|
PR GAS DIL/WSHOT DETER LNG VOL DSTRBJ VNTJ&CLSG VOL
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Aetna Medicare |
$63.50
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.00
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Medicare |
$26.00
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCN Commercial |
$31.87
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Mclaren Medicaid |
$12.99
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.83
|
| Rate for Payer: UHC Medicaid |
$12.99
|
| Rate for Payer: UHCCP Medicaid |
$12.99
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Aetna Commercial |
$603.17
|
| Rate for Payer: Aetna Medicare |
$782.00
|
| Rate for Payer: BCBS Complete |
$290.75
|
| Rate for Payer: BCN Commercial |
$693.69
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Mclaren Medicaid |
$276.90
|
| Rate for Payer: Meridian Medicaid |
$290.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$741.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.54
|
| Rate for Payer: UHC Medicaid |
$276.90
|
| Rate for Payer: UHCCP Medicaid |
$276.90
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,561.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$609.61 |
| Max. Negotiated Rate |
$1,920.75 |
| Rate for Payer: Aetna Commercial |
$1,376.05
|
| Rate for Payer: Aetna Medicare |
$1,280.50
|
| Rate for Payer: BCBS Complete |
$640.09
|
| Rate for Payer: BCN Commercial |
$1,531.30
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Mclaren Medicaid |
$609.61
|
| Rate for Payer: Meridian Medicaid |
$640.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,920.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$609.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,865.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,865.77
|
| Rate for Payer: UHC Medicaid |
$609.61
|
| Rate for Payer: UHCCP Medicaid |
$609.61
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$278.87 |
| Rate for Payer: Aetna Commercial |
$211.81
|
| Rate for Payer: Aetna Commercial |
$211.81
|
| Rate for Payer: Aetna Medicare |
$176.50
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$257.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$257.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.18
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$160.50
|
| Rate for Payer: BCN Commercial |
$246.50
|
| Rate for Payer: BCN Commercial |
$246.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.33
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$450.50 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Aetna Commercial |
$533.12
|
| Rate for Payer: Aetna Commercial |
$533.12
|
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: Aetna Medicare |
$450.50
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$602.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$602.07
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$801.31 |
| Max. Negotiated Rate |
$2,463.44 |
| Rate for Payer: Aetna Commercial |
$1,816.01
|
| Rate for Payer: Aetna Medicare |
$1,350.00
|
| Rate for Payer: BCBS Complete |
$841.38
|
| Rate for Payer: BCN Commercial |
$2,021.81
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Mclaren Medicaid |
$801.31
|
| Rate for Payer: Meridian Medicaid |
$841.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,025.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,463.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,463.44
|
| Rate for Payer: UHC Medicaid |
$801.31
|
| Rate for Payer: UHCCP Medicaid |
$801.31
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,658.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$784.69 |
| Max. Negotiated Rate |
$2,403.98 |
| Rate for Payer: Aetna Commercial |
$1,773.70
|
| Rate for Payer: Aetna Medicare |
$1,329.00
|
| Rate for Payer: BCBS Complete |
$823.92
|
| Rate for Payer: BCN Commercial |
$1,973.00
|
| Rate for Payer: Cash Price |
$2,126.40
|
| Rate for Payer: Cash Price |
$2,126.40
|
| Rate for Payer: Mclaren Medicaid |
$784.69
|
| Rate for Payer: Meridian Medicaid |
$823.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,993.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,403.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,403.98
|
| Rate for Payer: UHC Medicaid |
$784.69
|
| Rate for Payer: UHCCP Medicaid |
$784.69
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$811.53 |
| Max. Negotiated Rate |
$2,490.13 |
| Rate for Payer: Aetna Commercial |
$1,836.77
|
| Rate for Payer: Aetna Medicare |
$1,453.00
|
| Rate for Payer: BCBS Complete |
$852.11
|
| Rate for Payer: BCN Commercial |
$2,043.71
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Mclaren Medicaid |
$811.53
|
| Rate for Payer: Meridian Medicaid |
$852.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,179.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,490.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,490.13
|
| Rate for Payer: UHC Medicaid |
$811.53
|
| Rate for Payer: UHCCP Medicaid |
$811.53
|
|
|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$381.91 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$817.73
|
| Rate for Payer: Aetna Medicare |
$1,098.00
|
| Rate for Payer: BCBS Complete |
$401.01
|
| Rate for Payer: BCN Commercial |
$923.26
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Mclaren Medicaid |
$381.91
|
| Rate for Payer: Meridian Medicaid |
$401.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,647.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,124.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,124.92
|
| Rate for Payer: UHC Medicaid |
$381.91
|
| Rate for Payer: UHCCP Medicaid |
$381.91
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$3,022.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$628.78 |
| Max. Negotiated Rate |
$2,266.50 |
| Rate for Payer: Aetna Commercial |
$1,410.13
|
| Rate for Payer: Aetna Medicare |
$1,511.00
|
| Rate for Payer: BCBS Complete |
$660.22
|
| Rate for Payer: BCN Commercial |
$1,575.11
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Mclaren Medicaid |
$628.78
|
| Rate for Payer: Meridian Medicaid |
$660.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,266.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$628.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,919.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,919.17
|
| Rate for Payer: UHC Medicaid |
$628.78
|
| Rate for Payer: UHCCP Medicaid |
$628.78
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$947.51
|
| Rate for Payer: Aetna Medicare |
$1,098.00
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCN Commercial |
$1,060.21
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Mclaren Medicaid |
$431.11
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,647.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,291.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,291.79
|
| Rate for Payer: UHC Medicaid |
$431.11
|
| Rate for Payer: UHCCP Medicaid |
$431.11
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$479.46 |
| Max. Negotiated Rate |
$1,743.00 |
| Rate for Payer: Aetna Commercial |
$1,058.66
|
| Rate for Payer: Aetna Medicare |
$1,162.00
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCN Commercial |
$1,188.18
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Mclaren Medicaid |
$479.46
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,743.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,447.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,447.73
|
| Rate for Payer: UHC Medicaid |
$479.46
|
| Rate for Payer: UHCCP Medicaid |
$479.46
|
|
|
PR GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC
|
Professional
|
Both
|
$3,057.00
|
|
|
Service Code
|
HCPCS 43502
|
| Min. Negotiated Rate |
$907.59 |
| Max. Negotiated Rate |
$2,791.09 |
| Rate for Payer: Aetna Commercial |
$2,065.78
|
| Rate for Payer: Aetna Medicare |
$1,528.50
|
| Rate for Payer: BCBS Complete |
$952.97
|
| Rate for Payer: BCN Commercial |
$2,290.71
|
| Rate for Payer: Cash Price |
$2,445.60
|
| Rate for Payer: Cash Price |
$2,445.60
|
| Rate for Payer: Mclaren Medicaid |
$907.59
|
| Rate for Payer: Meridian Medicaid |
$952.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,292.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,791.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,791.09
|
| Rate for Payer: UHC Medicaid |
$907.59
|
| Rate for Payer: UHCCP Medicaid |
$907.59
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$808.97 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna Commercial |
$1,821.39
|
| Rate for Payer: Aetna Medicare |
$2,047.50
|
| Rate for Payer: BCBS Complete |
$849.42
|
| Rate for Payer: BCN Commercial |
$2,021.30
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Mclaren Medicaid |
$808.97
|
| Rate for Payer: Meridian Medicaid |
$849.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,071.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,462.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,462.82
|
| Rate for Payer: UHC Medicaid |
$808.97
|
| Rate for Payer: UHCCP Medicaid |
$808.97
|
|
|
PR GEL-ONE
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$512.21 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna Commercial |
$512.21
|
| Rate for Payer: Aetna Medicare |
$704.00
|
| Rate for Payer: BCBS Trust/PPO |
$538.01
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.00
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$2,275.28 |
| Rate for Payer: Aetna Commercial |
$1,759.47
|
| Rate for Payer: Aetna Commercial |
$1,759.47
|
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: Aetna Medicare |
$1,760.00
|
| Rate for Payer: BCN Commercial |
$2,275.28
|
| Rate for Payer: BCN Commercial |
$2,275.28
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,640.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,098.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,098.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,098.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,098.28
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$833.50 |
| Max. Negotiated Rate |
$1,250.25 |
| Rate for Payer: Aetna Commercial |
$912.51
|
| Rate for Payer: Aetna Medicare |
$833.50
|
| Rate for Payer: BCN Commercial |
$1,040.28
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,250.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$959.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$959.36
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$755.51 |
| Max. Negotiated Rate |
$2,377.88 |
| Rate for Payer: Aetna Commercial |
$1,746.53
|
| Rate for Payer: Aetna Medicare |
$1,230.00
|
| Rate for Payer: BCBS Complete |
$793.29
|
| Rate for Payer: BCN Commercial |
$1,951.59
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Mclaren Medicaid |
$755.51
|
| Rate for Payer: Meridian Medicaid |
$793.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,845.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,377.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,377.88
|
| Rate for Payer: UHC Medicaid |
$755.51
|
| Rate for Payer: UHCCP Medicaid |
$755.51
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,957.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$623.45 |
| Max. Negotiated Rate |
$1,921.59 |
| Rate for Payer: Aetna Commercial |
$1,414.53
|
| Rate for Payer: Aetna Medicare |
$978.50
|
| Rate for Payer: BCBS Complete |
$654.62
|
| Rate for Payer: BCN Commercial |
$1,577.10
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Mclaren Medicaid |
$623.45
|
| Rate for Payer: Meridian Medicaid |
$654.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,467.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,921.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,921.59
|
| Rate for Payer: UHC Medicaid |
$623.45
|
| Rate for Payer: UHCCP Medicaid |
$623.45
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$4,063.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$1,222.41 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$2,879.11
|
| Rate for Payer: Aetna Medicare |
$2,031.50
|
| Rate for Payer: BCBS Complete |
$1,283.53
|
| Rate for Payer: BCN Commercial |
$3,215.96
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Mclaren Medicaid |
$1,222.41
|
| Rate for Payer: Meridian Medicaid |
$1,283.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,222.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,918.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,918.45
|
| Rate for Payer: UHC Medicaid |
$1,222.41
|
| Rate for Payer: UHCCP Medicaid |
$1,222.41
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$4,221.00
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$1,238.60 |
| Max. Negotiated Rate |
$3,974.27 |
| Rate for Payer: Aetna Commercial |
$2,915.24
|
| Rate for Payer: Aetna Medicare |
$2,110.50
|
| Rate for Payer: BCBS Complete |
$1,300.53
|
| Rate for Payer: BCN Commercial |
$3,261.78
|
| Rate for Payer: Cash Price |
$3,376.80
|
| Rate for Payer: Cash Price |
$3,376.80
|
| Rate for Payer: Mclaren Medicaid |
$1,238.60
|
| Rate for Payer: Meridian Medicaid |
$1,300.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,165.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,238.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,974.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,974.27
|
| Rate for Payer: UHC Medicaid |
$1,238.60
|
| Rate for Payer: UHCCP Medicaid |
$1,238.60
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Mclaren Medicaid |
$10.44
|
| Rate for Payer: Meridian Medicaid |
$10.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.57
|
| Rate for Payer: UHC Medicaid |
$10.44
|
| Rate for Payer: UHCCP Medicaid |
$10.44
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$389.79 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Aetna Commercial |
$749.79
|
| Rate for Payer: Aetna Medicare |
$877.00
|
| Rate for Payer: BCBS Complete |
$409.28
|
| Rate for Payer: BCN Commercial |
$1,051.73
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Mclaren Medicaid |
$389.79
|
| Rate for Payer: Meridian Medicaid |
$409.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,315.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$962.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$962.61
|
| Rate for Payer: UHC Medicaid |
$389.79
|
| Rate for Payer: UHCCP Medicaid |
$389.79
|
|
