer: Nomi Health Commercial |
$1,058.08
|
| Rate for Payer: PACE SWMI |
$881.73
|
| Rate for Payer: PHP Medicare Advantage |
$881.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health Medicare |
$881.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.73
|
| Rate for Payer: UHC Medicare Advantage |
$881.73
|
| Rate for Payer: UHCCP DNSP |
$881.73
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$2,977.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
29828
|
| Min. Negotiated Rate |
$881.73 |
| Max. Negotiated Rate |
$1,935.05 |
| Rate for Payer: Aetna Commercial |
$1,181.52
|
| Rate for Payer: Aetna Medicare |
$881.73
|
| Rate for Payer: BCBS Complete |
$1,190.80
|
| Rate for Payer: BCBS MAPPO |
$881.73
|
| Rate for Payer: BCN Medicare Advantage |
$881.73
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,269.69
|
| Rate for Payer: Cofinity Commercial |
$1,181.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.73
|
| Rate for Payer: Healthscope Commercial |
$1,058.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.82
|
| Rate for Payer: Nomi Health Commercial |
$1,058.08
|
| Rate for Payer: PACE SWMI |
$881.73
|
| Rate for Payer: PHP Medicare Advantage |
$881.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health Medicare |
$881.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.73
|
| Rate for Payer: UHC Medicare Advantage |
$881.73
|
| Rate for Payer: UHCCP DNSP |
$881.73
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Facility
|
IP
|
$2,977.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
29828
|
| Min. Negotiated Rate |
$1,935.05 |
| Max. Negotiated Rate |
$2,977.00 |
| Rate for Payer: Aetna Commercial |
$2,679.30
|
| Rate for Payer: ASR ASR |
$2,887.69
|
| Rate for Payer: ASR Commercial |
$2,887.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.96
|
| Rate for Payer: BCN Commercial |
$2,308.07
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$2,798.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.60
|
| Rate for Payer: Healthscope Commercial |
$2,977.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,887.69
|
| Rate for Payer: Mclaren Commercial |
$2,679.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.45
|
| Rate for Payer: Nomi Health Commercial |
$2,441.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,619.76
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Facility
|
OP
|
$2,977.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
29828
|
| Min. Negotiated Rate |
$1,935.05 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,679.30
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$2,887.69
|
| Rate for Payer: ASR Commercial |
$2,887.69
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,437.87
|
| Rate for Payer: BCN Commercial |
$2,308.07
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$2,798.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,977.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,887.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,679.30
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.45
|
| Rate for Payer: Nomi Health Commercial |
$2,441.14
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,608.45
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$2,086.88
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,619.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Facility
|
IP
|
$3,236.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
29806
|
| Min. Negotiated Rate |
$2,103.40 |
| Max. Negotiated Rate |
$3,236.00 |
| Rate for Payer: Aetna Commercial |
$2,912.40
|
| Rate for Payer: ASR ASR |
$3,138.92
|
| Rate for Payer: ASR Commercial |
$3,138.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,637.02
|
| Rate for Payer: BCN Commercial |
$2,508.87
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cofinity Commercial |
$3,041.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.80
|
| Rate for Payer: Healthscope Commercial |
$3,236.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,138.92
|
| Rate for Payer: Mclaren Commercial |
$2,912.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.60
|
| Rate for Payer: Nomi Health Commercial |
$2,653.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,103.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,847.68
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Facility
|
OP
|
$3,236.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
29806
|
| Min. Negotiated Rate |
$2,103.40 |
| Max. Negotiated Rate |
$10,799.07 |
| Rate for Payer: Aetna Commercial |
$2,912.40
|
| Rate for Payer: Aetna Medicare |
$6,967.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: ASR ASR |
$3,138.92
|
| Rate for Payer: ASR Commercial |
$3,138.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,649.96
|
| Rate for Payer: BCN Commercial |
$2,508.87
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cofinity Commercial |
$3,041.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$3,236.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,138.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,967.14
|
| Rate for Payer: Mclaren Commercial |
$2,912.40
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.60
|
| Rate for Payer: Nomi Health Commercial |
$2,653.52
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$7,663.85
|
| Rate for Payer: PHP Medicaid |
$3,734.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,103.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,835.38
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health Narrow Network |
$2,268.44
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,847.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$10,799.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP DNSP |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Professional
|
Both
|
$3,236.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
29806
|
| Min. Negotiated Rate |
$1,018.37 |
| Max. Negotiated Rate |
$2,103.40 |
| Rate for Payer: Aetna Commercial |
$1,364.62
|
| Rate for Payer: Aetna Medicare |
$1,018.37
|
| Rate for Payer: BCBS Complete |
$1,294.40
|
| Rate for Payer: BCBS MAPPO |
$1,018.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.37
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,466.45
|
| Rate for Payer: Cofinity Commercial |
$1,364.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.37
|
| Rate for Payer: Healthscope Commercial |
$1,222.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,222.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.29
|
| Rate for Payer: Nomi Health Commercial |
$1,222.04
|
| Rate for Payer: PACE SWMI |
$1,018.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,103.40
|
| Rate for Payer: Priority Health Medicare |
$1,018.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.37
|
| Rate for Payer: UHCCP DNSP |
$1,018.37
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY
|
Professional
|
Both
|
$3,236.00
|
|
|
Service Code
|
HCPCS 29806
|
| Min. Negotiated Rate |
$1,018.37 |
| Max. Negotiated Rate |
$2,103.40 |
| Rate for Payer: Aetna Commercial |
$1,364.62
|
| Rate for Payer: Aetna Medicare |
$1,018.37
|
| Rate for Payer: BCBS Complete |
$1,294.40
|
| Rate for Payer: BCBS MAPPO |
$1,018.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.37
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,466.45
|
| Rate for Payer: Cofinity Commercial |
$1,364.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.37
|
| Rate for Payer: Healthscope Commercial |
$1,222.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,222.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.29
|
| Rate for Payer: Nomi Health Commercial |
$1,222.04
|
| Rate for Payer: PACE SWMI |
$1,018.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,103.40
|
| Rate for Payer: Priority Health Medicare |
$1,018.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.37
|
| Rate for Payer: UHCCP DNSP |
$1,018.37
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 29821
|
| Min. Negotiated Rate |
$573.42 |
| Max. Negotiated Rate |
$1,473.55 |
| Rate for Payer: Aetna Commercial |
$768.38
|
| Rate for Payer: Aetna Medicare |
$573.42
|
| Rate for Payer: BCBS Complete |
$906.80
|
| Rate for Payer: BCBS MAPPO |
$573.42
|
| Rate for Payer: BCN Medicare Advantage |
$573.42
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$825.72
|
| Rate for Payer: Cofinity Commercial |
$768.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.42
|
| Rate for Payer: Healthscope Commercial |
$688.10
|
| Rate for Payer: Healthscope Whirlpool |
$688.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$602.09
|
| Rate for Payer: Nomi Health Commercial |
$688.10
|
| Rate for Payer: PACE SWMI |
$573.42
|
| Rate for Payer: PHP Medicare Advantage |
$573.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.55
|
| Rate for Payer: Priority Health Medicare |
$573.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.42
|
| Rate for Payer: UHC Medicare Advantage |
$573.42
|
| Rate for Payer: UHCCP DNSP |
$573.42
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Facility
|
IP
|
$2,103.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
29824
|
| Min. Negotiated Rate |
$1,366.95 |
| Max. Negotiated Rate |
$2,103.00 |
| Rate for Payer: Aetna Commercial |
$1,892.70
|
| Rate for Payer: ASR ASR |
$2,039.91
|
| Rate for Payer: ASR Commercial |
$2,039.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.73
|
| Rate for Payer: BCN Commercial |
$1,630.46
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$1,976.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.40
|
| Rate for Payer: Healthscope Commercial |
$2,103.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,039.91
|
| Rate for Payer: Mclaren Commercial |
$1,892.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.55
|
| Rate for Payer: Nomi Health Commercial |
$1,724.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,850.64
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
29824
|
| Min. Negotiated Rate |
$652.90 |
| Max. Negotiated Rate |
$1,366.95 |
| Rate for Payer: Aetna Commercial |
$874.89
|
| Rate for Payer: Aetna Medicare |
$652.90
|
| Rate for Payer: BCBS Complete |
$841.20
|
| Rate for Payer: BCBS MAPPO |
$652.90
|
| Rate for Payer: BCN Medicare Advantage |
$652.90
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$940.18
|
| Rate for Payer: Cofinity Commercial |
$874.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.90
|
| Rate for Payer: Healthscope Commercial |
$783.48
|
| Rate for Payer: Healthscope Whirlpool |
$783.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.54
|
| Rate for Payer: Nomi Health Commercial |
$783.48
|
| Rate for Payer: PACE SWMI |
$652.90
|
| Rate for Payer: PHP Medicare Advantage |
$652.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health Medicare |
$652.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.90
|
| Rate for Payer: UHC Medicare Advantage |
$652.90
|
| Rate for Payer: UHCCP DNSP |
$652.90
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Facility
|
OP
|
$2,103.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
29824
|
| Min. Negotiated Rate |
$1,366.95 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,892.70
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$2,039.91
|
| Rate for Payer: ASR Commercial |
$2,039.91
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,722.15
|
| Rate for Payer: BCN Commercial |
$1,630.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$1,976.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$2,103.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,039.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,892.70
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.55
|
| Rate for Payer: Nomi Health Commercial |
$1,724.46
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,842.65
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,474.20
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,850.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 29824
|
| Min. Negotiated Rate |
$652.90 |
| Max. Negotiated Rate |
$1,366.95 |
| Rate for Payer: Aetna Commercial |
$874.89
|
| Rate for Payer: Aetna Medicare |
$652.90
|
| Rate for Payer: BCBS Complete |
$841.20
|
| Rate for Payer: BCBS MAPPO |
$652.90
|
| Rate for Payer: BCN Medicare Advantage |
$652.90
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$940.18
|
| Rate for Payer: Cofinity Commercial |
$874.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.90
|
| Rate for Payer: Healthscope Commercial |
$783.48
|
| Rate for Payer: Healthscope Whirlpool |
$783.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.54
|
| Rate for Payer: Nomi Health Commercial |
$783.48
|
| Rate for Payer: PACE SWMI |
$652.90
|
| Rate for Payer: PHP Medicare Advantage |
$652.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health Medicare |
$652.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.90
|
| Rate for Payer: UHC Medicare Advantage |
$652.90
|
| Rate for Payer: UHCCP DNSP |
$652.90
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
29822
|
| Min. Negotiated Rate |
$1,430.65 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,980.90
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$2,134.97
|
| Rate for Payer: ASR Commercial |
$2,134.97
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,802.40
|
| Rate for Payer: BCN Commercial |
$1,706.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cofinity Commercial |
$2,068.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$2,201.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,134.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,980.90
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.85
|
| Rate for Payer: Nomi Health Commercial |
$1,804.82
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,928.52
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
Both
|
$2,201.00
|
|
|
Service Code
|
HCPCS 29822
|
| Min. Negotiated Rate |
$522.95 |
| Max. Negotiated Rate |
$1,430.65 |
| Rate for Payer: Aetna Commercial |
$700.75
|
| Rate for Payer: Aetna Medicare |
$522.95
|
| Rate for Payer: BCBS Complete |
$880.40
|
| Rate for Payer: BCBS MAPPO |
$522.95
|
| Rate for Payer: BCN Medicare Advantage |
$522.95
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cofinity Commercial |
$753.05
|
| Rate for Payer: Cofinity Commercial |
$700.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.95
|
| Rate for Payer: Healthscope Commercial |
$627.54
|
| Rate for Payer: Healthscope Whirlpool |
$627.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$549.10
|
| Rate for Payer: Nomi Health Commercial |
$627.54
|
| Rate for Payer: PACE SWMI |
$522.95
|
| Rate for Payer: PHP Medicare Advantage |
$522.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.65
|
| Rate for Payer: Priority Health Medicare |
$522.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$522.95
|
| Rate for Payer: UHC Medicare Advantage |
$522.95
|
| Rate for Payer: UHCCP DNSP |
$522.95
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
29822
|
| Min. Negotiated Rate |
$1,430.65 |
| Max. Negotiated Rate |
$2,201.00 |
| Rate for Payer: Aetna Commercial |
$1,980.90
|
| Rate for Payer: ASR ASR |
$2,134.97
|
| Rate for Payer: ASR Commercial |
$2,134.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.59
|
| Rate for Payer: BCN Commercial |
$1,706.44
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cofinity Commercial |
$2,068.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.80
|
| Rate for Payer: Healthscope Commercial |
$2,201.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,134.97
|
| Rate for Payer: Mclaren Commercial |
$1,980.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.85
|
| Rate for Payer: Nomi Health Commercial |
$1,804.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.88
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
Both
|
$2,201.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
29822
|
| Min. Negotiated Rate |
$522.95 |
| Max. Negotiated Rate |
$1,430.65 |
| Rate for Payer: Aetna Commercial |
$700.75
|
| Rate for Payer: Aetna Medicare |
$522.95
|
| Rate for Payer: BCBS Complete |
$880.40
|
| Rate for Payer: BCBS MAPPO |
$522.95
|
| Rate for Payer: BCN Medicare Advantage |
$522.95
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cash Price |
$1,760.80
|
| Rate for Payer: Cofinity Commercial |
$753.05
|
| Rate for Payer: Cofinity Commercial |
$700.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.95
|
| Rate for Payer: Healthscope Commercial |
$627.54
|
| Rate for Payer: Healthscope Whirlpool |
$627.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$549.10
|
| Rate for Payer: Nomi Health Commercial |
$627.54
|
| Rate for Payer: PACE SWMI |
$522.95
|
| Rate for Payer: PHP Medicare Advantage |
$522.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.65
|
| Rate for Payer: Priority Health Medicare |
$522.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$522.95
|
| Rate for Payer: UHC Medicare Advantage |
$522.95
|
| Rate for Payer: UHCCP DNSP |
$522.95
|
|
