|
PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 57700
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$915.54 |
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Medicare |
$349.94
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS MAPPO |
$349.94
|
| Rate for Payer: BCBS Trust/PPO |
$915.54
|
| Rate for Payer: BCN Commercial |
$526.80
|
| Rate for Payer: BCN Medicare Advantage |
$349.94
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$503.91
|
| Rate for Payer: Cofinity Commercial |
$468.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.94
|
| Rate for Payer: Healthscope Commercial |
$419.93
|
| Rate for Payer: Healthscope Whirlpool |
$419.93
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.44
|
| Rate for Payer: PACE SWMI |
$349.94
|
| Rate for Payer: PHP Medicare Advantage |
$349.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$510.35
|
| Rate for Payer: Priority Health Medicare |
$349.94
|
| Rate for Payer: Priority Health Narrow Network |
$510.35
|
| Rate for Payer: UHC Medicare Advantage |
$360.44
|
|
|
PR CERTOLIZUMAB PEGOL INJ 1MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0717
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$5.07
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.07
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$6.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Healthscope Whirlpool |
$6.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.33
|
| Rate for Payer: PACE SWMI |
$5.07
|
| Rate for Payer: PHP Medicare Advantage |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$5.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.23
|
|
|
PR CERV FLEX N/ADJ FOAM PRE OTS
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS L0120
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR CERVICAL CAP CONTRACEPTIVE
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS A4261
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$1,481.35 |
| Rate for Payer: Aetna Commercial |
$26.50
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.35
|
| Rate for Payer: BCN Commercial |
$78.84
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$928.68 |
| Max. Negotiated Rate |
$3,145.81 |
| Rate for Payer: Aetna Commercial |
$1,920.58
|
| Rate for Payer: Aetna Medicare |
$1,433.27
|
| Rate for Payer: BCBS Complete |
$975.11
|
| Rate for Payer: BCBS MAPPO |
$1,433.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.28
|
| Rate for Payer: BCN Commercial |
$2,122.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,433.27
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cofinity Commercial |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$1,920.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,433.27
|
| Rate for Payer: Healthscope Commercial |
$1,719.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,719.92
|
| Rate for Payer: Meridian Medicaid |
$975.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,504.93
|
| Rate for Payer: PACE SWMI |
$1,433.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,433.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$928.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,741.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,145.81
|
| Rate for Payer: Priority Health Medicare |
$1,433.27
|
| Rate for Payer: Priority Health Narrow Network |
$3,145.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,476.27
|
|
|
PR CERVICAL LYMPHADENECTOMY
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 38720
|
| Min. Negotiated Rate |
$671.47 |
| Max. Negotiated Rate |
$2,903.16 |
| Rate for Payer: Aetna Commercial |
$1,774.07
|
| Rate for Payer: Aetna Medicare |
$1,323.93
|
| Rate for Payer: BCBS Complete |
$903.55
|
| Rate for Payer: BCBS MAPPO |
$1,323.93
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,958.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,323.93
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cofinity Commercial |
$1,906.46
|
| Rate for Payer: Cofinity Commercial |
$1,774.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,323.93
|
| Rate for Payer: Healthscope Commercial |
$1,588.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,588.72
|
| Rate for Payer: Meridian Medicaid |
$903.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,390.13
|
| Rate for Payer: PACE SWMI |
$1,323.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,323.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,903.16
|
| Rate for Payer: Priority Health Medicare |
$1,323.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,903.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,363.65
|
|
|
PR CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 59620
|
| Min. Negotiated Rate |
$873.68 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna Commercial |
$1,265.75
|
| Rate for Payer: Aetna Medicare |
$944.59
|
| Rate for Payer: BCBS Complete |
$917.36
|
| Rate for Payer: BCBS MAPPO |
$944.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.64
|
| Rate for Payer: BCN Commercial |
$1,636.60
|
| Rate for Payer: BCN Medicare Advantage |
$944.59
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cofinity Commercial |
$1,360.21
|
| Rate for Payer: Cofinity Commercial |
$1,265.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.59
|
| Rate for Payer: Healthscope Commercial |
$1,133.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,133.51
|
| Rate for Payer: Meridian Medicaid |
$917.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$991.82
|
| Rate for Payer: PACE SWMI |
$944.59
|
| Rate for Payer: PHP Medicare Advantage |
$944.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$873.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,715.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,325.39
|
| Rate for Payer: Priority Health Medicare |
$944.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,325.39
|
| Rate for Payer: UHC Medicare Advantage |
$972.93
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,275.00
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$164.30 |
| Max. Negotiated Rate |
$1,592.50 |
| Rate for Payer: Aetna Commercial |
$1,222.48
|
| Rate for Payer: Aetna Medicare |
$912.30
|
| Rate for Payer: BCBS Complete |
$884.87
|
| Rate for Payer: BCBS MAPPO |
$912.30
|
| Rate for Payer: BCBS Trust/PPO |
$164.30
|
| Rate for Payer: BCN Commercial |
$1,558.66
|
| Rate for Payer: BCN Medicare Advantage |
$912.30
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cofinity Commercial |
$1,313.71
|
| Rate for Payer: Cofinity Commercial |
$1,222.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$912.30
|
| Rate for Payer: Healthscope Commercial |
$1,094.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,094.76
|
| Rate for Payer: Meridian Medicaid |
$884.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$957.92
|
| Rate for Payer: PACE SWMI |
$912.30
|
| Rate for Payer: PHP Medicare Advantage |
$912.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,592.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,281.01
|
| Rate for Payer: Priority Health Medicare |
$912.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,281.01
|
| Rate for Payer: UHC Medicare Advantage |
$939.67
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,542.00
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$181.74 |
| Max. Negotiated Rate |
$1,885.36 |
| Rate for Payer: Aetna Commercial |
$1,754.44
|
| Rate for Payer: Aetna Medicare |
$1,309.28
|
| Rate for Payer: BCBS Complete |
$1,307.82
|
| Rate for Payer: BCBS MAPPO |
$1,309.28
|
| Rate for Payer: BCBS Trust/PPO |
$181.74
|
| Rate for Payer: BCN Commercial |
$1,809.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.28
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cofinity Commercial |
$1,885.36
|
| Rate for Payer: Cofinity Commercial |
$1,754.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.28
|
| Rate for Payer: Healthscope Commercial |
$1,571.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,571.14
|
| Rate for Payer: Meridian Medicaid |
$1,307.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,374.74
|
| Rate for Payer: PACE SWMI |
$1,309.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,245.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,779.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,844.78
|
| Rate for Payer: Priority Health Medicare |
$1,309.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,844.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,348.56
|
|
|
PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$2,717.00
|
|
|
Service Code
|
HCPCS 59622
|
| Min. Negotiated Rate |
$1,128.98 |
| Max. Negotiated Rate |
$1,956.53 |
| Rate for Payer: Aetna Commercial |
$1,820.66
|
| Rate for Payer: Aetna Medicare |
$1,358.70
|
| Rate for Payer: BCBS Complete |
$1,355.37
|
| Rate for Payer: BCBS MAPPO |
$1,358.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,899.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,358.70
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,820.66
|
| Rate for Payer: Cofinity Commercial |
$1,956.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,358.70
|
| Rate for Payer: Healthscope Commercial |
$1,630.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,630.44
|
| Rate for Payer: Meridian Medicaid |
$1,355.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,426.64
|
| Rate for Payer: PACE SWMI |
$1,358.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,358.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,290.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,915.60
|
| Rate for Payer: Priority Health Medicare |
$1,358.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,915.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,399.46
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$75.62 |
| Max. Negotiated Rate |
$705.28 |
| Rate for Payer: Aetna Commercial |
$160.56
|
| Rate for Payer: Aetna Medicare |
$119.82
|
| Rate for Payer: BCBS Complete |
$79.40
|
| Rate for Payer: BCBS MAPPO |
$119.82
|
| Rate for Payer: BCBS Trust/PPO |
$705.28
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$119.82
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$172.54
|
| Rate for Payer: Cofinity Commercial |
$160.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.82
|
| Rate for Payer: Healthscope Commercial |
$143.78
|
| Rate for Payer: Healthscope Whirlpool |
$143.78
|
| Rate for Payer: Meridian Medicaid |
$79.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.81
|
| Rate for Payer: PACE SWMI |
$119.82
|
| Rate for Payer: PHP Medicare Advantage |
$119.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.38
|
| Rate for Payer: Priority Health Medicare |
$119.82
|
| Rate for Payer: Priority Health Narrow Network |
$189.38
|
| Rate for Payer: UHC Medicare Advantage |
$123.41
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$2,051.39 |
| Rate for Payer: Aetna Commercial |
$104.43
|
| Rate for Payer: Aetna Medicare |
$77.93
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS MAPPO |
$77.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.39
|
| Rate for Payer: BCN Commercial |
$198.89
|
| Rate for Payer: BCN Medicare Advantage |
$77.93
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$112.22
|
| Rate for Payer: Cofinity Commercial |
$104.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.93
|
| Rate for Payer: Healthscope Commercial |
$93.52
|
| Rate for Payer: Healthscope Whirlpool |
$93.52
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.83
|
| Rate for Payer: PACE SWMI |
$77.93
|
| Rate for Payer: PHP Medicare Advantage |
$77.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.52
|
| Rate for Payer: Priority Health Medicare |
$77.93
|
| Rate for Payer: Priority Health Narrow Network |
$127.52
|
| Rate for Payer: UHC Medicare Advantage |
$80.27
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$1,992.75 |
| Rate for Payer: Aetna Commercial |
$67.34
|
| Rate for Payer: Aetna Medicare |
$50.25
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$50.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.75
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Medicare Advantage |
$50.25
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$72.36
|
| Rate for Payer: Cofinity Commercial |
$67.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.25
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Healthscope Whirlpool |
$60.30
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.76
|
| Rate for Payer: PACE SWMI |
$50.25
|
| Rate for Payer: PHP Medicare Advantage |
$50.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.14
|
| Rate for Payer: Priority Health Medicare |
$50.25
|
| Rate for Payer: Priority Health Narrow Network |
$82.14
|
| Rate for Payer: UHC Medicare Advantage |
$51.76
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$573.30 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$737.10
|
| Rate for Payer: ASR ASR |
$794.43
|
| Rate for Payer: BCBS Trust/PPO |
$634.97
|
| Rate for Payer: BCN Commercial |
$634.97
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$769.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Healthscope Commercial |
$819.00
|
| Rate for Payer: Healthscope Whirlpool |
$794.43
|
| Rate for Payer: Mclaren Commercial |
$737.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.72
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 43760
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$737.10
|
| Rate for Payer: ASR ASR |
$794.43
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS Trust/PPO |
$634.97
|
| Rate for Payer: BCN Commercial |
$634.97
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$769.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Healthscope Commercial |
$819.00
|
| Rate for Payer: Healthscope Whirlpool |
$794.43
|
| Rate for Payer: Mclaren Commercial |
$737.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.29
|
| Rate for Payer: Priority Health Narrow Network |
$581.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$720.72
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$48.53
|
| Rate for Payer: Aetna Medicare |
$36.22
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS MAPPO |
$36.22
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$128.52
|
| Rate for Payer: BCN Medicare Advantage |
$36.22
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$52.16
|
| Rate for Payer: Cofinity Commercial |
$48.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.22
|
| Rate for Payer: Healthscope Commercial |
$43.46
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.03
|
| Rate for Payer: PACE SWMI |
$36.22
|
| Rate for Payer: PHP Medicare Advantage |
$36.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.62
|
| Rate for Payer: Priority Health Medicare |
$36.22
|
| Rate for Payer: Priority Health Narrow Network |
$45.62
|
| Rate for Payer: UHC Medicare Advantage |
$37.31
|
|
|
PR CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
HCPCS 15788
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$276.31
|
| Rate for Payer: Aetna Medicare |
$206.20
|
| Rate for Payer: BCBS Complete |
$146.26
|
| Rate for Payer: BCBS MAPPO |
$206.20
|
| Rate for Payer: BCBS Trust/PPO |
$25.00
|
| Rate for Payer: BCN Commercial |
$459.42
|
| Rate for Payer: BCN Medicare Advantage |
$206.20
|
| Rate for Payer: Cash Price |
$699.20
|
| Rate for Payer: Cash Price |
$699.20
|
| Rate for Payer: Cofinity Commercial |
$296.93
|
| Rate for Payer: Cofinity Commercial |
$276.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.20
|
| Rate for Payer: Healthscope Commercial |
$247.44
|
| Rate for Payer: Healthscope Whirlpool |
$247.44
|
| Rate for Payer: Meridian Medicaid |
$146.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.51
|
| Rate for Payer: PACE SWMI |
$206.20
|
| Rate for Payer: PHP Medicare Advantage |
$206.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.29
|
| Rate for Payer: Priority Health Medicare |
$206.20
|
| Rate for Payer: Priority Health Narrow Network |
$264.29
|
| Rate for Payer: UHC Medicare Advantage |
$212.39
|
|
|
PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 64644
|
| Min. Negotiated Rate |
$74.12 |
| Max. Negotiated Rate |
$896.53 |
| Rate for Payer: Aetna Commercial |
$153.15
|
| Rate for Payer: Aetna Medicare |
$114.29
|
| Rate for Payer: BCBS Complete |
$77.83
|
| Rate for Payer: BCBS MAPPO |
$114.29
|
| Rate for Payer: BCBS Trust/PPO |
$896.53
|
| Rate for Payer: BCN Commercial |
$258.02
|
| Rate for Payer: BCN Medicare Advantage |
$114.29
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$164.58
|
| Rate for Payer: Cofinity Commercial |
$153.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.29
|
| Rate for Payer: Healthscope Commercial |
$137.15
|
| Rate for Payer: Healthscope Whirlpool |
$137.15
|
| Rate for Payer: Meridian Medicaid |
$77.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.00
|
| Rate for Payer: PACE SWMI |
$114.29
|
| Rate for Payer: PHP Medicare Advantage |
$114.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.35
|
| Rate for Payer: Priority Health Medicare |
$114.29
|
| Rate for Payer: Priority Health Narrow Network |
$195.35
|
| Rate for Payer: UHC Medicare Advantage |
$117.72
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 64643
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$151.09 |
| Rate for Payer: Aetna Commercial |
$93.26
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$69.60
|
| Rate for Payer: BCBS Trust/PPO |
$151.09
|
| Rate for Payer: BCN Commercial |
$135.36
|
| Rate for Payer: BCN Medicare Advantage |
$69.60
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$100.22
|
| Rate for Payer: Cofinity Commercial |
$93.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.60
|
| Rate for Payer: Healthscope Commercial |
$83.52
|
| Rate for Payer: Healthscope Whirlpool |
$83.52
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.08
|
| Rate for Payer: PACE SWMI |
$69.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.33
|
| Rate for Payer: Priority Health Medicare |
$69.60
|
| Rate for Payer: Priority Health Narrow Network |
$118.33
|
| Rate for Payer: UHC Medicare Advantage |
$71.69
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 64645
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$831.02 |
| Rate for Payer: Aetna Commercial |
$108.69
|
| Rate for Payer: Aetna Medicare |
$81.11
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS MAPPO |
$81.11
|
| Rate for Payer: BCBS Trust/PPO |
$831.02
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$81.11
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$108.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.11
|
| Rate for Payer: Healthscope Commercial |
$97.33
|
| Rate for Payer: Healthscope Whirlpool |
$97.33
|
| Rate for Payer: Meridian Medicaid |
$54.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.17
|
| Rate for Payer: PACE SWMI |
$81.11
|
| Rate for Payer: PHP Medicare Advantage |
$81.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.60
|
| Rate for Payer: Priority Health Medicare |
$81.11
|
| Rate for Payer: Priority Health Narrow Network |
$137.60
|
| Rate for Payer: UHC Medicare Advantage |
$83.54
|
|
|
PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 64614
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: BCBS Complete |
$184.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.00
|
|
|
PR CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 46505
|
| Min. Negotiated Rate |
$160.82 |
| Max. Negotiated Rate |
$3,709.19 |
| Rate for Payer: Aetna Commercial |
$328.47
|
| Rate for Payer: Aetna Medicare |
$245.13
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS MAPPO |
$245.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.19
|
| Rate for Payer: BCN Commercial |
$463.76
|
| Rate for Payer: BCN Medicare Advantage |
$245.13
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cofinity Commercial |
$352.99
|
| Rate for Payer: Cofinity Commercial |
$328.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.13
|
| Rate for Payer: Healthscope Commercial |
$294.16
|
| Rate for Payer: Healthscope Whirlpool |
$294.16
|
| Rate for Payer: Meridian Medicaid |
$168.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$257.39
|
| Rate for Payer: PACE SWMI |
$245.13
|
| Rate for Payer: PHP Medicare Advantage |
$245.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.74
|
| Rate for Payer: Priority Health Medicare |
$245.13
|
| Rate for Payer: Priority Health Narrow Network |
$442.74
|
| Rate for Payer: UHC Medicare Advantage |
$252.48
|
|
|
PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 64617
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$525.13 |
| Rate for Payer: Aetna Commercial |
$143.31
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$106.95
|
| Rate for Payer: BCBS Trust/PPO |
$525.13
|
| Rate for Payer: BCN Commercial |
$238.96
|
| Rate for Payer: BCN Medicare Advantage |
$106.95
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$143.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.95
|
| Rate for Payer: Healthscope Commercial |
$128.34
|
| Rate for Payer: Healthscope Whirlpool |
$128.34
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.30
|
| Rate for Payer: PACE SWMI |
$106.95
|
| Rate for Payer: PHP Medicare Advantage |
$106.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$106.95
|
| Rate for Payer: Priority Health Narrow Network |
$182.90
|
| Rate for Payer: UHC Medicare Advantage |
$110.16
|
|
