|
PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR
|
Professional
|
Both
|
$4,498.00
|
|
|
Service Code
|
HCPCS 20962
|
| Min. Negotiated Rate |
$1,706.77 |
| Max. Negotiated Rate |
$4,061.20 |
| Rate for Payer: Aetna Commercial |
$3,507.61
|
| Rate for Payer: Aetna Medicare |
$2,617.62
|
| Rate for Payer: BCBS Complete |
$1,792.11
|
| Rate for Payer: BCBS MAPPO |
$2,617.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$3,886.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,617.62
|
| Rate for Payer: Cash Price |
$3,598.40
|
| Rate for Payer: Cash Price |
$3,598.40
|
| Rate for Payer: Cofinity Commercial |
$3,769.37
|
| Rate for Payer: Cofinity Commercial |
$3,507.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,617.62
|
| Rate for Payer: Healthscope Commercial |
$3,141.14
|
| Rate for Payer: Healthscope Whirlpool |
$3,141.14
|
| Rate for Payer: Meridian Medicaid |
$1,792.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,748.50
|
| Rate for Payer: PACE SWMI |
$2,617.62
|
| Rate for Payer: PHP Medicare Advantage |
$2,617.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,706.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,148.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,061.20
|
| Rate for Payer: Priority Health Medicare |
$2,617.62
|
| Rate for Payer: Priority Health Narrow Network |
$4,061.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,696.15
|
|
|
PR BOTOX UNIT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 00084
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
|
|
PR BRACHIOPLASTY
|
Professional
|
Both
|
$4,500.00
|
|
|
Service Code
|
HCPCS 00537
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: BCBS Complete |
$1,800.00
|
| Rate for Payer: Cash Price |
$3,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,150.00
|
|
|
PR BREAST AUGMENTATION WITH IMPLANT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19325
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$806.72
|
| Rate for Payer: Aetna Medicare |
$602.03
|
| Rate for Payer: BCBS Complete |
$415.10
|
| Rate for Payer: BCBS MAPPO |
$602.03
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$901.13
|
| Rate for Payer: BCN Medicare Advantage |
$602.03
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cofinity Commercial |
$866.92
|
| Rate for Payer: Cofinity Commercial |
$806.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.03
|
| Rate for Payer: Healthscope Commercial |
$722.44
|
| Rate for Payer: Healthscope Whirlpool |
$722.44
|
| Rate for Payer: Meridian Medicaid |
$415.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$632.13
|
| Rate for Payer: PACE SWMI |
$602.03
|
| Rate for Payer: PHP Medicare Advantage |
$602.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$757.96
|
| Rate for Payer: Priority Health Medicare |
$602.03
|
| Rate for Payer: Priority Health Narrow Network |
$757.96
|
| Rate for Payer: UHC Medicare Advantage |
$620.09
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 2.5
|
Professional
|
Both
|
$6,540.00
|
|
|
Service Code
|
HCPCS 00258
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,616.00 |
| Max. Negotiated Rate |
$4,578.00 |
| Rate for Payer: BCBS Complete |
$2,616.00
|
| Rate for Payer: Cash Price |
$5,232.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,578.00
|
|
|
PR BREAST AUGMENT W MASTOPEXY-GEL 3.5
|
Professional
|
Both
|
$7,440.00
|
|
|
Service Code
|
HCPCS 00260
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,976.00 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: BCBS Complete |
$2,976.00
|
| Rate for Payer: Cash Price |
$5,952.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,208.00
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 00257
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,200.00 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: BCBS Complete |
$2,200.00
|
| Rate for Payer: Cash Price |
$4,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,850.00
|
|
|
PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5
|
Professional
|
Both
|
$6,400.00
|
|
|
Service Code
|
HCPCS 00259
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,560.00 |
| Max. Negotiated Rate |
$4,480.00 |
| Rate for Payer: BCBS Complete |
$2,560.00
|
| Rate for Payer: Cash Price |
$5,120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,480.00
|
|
|
PR BREAST IMPLANT WARRANTY
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00523
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
|
|
PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST
|
Professional
|
Both
|
$4,715.00
|
|
|
Service Code
|
HCPCS 19368
|
| Min. Negotiated Rate |
$1,327.27 |
| Max. Negotiated Rate |
$3,300.50 |
| Rate for Payer: Aetna Commercial |
$2,860.83
|
| Rate for Payer: Aetna Medicare |
$2,134.95
|
| Rate for Payer: BCBS Complete |
$1,449.47
|
| Rate for Payer: BCBS MAPPO |
$2,134.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$3,163.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,134.95
|
| Rate for Payer: Cash Price |
$3,772.00
|
| Rate for Payer: Cash Price |
$3,772.00
|
| Rate for Payer: Cofinity Commercial |
$3,074.33
|
| Rate for Payer: Cofinity Commercial |
$2,860.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,134.95
|
| Rate for Payer: Healthscope Commercial |
$2,561.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,561.94
|
| Rate for Payer: Meridian Medicaid |
$1,449.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,241.70
|
| Rate for Payer: PACE SWMI |
$2,134.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,134.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,380.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,300.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,661.07
|
| Rate for Payer: Priority Health Medicare |
$2,134.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,661.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,199.00
|
|
|
PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP
|
Professional
|
Both
|
$4,130.00
|
|
|
Service Code
|
HCPCS 19369
|
| Min. Negotiated Rate |
$199.98 |
| Max. Negotiated Rate |
$2,939.88 |
| Rate for Payer: Aetna Commercial |
$2,657.46
|
| Rate for Payer: Aetna Medicare |
$1,983.18
|
| Rate for Payer: BCBS Complete |
$1,347.04
|
| Rate for Payer: BCBS MAPPO |
$1,983.18
|
| Rate for Payer: BCBS Trust/PPO |
$199.98
|
| Rate for Payer: BCN Commercial |
$2,939.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,983.18
|
| Rate for Payer: Cash Price |
$3,304.00
|
| Rate for Payer: Cash Price |
$3,304.00
|
| Rate for Payer: Cofinity Commercial |
$2,657.46
|
| Rate for Payer: Cofinity Commercial |
$2,855.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,983.18
|
| Rate for Payer: Healthscope Commercial |
$2,379.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,379.82
|
| Rate for Payer: Meridian Medicaid |
$1,347.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,082.34
|
| Rate for Payer: PACE SWMI |
$1,983.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,983.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,282.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,891.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,472.80
|
| Rate for Payer: Priority Health Medicare |
$1,983.18
|
| Rate for Payer: Priority Health Narrow Network |
$2,472.80
|
| Rate for Payer: UHC Medicare Advantage |
$2,042.68
|
|
|
PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP
|
Professional
|
Both
|
$2,973.00
|
|
|
Service Code
|
HCPCS 19367
|
| Min. Negotiated Rate |
$1,128.69 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Aetna Commercial |
$2,331.10
|
| Rate for Payer: Aetna Medicare |
$1,739.63
|
| Rate for Payer: BCBS Complete |
$1,185.12
|
| Rate for Payer: BCBS MAPPO |
$1,739.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,327.27
|
| Rate for Payer: BCN Commercial |
$2,583.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,739.63
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cofinity Commercial |
$2,331.10
|
| Rate for Payer: Cofinity Commercial |
$2,505.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,739.63
|
| Rate for Payer: Healthscope Commercial |
$2,087.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,087.56
|
| Rate for Payer: Meridian Medicaid |
$1,185.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,826.61
|
| Rate for Payer: PACE SWMI |
$1,739.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,739.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,128.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,081.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,172.75
|
| Rate for Payer: Priority Health Medicare |
$1,739.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,172.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,791.82
|
|
|
PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP
|
Professional
|
Both
|
$2,863.00
|
|
|
Service Code
|
HCPCS 19361
|
| Min. Negotiated Rate |
$312.59 |
| Max. Negotiated Rate |
$2,274.31 |
| Rate for Payer: Aetna Commercial |
$2,051.49
|
| Rate for Payer: Aetna Medicare |
$1,530.96
|
| Rate for Payer: BCBS Complete |
$1,043.99
|
| Rate for Payer: BCBS MAPPO |
$1,530.96
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$2,274.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,530.96
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cash Price |
$2,290.40
|
| Rate for Payer: Cofinity Commercial |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,051.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,530.96
|
| Rate for Payer: Healthscope Commercial |
$1,837.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,837.15
|
| Rate for Payer: Meridian Medicaid |
$1,043.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,607.51
|
| Rate for Payer: PACE SWMI |
$1,530.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,530.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$994.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,004.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,912.97
|
| Rate for Payer: Priority Health Medicare |
$1,530.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,912.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,576.89
|
|
|
PR BREAST RECONSTRUC W OTHR TECHNIQ
|
Professional
|
Both
|
$2,846.00
|
|
|
Service Code
|
HCPCS 19366
|
| Min. Negotiated Rate |
$1,138.40 |
| Max. Negotiated Rate |
$1,992.20 |
| Rate for Payer: BCBS Complete |
$1,138.40
|
| Rate for Payer: Cash Price |
$2,276.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,992.20
|
|
|
PR BREAST REDUCTION
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 19318
|
| Min. Negotiated Rate |
$293.06 |
| Max. Negotiated Rate |
$1,597.97 |
| Rate for Payer: Aetna Commercial |
$1,439.52
|
| Rate for Payer: Aetna Medicare |
$1,074.27
|
| Rate for Payer: BCBS Complete |
$734.24
|
| Rate for Payer: BCBS MAPPO |
$1,074.27
|
| Rate for Payer: BCBS Trust/PPO |
$293.06
|
| Rate for Payer: BCN Commercial |
$1,597.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,074.27
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,439.52
|
| Rate for Payer: Cofinity Commercial |
$1,546.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,074.27
|
| Rate for Payer: Healthscope Commercial |
$1,289.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,289.12
|
| Rate for Payer: Meridian Medicaid |
$734.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,127.98
|
| Rate for Payer: PACE SWMI |
$1,074.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,074.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$699.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.10
|
| Rate for Payer: Priority Health Medicare |
$1,074.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,344.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,106.50
|
|
|
PR BREATH HYDROGEN/METHANE TEST
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 91065
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$105.20
|
| Rate for Payer: Aetna Medicare |
$78.51
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$78.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$78.51
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$113.05
|
| Rate for Payer: Cofinity Commercial |
$105.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.51
|
| Rate for Payer: Healthscope Commercial |
$94.21
|
| Rate for Payer: Healthscope Whirlpool |
$94.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.44
|
| Rate for Payer: PACE SWMI |
$78.51
|
| Rate for Payer: PHP Medicare Advantage |
$78.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.19
|
| Rate for Payer: Priority Health Medicare |
$78.51
|
| Rate for Payer: Priority Health Narrow Network |
$113.19
|
| Rate for Payer: UHC Medicare Advantage |
$80.87
|
|
|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 94450
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Aetna Commercial |
$103.26
|
| Rate for Payer: Aetna Medicare |
$77.06
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS MAPPO |
$77.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$77.06
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Cofinity Commercial |
$110.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.06
|
| Rate for Payer: Healthscope Commercial |
$92.47
|
| Rate for Payer: Healthscope Whirlpool |
$92.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.91
|
| Rate for Payer: PACE SWMI |
$77.06
|
| Rate for Payer: PHP Medicare Advantage |
$77.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.04
|
| Rate for Payer: Priority Health Medicare |
$77.06
|
| Rate for Payer: Priority Health Narrow Network |
$110.04
|
| Rate for Payer: UHC Medicare Advantage |
$79.37
|
|
|
PR BRIEF CHECK IN BY MD/QHP
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS G2012
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$403.09 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: BCBS Trust/PPO |
$403.09
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$16.47
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$14.75
|
| Rate for Payer: Healthscope Whirlpool |
$14.75
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.85
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$15.85
|
| Rate for Payer: UHC Medicare Advantage |
$12.66
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 94060
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$1,399.47 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Aetna Medicare |
$36.28
|
| Rate for Payer: Aetna Medicare |
$36.28
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$43.54
|
| Rate for Payer: Healthscope Commercial |
$43.54
|
| Rate for Payer: Healthscope Whirlpool |
$43.54
|
| Rate for Payer: Healthscope Whirlpool |
$43.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health Narrow Network |
$85.70
|
| Rate for Payer: Priority Health Narrow Network |
$85.70
|
| Rate for Payer: UHC Medicare Advantage |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$37.37
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$720.60 |
| Rate for Payer: Aetna Commercial |
$171.13
|
| Rate for Payer: Aetna Medicare |
$127.71
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$127.71
|
| Rate for Payer: BCBS Trust/PPO |
$720.60
|
| Rate for Payer: BCN Commercial |
$399.74
|
| Rate for Payer: BCN Medicare Advantage |
$127.71
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cofinity Commercial |
$183.90
|
| Rate for Payer: Cofinity Commercial |
$171.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.71
|
| Rate for Payer: Healthscope Commercial |
$153.25
|
| Rate for Payer: Healthscope Whirlpool |
$153.25
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.10
|
| Rate for Payer: PACE SWMI |
$127.71
|
| Rate for Payer: PHP Medicare Advantage |
$127.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.81
|
| Rate for Payer: Priority Health Medicare |
$127.71
|
| Rate for Payer: Priority Health Narrow Network |
$177.81
|
| Rate for Payer: UHC Medicare Advantage |
$131.54
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 31652
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$1,843.29 |
| Rate for Payer: Aetna Commercial |
$287.16
|
| Rate for Payer: Aetna Medicare |
$214.30
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$214.30
|
| Rate for Payer: BCBS Trust/PPO |
$853.73
|
| Rate for Payer: BCN Commercial |
$1,843.29
|
| Rate for Payer: BCN Medicare Advantage |
$214.30
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$308.59
|
| Rate for Payer: Cofinity Commercial |
$287.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.30
|
| Rate for Payer: Healthscope Commercial |
$257.16
|
| Rate for Payer: Healthscope Whirlpool |
$257.16
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.02
|
| Rate for Payer: PACE SWMI |
$214.30
|
| Rate for Payer: PHP Medicare Advantage |
$214.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.73
|
| Rate for Payer: Priority Health Medicare |
$214.30
|
| Rate for Payer: Priority Health Narrow Network |
$297.73
|
| Rate for Payer: UHC Medicare Advantage |
$220.73
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 31653
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$1,916.10 |
| Rate for Payer: Aetna Commercial |
$318.52
|
| Rate for Payer: Aetna Medicare |
$237.70
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS MAPPO |
$237.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.30
|
| Rate for Payer: BCN Commercial |
$1,916.10
|
| Rate for Payer: BCN Medicare Advantage |
$237.70
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$342.29
|
| Rate for Payer: Cofinity Commercial |
$318.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.70
|
| Rate for Payer: Healthscope Commercial |
$285.24
|
| Rate for Payer: Healthscope Whirlpool |
$285.24
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.58
|
| Rate for Payer: PACE SWMI |
$237.70
|
| Rate for Payer: PHP Medicare Advantage |
$237.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.16
|
| Rate for Payer: Priority Health Medicare |
$237.70
|
| Rate for Payer: Priority Health Narrow Network |
$330.16
|
| Rate for Payer: UHC Medicare Advantage |
$244.83
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna Commercial |
$171.67
|
| Rate for Payer: Aetna Medicare |
$128.11
|
| Rate for Payer: BCBS Complete |
$87.22
|
| Rate for Payer: BCBS MAPPO |
$128.11
|
| Rate for Payer: BCBS Trust/PPO |
$372.29
|
| Rate for Payer: BCN Commercial |
$397.64
|
| Rate for Payer: BCN Medicare Advantage |
$128.11
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$184.48
|
| Rate for Payer: Cofinity Commercial |
$171.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.11
|
| Rate for Payer: Healthscope Commercial |
$153.73
|
| Rate for Payer: Healthscope Whirlpool |
$153.73
|
| Rate for Payer: Meridian Medicaid |
$87.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.52
|
| Rate for Payer: PACE SWMI |
$128.11
|
| Rate for Payer: PHP Medicare Advantage |
$128.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.28
|
| Rate for Payer: Priority Health Medicare |
$128.11
|
| Rate for Payer: Priority Health Narrow Network |
$178.28
|
| Rate for Payer: UHC Medicare Advantage |
$131.95
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,147.47 |
| Rate for Payer: Aetna Commercial |
$174.25
|
| Rate for Payer: Aetna Medicare |
$130.04
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$130.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.47
|
| Rate for Payer: BCN Commercial |
$371.40
|
| Rate for Payer: BCN Medicare Advantage |
$130.04
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$187.26
|
| Rate for Payer: Cofinity Commercial |
$174.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.04
|
| Rate for Payer: Healthscope Commercial |
$156.05
|
| Rate for Payer: Healthscope Whirlpool |
$156.05
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.54
|
| Rate for Payer: PACE SWMI |
$130.04
|
| Rate for Payer: PHP Medicare Advantage |
$130.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.05
|
| Rate for Payer: Priority Health Medicare |
$130.04
|
| Rate for Payer: Priority Health Narrow Network |
$181.05
|
| Rate for Payer: UHC Medicare Advantage |
$133.94
|
|
|
PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 31630
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$786.64 |
| Rate for Payer: Aetna Commercial |
$258.78
|
| Rate for Payer: Aetna Medicare |
$193.12
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS MAPPO |
$193.12
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$283.43
|
| Rate for Payer: BCN Medicare Advantage |
$193.12
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$278.09
|
| Rate for Payer: Cofinity Commercial |
$258.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.12
|
| Rate for Payer: Healthscope Commercial |
$231.74
|
| Rate for Payer: Healthscope Whirlpool |
$231.74
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.78
|
| Rate for Payer: PACE SWMI |
$193.12
|
| Rate for Payer: PHP Medicare Advantage |
$193.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.57
|
| Rate for Payer: Priority Health Medicare |
$193.12
|
| Rate for Payer: Priority Health Narrow Network |
$268.57
|
| Rate for Payer: UHC Medicare Advantage |
$198.91
|
|
