|
PR DIABETES PREVENTION PROGRAM
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 00268
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
|
|
PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 0403T
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$131.11 |
| Rate for Payer: Aetna Commercial |
$32.06
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$131.11
|
| Rate for Payer: BCN Commercial |
$58.68
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$303.74 |
| Max. Negotiated Rate |
$888.30 |
| Rate for Payer: Aetna Commercial |
$619.16
|
| Rate for Payer: Aetna Medicare |
$462.06
|
| Rate for Payer: BCBS Complete |
$318.93
|
| Rate for Payer: BCBS MAPPO |
$462.06
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: BCN Medicare Advantage |
$462.06
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cofinity Commercial |
$665.37
|
| Rate for Payer: Cofinity Commercial |
$619.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.06
|
| Rate for Payer: Healthscope Commercial |
$554.47
|
| Rate for Payer: Healthscope Whirlpool |
$554.47
|
| Rate for Payer: Meridian Medicaid |
$318.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$485.16
|
| Rate for Payer: PACE SWMI |
$462.06
|
| Rate for Payer: PHP Medicare Advantage |
$462.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$723.59
|
| Rate for Payer: Priority Health Medicare |
$462.06
|
| Rate for Payer: Priority Health Narrow Network |
$723.59
|
| Rate for Payer: UHC Medicare Advantage |
$475.92
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$437.96 |
| Rate for Payer: Aetna Commercial |
$88.33
|
| Rate for Payer: Aetna Medicare |
$65.92
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$65.92
|
| Rate for Payer: BCBS Trust/PPO |
$437.96
|
| Rate for Payer: BCN Commercial |
$226.75
|
| Rate for Payer: BCN Medicare Advantage |
$65.92
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$88.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.92
|
| Rate for Payer: Healthscope Commercial |
$79.10
|
| Rate for Payer: Healthscope Whirlpool |
$79.10
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.22
|
| Rate for Payer: PACE SWMI |
$65.92
|
| Rate for Payer: PHP Medicare Advantage |
$65.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.86
|
| Rate for Payer: Priority Health Medicare |
$65.92
|
| Rate for Payer: Priority Health Narrow Network |
$144.86
|
| Rate for Payer: UHC Medicare Advantage |
$67.90
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$91.55
|
| Rate for Payer: Aetna Medicare |
$68.32
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS MAPPO |
$68.32
|
| Rate for Payer: BCBS Trust/PPO |
$400.45
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: BCN Medicare Advantage |
$68.32
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$98.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.32
|
| Rate for Payer: Healthscope Commercial |
$81.98
|
| Rate for Payer: Healthscope Whirlpool |
$81.98
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.74
|
| Rate for Payer: PACE SWMI |
$68.32
|
| Rate for Payer: PHP Medicare Advantage |
$68.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.95
|
| Rate for Payer: Priority Health Medicare |
$68.32
|
| Rate for Payer: Priority Health Narrow Network |
$149.95
|
| Rate for Payer: UHC Medicare Advantage |
$70.37
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$367.17 |
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Medicare |
$73.86
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$73.86
|
| Rate for Payer: BCBS Trust/PPO |
$367.17
|
| Rate for Payer: BCN Commercial |
$255.58
|
| Rate for Payer: BCN Medicare Advantage |
$73.86
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$98.97
|
| Rate for Payer: Cofinity Commercial |
$106.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.86
|
| Rate for Payer: Healthscope Commercial |
$88.63
|
| Rate for Payer: Healthscope Whirlpool |
$88.63
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.55
|
| Rate for Payer: PACE SWMI |
$73.86
|
| Rate for Payer: PHP Medicare Advantage |
$73.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.53
|
| Rate for Payer: Priority Health Medicare |
$73.86
|
| Rate for Payer: Priority Health Narrow Network |
$161.53
|
| Rate for Payer: UHC Medicare Advantage |
$76.08
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$874.34 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare |
$62.39
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$62.39
|
| Rate for Payer: BCBS Trust/PPO |
$874.34
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: BCN Medicare Advantage |
$62.39
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cofinity Commercial |
$89.84
|
| Rate for Payer: Cofinity Commercial |
$83.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.39
|
| Rate for Payer: Healthscope Commercial |
$74.87
|
| Rate for Payer: Healthscope Whirlpool |
$74.87
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.51
|
| Rate for Payer: PACE SWMI |
$62.39
|
| Rate for Payer: PHP Medicare Advantage |
$62.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.32
|
| Rate for Payer: Priority Health Medicare |
$62.39
|
| Rate for Payer: Priority Health Narrow Network |
$105.32
|
| Rate for Payer: UHC Medicare Advantage |
$64.26
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$1,578.56 |
| Rate for Payer: Aetna Commercial |
$113.90
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$85.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,578.56
|
| Rate for Payer: BCN Commercial |
$339.63
|
| Rate for Payer: BCN Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$113.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.00
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$102.00
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.25
|
| Rate for Payer: PACE SWMI |
$85.00
|
| Rate for Payer: PHP Medicare Advantage |
$85.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.38
|
| Rate for Payer: Priority Health Medicare |
$85.00
|
| Rate for Payer: Priority Health Narrow Network |
$144.38
|
| Rate for Payer: UHC Medicare Advantage |
$87.55
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$2,818.21 |
| Rate for Payer: Aetna Commercial |
$263.94
|
| Rate for Payer: Aetna Medicare |
$196.97
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCBS MAPPO |
$196.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: BCN Commercial |
$2,818.21
|
| Rate for Payer: BCN Medicare Advantage |
$196.97
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cofinity Commercial |
$283.64
|
| Rate for Payer: Cofinity Commercial |
$263.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.97
|
| Rate for Payer: Healthscope Commercial |
$236.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.36
|
| Rate for Payer: Meridian Medicaid |
$130.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$206.82
|
| Rate for Payer: PACE SWMI |
$196.97
|
| Rate for Payer: PHP Medicare Advantage |
$196.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$196.97
|
| Rate for Payer: Priority Health Narrow Network |
$311.73
|
| Rate for Payer: UHC Medicare Advantage |
$202.88
|
|
|
PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 90945
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$111.30
|
| Rate for Payer: Aetna Medicare |
$83.06
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$83.06
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$83.06
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cofinity Commercial |
$119.61
|
| Rate for Payer: Cofinity Commercial |
$111.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$99.67
|
| Rate for Payer: Healthscope Whirlpool |
$99.67
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.21
|
| Rate for Payer: PACE SWMI |
$83.06
|
| Rate for Payer: PHP Medicare Advantage |
$83.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.19
|
| Rate for Payer: Priority Health Medicare |
$83.06
|
| Rate for Payer: Priority Health Narrow Network |
$113.19
|
| Rate for Payer: UHC Medicare Advantage |
$85.55
|
|
|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$319.62 |
| Rate for Payer: Aetna Commercial |
$160.87
|
| Rate for Payer: Aetna Medicare |
$120.05
|
| Rate for Payer: BCBS Complete |
$80.97
|
| Rate for Payer: BCBS MAPPO |
$120.05
|
| Rate for Payer: BCBS Trust/PPO |
$319.62
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Medicare Advantage |
$120.05
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$172.87
|
| Rate for Payer: Cofinity Commercial |
$160.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.05
|
| Rate for Payer: Healthscope Commercial |
$144.06
|
| Rate for Payer: Healthscope Whirlpool |
$144.06
|
| Rate for Payer: Meridian Medicaid |
$80.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.05
|
| Rate for Payer: PACE SWMI |
$120.05
|
| Rate for Payer: PHP Medicare Advantage |
$120.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.14
|
| Rate for Payer: Priority Health Medicare |
$120.05
|
| Rate for Payer: Priority Health Narrow Network |
$162.14
|
| Rate for Payer: UHC Medicare Advantage |
$123.65
|
|
|
PR DIAPHRAGM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS A4266
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCN Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
|
|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$2,039.77 |
| Rate for Payer: Aetna Commercial |
$64.11
|
| Rate for Payer: Aetna Medicare |
$47.84
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS MAPPO |
$47.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.77
|
| Rate for Payer: BCN Commercial |
$115.33
|
| Rate for Payer: BCN Medicare Advantage |
$47.84
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$64.11
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$57.41
|
| Rate for Payer: Healthscope Whirlpool |
$57.41
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.23
|
| Rate for Payer: PACE SWMI |
$47.84
|
| Rate for Payer: PHP Medicare Advantage |
$47.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.70
|
| Rate for Payer: Priority Health Medicare |
$47.84
|
| Rate for Payer: Priority Health Narrow Network |
$67.70
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$534.10 |
| Rate for Payer: Aetna Commercial |
$348.94
|
| Rate for Payer: Aetna Medicare |
$260.40
|
| Rate for Payer: BCBS Complete |
$305.20
|
| Rate for Payer: BCBS MAPPO |
$260.40
|
| Rate for Payer: BCBS Trust/PPO |
$346.56
|
| Rate for Payer: BCN Commercial |
$401.69
|
| Rate for Payer: BCN Medicare Advantage |
$260.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cofinity Commercial |
$348.94
|
| Rate for Payer: Cofinity Commercial |
$374.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$312.48
|
| Rate for Payer: Healthscope Whirlpool |
$312.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$273.42
|
| Rate for Payer: PACE SWMI |
$260.40
|
| Rate for Payer: PHP Medicare Advantage |
$260.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.19
|
| Rate for Payer: Priority Health Medicare |
$260.40
|
| Rate for Payer: Priority Health Narrow Network |
$369.19
|
| Rate for Payer: UHC Medicare Advantage |
$268.21
|
|
|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$223.62
|
| Rate for Payer: Aetna Medicare |
$166.88
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS MAPPO |
$166.88
|
| Rate for Payer: BCBS Trust/PPO |
$585.88
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: BCN Medicare Advantage |
$166.88
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cash Price |
$281.60
|
| Rate for Payer: Cofinity Commercial |
$240.31
|
| Rate for Payer: Cofinity Commercial |
$223.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.88
|
| Rate for Payer: Healthscope Commercial |
$200.26
|
| Rate for Payer: Healthscope Whirlpool |
$200.26
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.22
|
| Rate for Payer: PACE SWMI |
$166.88
|
| Rate for Payer: PHP Medicare Advantage |
$166.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.86
|
| Rate for Payer: Priority Health Medicare |
$166.88
|
| Rate for Payer: Priority Health Narrow Network |
$299.86
|
| Rate for Payer: UHC Medicare Advantage |
$171.89
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$1,102.03 |
| Rate for Payer: Aetna Commercial |
$116.51
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$86.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.03
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: BCN Medicare Advantage |
$86.95
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$116.51
|
| Rate for Payer: Cofinity Commercial |
$125.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.95
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Healthscope Whirlpool |
$104.34
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.30
|
| Rate for Payer: PACE SWMI |
$86.95
|
| Rate for Payer: PHP Medicare Advantage |
$86.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.81
|
| Rate for Payer: Priority Health Medicare |
$86.95
|
| Rate for Payer: Priority Health Narrow Network |
$155.81
|
| Rate for Payer: UHC Medicare Advantage |
$89.56
|
|
|
PR DILATE ESOPHAGUS,BALLOON RETROGRADE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 43456
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$568.40 |
| Rate for Payer: BCBS Complete |
$324.80
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.40
|
|
|
PR DILATE ESOPH,BALLN,>30MM ACHALASIA
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 43458
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$706.30 |
| Rate for Payer: BCBS Complete |
$403.60
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.30
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$927.17 |
| Rate for Payer: Aetna Commercial |
$54.50
|
| Rate for Payer: Aetna Medicare |
$40.67
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$927.17
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Medicare Advantage |
$40.67
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Cofinity Commercial |
$54.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.67
|
| Rate for Payer: Healthscope Commercial |
$48.80
|
| Rate for Payer: Healthscope Whirlpool |
$48.80
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.70
|
| Rate for Payer: PACE SWMI |
$40.67
|
| Rate for Payer: PHP Medicare Advantage |
$40.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.46
|
| Rate for Payer: Priority Health Medicare |
$40.67
|
| Rate for Payer: Priority Health Narrow Network |
$66.46
|
| Rate for Payer: UHC Medicare Advantage |
$41.89
|
|
|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$2,149.12 |
| Rate for Payer: Aetna Commercial |
$53.31
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS MAPPO |
$39.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.12
|
| Rate for Payer: BCN Commercial |
$108.48
|
| Rate for Payer: BCN Medicare Advantage |
$39.78
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Commercial |
$53.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.78
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Healthscope Whirlpool |
$47.74
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.77
|
| Rate for Payer: PACE SWMI |
$39.78
|
| Rate for Payer: PHP Medicare Advantage |
$39.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.84
|
| Rate for Payer: Priority Health Medicare |
$39.78
|
| Rate for Payer: Priority Health Narrow Network |
$64.84
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,422.71 |
| Rate for Payer: Aetna Commercial |
$62.75
|
| Rate for Payer: Aetna Medicare |
$46.83
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$46.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$114.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.83
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$62.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.83
|
| Rate for Payer: Healthscope Commercial |
$56.20
|
| Rate for Payer: Healthscope Whirlpool |
$56.20
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.17
|
| Rate for Payer: PACE SWMI |
$46.83
|
| Rate for Payer: PHP Medicare Advantage |
$46.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.23
|
| Rate for Payer: Priority Health Medicare |
$46.83
|
| Rate for Payer: Priority Health Narrow Network |
$67.23
|
| Rate for Payer: UHC Medicare Advantage |
$48.23
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$1,924.60 |
| Rate for Payer: Aetna Commercial |
$169.48
|
| Rate for Payer: Aetna Medicare |
$126.48
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$126.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: BCN Medicare Advantage |
$126.48
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$182.13
|
| Rate for Payer: Cofinity Commercial |
$169.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$151.78
|
| Rate for Payer: Healthscope Whirlpool |
$151.78
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132.80
|
| Rate for Payer: PACE SWMI |
$126.48
|
| Rate for Payer: PHP Medicare Advantage |
$126.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.69
|
| Rate for Payer: Priority Health Medicare |
$126.48
|
| Rate for Payer: Priority Health Narrow Network |
$183.69
|
| Rate for Payer: UHC Medicare Advantage |
$130.27
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$150.38 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$230.53
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Healthscope Commercial |
$276.64
|
| Rate for Payer: Healthscope Whirlpool |
$276.64
|
| Rate for Payer: Meridian Medicaid |
$157.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.87
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow Network |
$331.87
|
| Rate for Payer: UHC Medicare Advantage |
$237.45
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$150.38 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$230.53
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Healthscope Commercial |
$276.64
|
| Rate for Payer: Healthscope Whirlpool |
$276.64
|
| Rate for Payer: Meridian Medicaid |
$157.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.87
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow Network |
$331.87
|
| Rate for Payer: UHC Medicare Advantage |
$237.45
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$591.50 |
| Max. Negotiated Rate |
$845.00 |
| Rate for Payer: Aetna Commercial |
$760.50
|
| Rate for Payer: ASR ASR |
$819.65
|
| Rate for Payer: BCBS Trust/PPO |
$655.13
|
| Rate for Payer: BCN Commercial |
$655.13
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$794.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.00
|
| Rate for Payer: Healthscope Commercial |
$845.00
|
| Rate for Payer: Healthscope Whirlpool |
$819.65
|
| Rate for Payer: Mclaren Commercial |
$760.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$743.60
|
|
