|
PR SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION
|
Facility
|
OP
|
$3,074.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
29807
|
| Min. Negotiated Rate |
$1,998.10 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$2,766.60
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$2,981.78
|
| Rate for Payer: ASR Commercial |
$2,981.78
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.30
|
| Rate for Payer: BCN Commercial |
$2,383.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Cofinity Commercial |
$2,889.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$3,074.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,981.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$2,766.60
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.90
|
| Rate for Payer: Nomi Health Commercial |
$2,520.68
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,693.44
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,154.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,705.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION
|
Facility
|
IP
|
$3,074.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
29807
|
| Min. Negotiated Rate |
$1,998.10 |
| Max. Negotiated Rate |
$3,074.00 |
| Rate for Payer: Aetna Commercial |
$2,766.60
|
| Rate for Payer: ASR ASR |
$2,981.78
|
| Rate for Payer: ASR Commercial |
$2,981.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,505.00
|
| Rate for Payer: BCN Commercial |
$2,383.27
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Cofinity Commercial |
$2,889.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,459.20
|
| Rate for Payer: Healthscope Commercial |
$3,074.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,981.78
|
| Rate for Payer: Mclaren Commercial |
$2,766.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,612.90
|
| Rate for Payer: Nomi Health Commercial |
$2,520.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,705.12
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION
|
Professional
|
Both
|
$3,074.00
|
|
|
Service Code
|
HCPCS 29807
|
| Min. Negotiated Rate |
$670.31 |
| Max. Negotiated Rate |
$1,998.10 |
| Rate for Payer: Aetna Commercial |
$1,378.96
|
| Rate for Payer: Aetna Medicare |
$1,537.00
|
| Rate for Payer: BCBS Complete |
$703.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.18
|
| Rate for Payer: BCN Commercial |
$1,517.34
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Meridian Medicaid |
$703.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,591.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,591.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,192.06
|
| Rate for Payer: UHC Exchange |
$1,192.06
|
| Rate for Payer: UHCCP Medicaid |
$670.31
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION
|
Professional
|
Both
|
$3,074.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
29807
|
| Min. Negotiated Rate |
$670.31 |
| Max. Negotiated Rate |
$1,998.10 |
| Rate for Payer: Aetna Commercial |
$1,378.96
|
| Rate for Payer: Aetna Medicare |
$1,537.00
|
| Rate for Payer: BCBS Complete |
$703.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.18
|
| Rate for Payer: BCN Commercial |
$1,517.34
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Cash Price |
$2,459.20
|
| Rate for Payer: Meridian Medicaid |
$703.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,998.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,591.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,591.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,192.06
|
| Rate for Payer: UHC Exchange |
$1,192.06
|
| Rate for Payer: UHCCP Medicaid |
$670.31
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT 29825
|
| Hospital Charge Code |
29825
|
| Min. Negotiated Rate |
$1,409.85 |
| Max. Negotiated Rate |
$2,169.00 |
| Rate for Payer: Aetna Commercial |
$1,952.10
|
| Rate for Payer: ASR ASR |
$2,103.93
|
| Rate for Payer: ASR Commercial |
$2,103.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.52
|
| Rate for Payer: BCN Commercial |
$1,681.63
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$2,038.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,735.20
|
| Rate for Payer: Healthscope Commercial |
$2,169.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,103.93
|
| Rate for Payer: Mclaren Commercial |
$1,952.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,843.65
|
| Rate for Payer: Nomi Health Commercial |
$1,778.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,908.72
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT 29825
|
| Hospital Charge Code |
29825
|
| Min. Negotiated Rate |
$1,409.85 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,952.10
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$2,103.93
|
| Rate for Payer: ASR Commercial |
$2,103.93
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,776.19
|
| Rate for Payer: BCN Commercial |
$1,681.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cofinity Commercial |
$2,038.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,735.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$2,169.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,103.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,952.10
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,843.65
|
| Rate for Payer: Nomi Health Commercial |
$1,778.58
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,900.48
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,520.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,908.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 29825
|
| Min. Negotiated Rate |
$383.61 |
| Max. Negotiated Rate |
$2,429.12 |
| Rate for Payer: Aetna Commercial |
$783.73
|
| Rate for Payer: Aetna Medicare |
$1,084.50
|
| Rate for Payer: BCBS Complete |
$402.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,429.12
|
| Rate for Payer: BCN Commercial |
$864.96
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Meridian Medicaid |
$402.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.30
|
| Rate for Payer: Priority Health Narrow Network |
$907.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.38
|
| Rate for Payer: UHC Exchange |
$667.38
|
| Rate for Payer: UHCCP Medicaid |
$383.61
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS
|
Professional
|
Both
|
$2,169.00
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
29825
|
| Min. Negotiated Rate |
$383.61 |
| Max. Negotiated Rate |
$2,429.12 |
| Rate for Payer: Aetna Commercial |
$783.73
|
| Rate for Payer: Aetna Medicare |
$1,084.50
|
| Rate for Payer: BCBS Complete |
$402.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,429.12
|
| Rate for Payer: BCN Commercial |
$864.96
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Meridian Medicaid |
$402.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,409.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.30
|
| Rate for Payer: Priority Health Narrow Network |
$907.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$667.38
|
| Rate for Payer: UHC Exchange |
$667.38
|
| Rate for Payer: UHCCP Medicaid |
$383.61
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Professional
|
Both
|
$3,399.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
29827
|
| Min. Negotiated Rate |
$691.61 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$1,428.39
|
| Rate for Payer: Aetna Medicare |
$1,699.50
|
| Rate for Payer: BCBS Complete |
$726.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.58
|
| Rate for Payer: BCN Commercial |
$1,566.21
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Meridian Medicaid |
$726.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,209.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,641.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,641.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.74
|
| Rate for Payer: UHC Exchange |
$1,249.74
|
| Rate for Payer: UHCCP Medicaid |
$691.61
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Facility
|
OP
|
$3,399.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
29827
|
| Min. Negotiated Rate |
$2,209.35 |
| Max. Negotiated Rate |
$10,848.88 |
| Rate for Payer: Aetna Commercial |
$3,059.10
|
| Rate for Payer: Aetna Medicare |
$6,999.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: ASR ASR |
$3,297.03
|
| Rate for Payer: ASR Commercial |
$3,297.03
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,783.44
|
| Rate for Payer: BCN Commercial |
$2,635.24
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cofinity Commercial |
$3,195.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,719.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$3,399.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,297.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,999.28
|
| Rate for Payer: Mclaren Commercial |
$3,059.10
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,889.15
|
| Rate for Payer: Nomi Health Commercial |
$2,787.18
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$7,699.21
|
| Rate for Payer: PHP Medicaid |
$3,751.61
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,209.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,978.20
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,382.70
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,991.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$10,848.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP DNSP |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Facility
|
IP
|
$3,399.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
29827
|
| Min. Negotiated Rate |
$2,209.35 |
| Max. Negotiated Rate |
$3,399.00 |
| Rate for Payer: Aetna Commercial |
$3,059.10
|
| Rate for Payer: ASR ASR |
$3,297.03
|
| Rate for Payer: ASR Commercial |
$3,297.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,769.85
|
| Rate for Payer: BCN Commercial |
$2,635.24
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cofinity Commercial |
$3,195.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,719.20
|
| Rate for Payer: Healthscope Commercial |
$3,399.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,297.03
|
| Rate for Payer: Mclaren Commercial |
$3,059.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,889.15
|
| Rate for Payer: Nomi Health Commercial |
$2,787.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,209.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,991.12
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Professional
|
Both
|
$3,399.00
|
|
|
Service Code
|
HCPCS 29827
|
| Min. Negotiated Rate |
$691.61 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$1,428.39
|
| Rate for Payer: Aetna Medicare |
$1,699.50
|
| Rate for Payer: BCBS Complete |
$726.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.58
|
| Rate for Payer: BCN Commercial |
$1,566.21
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Cash Price |
$2,719.20
|
| Rate for Payer: Meridian Medicaid |
$726.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,209.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,641.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,641.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.74
|
| Rate for Payer: UHC Exchange |
$1,249.74
|
| Rate for Payer: UHCCP Medicaid |
$691.61
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS 29823
|
| Min. Negotiated Rate |
$387.02 |
| Max. Negotiated Rate |
$1,641.25 |
| Rate for Payer: Aetna Commercial |
$790.59
|
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.32
|
| Rate for Payer: BCN Commercial |
$962.07
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.99
|
| Rate for Payer: Priority Health Narrow Network |
$917.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$716.02
|
| Rate for Payer: UHC Exchange |
$716.02
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Facility
|
OP
|
$2,525.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$1,641.25 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$2,272.50
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$2,449.25
|
| Rate for Payer: ASR Commercial |
$2,449.25
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,067.72
|
| Rate for Payer: BCN Commercial |
$1,957.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cofinity Commercial |
$2,373.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$2,525.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,449.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$2,272.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.25
|
| Rate for Payer: Nomi Health Commercial |
$2,070.50
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,212.40
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,770.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,222.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$387.02 |
| Max. Negotiated Rate |
$1,641.25 |
| Rate for Payer: Aetna Commercial |
$790.59
|
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.32
|
| Rate for Payer: BCN Commercial |
$962.07
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.99
|
| Rate for Payer: Priority Health Narrow Network |
$917.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$716.02
|
| Rate for Payer: UHC Exchange |
$716.02
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Facility
|
IP
|
$2,525.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$1,641.25 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna Commercial |
$2,272.50
|
| Rate for Payer: ASR ASR |
$2,449.25
|
| Rate for Payer: ASR Commercial |
$2,449.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,057.62
|
| Rate for Payer: BCN Commercial |
$1,957.63
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cofinity Commercial |
$2,373.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.00
|
| Rate for Payer: Healthscope Commercial |
$2,525.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,449.25
|
| Rate for Payer: Mclaren Commercial |
$2,272.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.25
|
| Rate for Payer: Nomi Health Commercial |
$2,070.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,222.00
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS 29826
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,787.84
|
| Rate for Payer: BCN Commercial |
$200.65
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.52
|
| Rate for Payer: Priority Health Narrow Network |
$259.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.67
|
| Rate for Payer: UHC Exchange |
$765.67
|
| Rate for Payer: UHCCP Medicaid |
$109.70
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Facility
|
IP
|
$2,525.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$1,641.25 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna Commercial |
$2,272.50
|
| Rate for Payer: ASR ASR |
$2,449.25
|
| Rate for Payer: ASR Commercial |
$2,449.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,057.62
|
| Rate for Payer: BCN Commercial |
$1,957.63
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cofinity Commercial |
$2,373.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.00
|
| Rate for Payer: Healthscope Commercial |
$2,525.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,449.25
|
| Rate for Payer: Mclaren Commercial |
$2,272.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.25
|
| Rate for Payer: Nomi Health Commercial |
$2,070.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,222.00
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Facility
|
OP
|
$2,525.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$1,010.00 |
| Max. Negotiated Rate |
$2,525.00 |
| Rate for Payer: Aetna Commercial |
$2,272.50
|
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: ASR ASR |
$2,449.25
|
| Rate for Payer: ASR Commercial |
$2,449.25
|
| Rate for Payer: BCBS Complete |
$1,010.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,067.72
|
| Rate for Payer: BCN Commercial |
$1,957.63
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cofinity Commercial |
$2,373.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.00
|
| Rate for Payer: Healthscope Commercial |
$2,525.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,449.25
|
| Rate for Payer: Mclaren Commercial |
$2,272.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.25
|
| Rate for Payer: Nomi Health Commercial |
$2,070.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,212.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,770.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,222.00
|
|
|
PR SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$2,787.84 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$1,262.50
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,787.84
|
| Rate for Payer: BCN Commercial |
$200.65
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Cash Price |
$2,020.00
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.52
|
| Rate for Payer: Priority Health Narrow Network |
$259.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$765.67
|
| Rate for Payer: UHC Exchange |
$765.67
|
| Rate for Payer: UHCCP Medicaid |
$109.70
|
|
|
PR SURGICAL TRAYS
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS A4550
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.07
|
| Rate for Payer: UHC Exchange |
$11.07
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Professional
|
Both
|
$5,673.00
|
|
|
Service Code
|
HCPCS 69706
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$4,200.67 |
| Rate for Payer: Aetna Commercial |
$274.21
|
| Rate for Payer: Aetna Medicare |
$2,836.50
|
| Rate for Payer: BCBS Complete |
$163.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,280.67
|
| Rate for Payer: BCN Commercial |
$4,200.67
|
| Rate for Payer: Cash Price |
$4,538.40
|
| Rate for Payer: Cash Price |
$4,538.40
|
| Rate for Payer: Meridian Medicaid |
$163.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,687.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.61
|
| Rate for Payer: Priority Health Narrow Network |
$352.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.36
|
| Rate for Payer: UHC Exchange |
$303.36
|
| Rate for Payer: UHCCP Medicaid |
$155.28
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Professional
|
Both
|
$5,488.00
|
|
|
Service Code
|
HCPCS 69705
|
| Min. Negotiated Rate |
$111.19 |
| Max. Negotiated Rate |
$4,063.84 |
| Rate for Payer: Aetna Commercial |
$196.86
|
| Rate for Payer: Aetna Medicare |
$2,744.00
|
| Rate for Payer: BCBS Complete |
$116.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,634.18
|
| Rate for Payer: BCN Commercial |
$4,063.84
|
| Rate for Payer: Cash Price |
$4,390.40
|
| Rate for Payer: Cash Price |
$4,390.40
|
| Rate for Payer: Meridian Medicaid |
$116.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.43
|
| Rate for Payer: Priority Health Narrow Network |
$252.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.66
|
| Rate for Payer: UHC Exchange |
$216.66
|
| Rate for Payer: UHCCP Medicaid |
$111.19
|
|
|
PR SURG OPENING,ESOPHAGUS,ABD APPRCH
|
Professional
|
Both
|
$2,787.00
|
|
|
Service Code
|
HCPCS 43350
|
| Min. Negotiated Rate |
$1,114.80 |
| Max. Negotiated Rate |
$1,811.55 |
| Rate for Payer: Aetna Medicare |
$1,393.50
|
| Rate for Payer: BCBS Complete |
$1,114.80
|
| Rate for Payer: Cash Price |
$2,229.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.55
|
|
|
PR SURG TX ANAL FISTULA 2ND STAGE
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 46285
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,300.22 |
| Rate for Payer: Aetna Commercial |
$558.65
|
| Rate for Payer: Aetna Medicare |
$485.00
|
| Rate for Payer: BCBS Complete |
$290.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,300.22
|
| Rate for Payer: BCN Commercial |
$826.84
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Meridian Medicaid |
$290.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$765.43
|
| Rate for Payer: Priority Health Narrow Network |
$765.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.84
|
| Rate for Payer: UHC Exchange |
$462.84
|
| Rate for Payer: UHCCP Medicaid |
$276.69
|
|
