|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$3,585.00 |
| Rate for Payer: Aetna Commercial |
$72.64
|
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$54.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,585.00
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: BCN Medicare Advantage |
$54.21
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$72.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.21
|
| Rate for Payer: Healthscope Commercial |
$65.05
|
| Rate for Payer: Healthscope Whirlpool |
$65.05
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.92
|
| Rate for Payer: PACE SWMI |
$54.21
|
| Rate for Payer: PHP Medicare Advantage |
$54.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.00
|
| Rate for Payer: Priority Health Medicare |
$54.21
|
| Rate for Payer: Priority Health Narrow Network |
$67.00
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$97.35
|
| Rate for Payer: Aetna Medicare |
$72.65
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$72.65
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$159.81
|
| Rate for Payer: BCN Medicare Advantage |
$72.65
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$97.35
|
| Rate for Payer: Cofinity Commercial |
$104.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.65
|
| Rate for Payer: Healthscope Commercial |
$87.18
|
| Rate for Payer: Healthscope Whirlpool |
$87.18
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.28
|
| Rate for Payer: PACE SWMI |
$72.65
|
| Rate for Payer: PHP Medicare Advantage |
$72.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.60
|
| Rate for Payer: Priority Health Medicare |
$72.65
|
| Rate for Payer: Priority Health Narrow Network |
$89.60
|
| Rate for Payer: UHC Medicare Advantage |
$74.83
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$349.63 |
| Rate for Payer: Aetna Commercial |
$66.01
|
| Rate for Payer: Aetna Medicare |
$49.26
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS MAPPO |
$49.26
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$70.29
|
| Rate for Payer: BCN Medicare Advantage |
$49.26
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$70.93
|
| Rate for Payer: Cofinity Commercial |
$66.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.26
|
| Rate for Payer: Healthscope Commercial |
$59.11
|
| Rate for Payer: Healthscope Whirlpool |
$59.11
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.72
|
| Rate for Payer: PACE SWMI |
$49.26
|
| Rate for Payer: PHP Medicare Advantage |
$49.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$49.26
|
| Rate for Payer: Priority Health Narrow Network |
$60.83
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
|
|
PR FINE NEEDLE ASP;W/IMAGING GUIDANCE
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 10022
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$184.80 |
| Rate for Payer: BCBS Complete |
$105.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.80
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
|
|
PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$1,577.50 |
| Rate for Payer: Aetna Commercial |
$438.89
|
| Rate for Payer: Aetna Medicare |
$327.53
|
| Rate for Payer: BCBS Complete |
$229.47
|
| Rate for Payer: BCBS MAPPO |
$327.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.50
|
| Rate for Payer: BCN Commercial |
$699.79
|
| Rate for Payer: BCN Medicare Advantage |
$327.53
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cofinity Commercial |
$438.89
|
| Rate for Payer: Cofinity Commercial |
$471.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.53
|
| Rate for Payer: Healthscope Commercial |
$393.04
|
| Rate for Payer: Healthscope Whirlpool |
$393.04
|
| Rate for Payer: Meridian Medicaid |
$229.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.91
|
| Rate for Payer: PACE SWMI |
$327.53
|
| Rate for Payer: PHP Medicare Advantage |
$327.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.80
|
| Rate for Payer: Priority Health Medicare |
$327.53
|
| Rate for Payer: Priority Health Narrow Network |
$596.80
|
| Rate for Payer: UHC Medicare Advantage |
$337.36
|
|
|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$664.07 |
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: Aetna Medicare |
$31.28
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$52.78
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$45.04
|
| Rate for Payer: Cofinity Commercial |
$41.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$37.54
|
| Rate for Payer: Healthscope Whirlpool |
$37.54
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.14
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health Narrow Network |
$38.14
|
| Rate for Payer: UHC Medicare Advantage |
$32.22
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$2,269.05 |
| Rate for Payer: Aetna Commercial |
$61.32
|
| Rate for Payer: Aetna Medicare |
$45.76
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$45.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,269.05
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$45.76
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$61.32
|
| Rate for Payer: Cofinity Commercial |
$65.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.76
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Whirlpool |
$54.91
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.05
|
| Rate for Payer: PACE SWMI |
$45.76
|
| Rate for Payer: PHP Medicare Advantage |
$45.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.87
|
| Rate for Payer: Priority Health Medicare |
$45.76
|
| Rate for Payer: Priority Health Narrow Network |
$64.87
|
| Rate for Payer: UHC Medicare Advantage |
$47.13
|
|
|
PR FITTING CONTACT LENS FOR MNGT OF KERATOCONUS
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 92072
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare |
$91.88
|
| Rate for Payer: BCBS Complete |
$61.51
|
| Rate for Payer: BCBS MAPPO |
$91.88
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$183.25
|
| Rate for Payer: BCN Medicare Advantage |
$91.88
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$132.31
|
| Rate for Payer: Cofinity Commercial |
$123.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.88
|
| Rate for Payer: Healthscope Commercial |
$110.26
|
| Rate for Payer: Healthscope Whirlpool |
$110.26
|
| Rate for Payer: Meridian Medicaid |
$61.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.47
|
| Rate for Payer: PACE SWMI |
$91.88
|
| Rate for Payer: PHP Medicare Advantage |
$91.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.61
|
| Rate for Payer: Priority Health Medicare |
$91.88
|
| Rate for Payer: Priority Health Narrow Network |
$111.61
|
| Rate for Payer: UHC Medicare Advantage |
$94.64
|
|
|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$190.21 |
| Max. Negotiated Rate |
$3,422.86 |
| Rate for Payer: Aetna Commercial |
$391.12
|
| Rate for Payer: Aetna Medicare |
$291.88
|
| Rate for Payer: BCBS Complete |
$199.72
|
| Rate for Payer: BCBS MAPPO |
$291.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,422.86
|
| Rate for Payer: BCN Commercial |
$431.50
|
| Rate for Payer: BCN Medicare Advantage |
$291.88
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$391.12
|
| Rate for Payer: Cofinity Commercial |
$420.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.88
|
| Rate for Payer: Healthscope Commercial |
$350.26
|
| Rate for Payer: Healthscope Whirlpool |
$350.26
|
| Rate for Payer: Meridian Medicaid |
$199.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$306.47
|
| Rate for Payer: PACE SWMI |
$291.88
|
| Rate for Payer: PHP Medicare Advantage |
$291.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.13
|
| Rate for Payer: Priority Health Medicare |
$291.88
|
| Rate for Payer: Priority Health Narrow Network |
$477.13
|
| Rate for Payer: UHC Medicare Advantage |
$300.64
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,699.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,709.25 |
| Rate for Payer: Aetna Commercial |
$1,097.89
|
| Rate for Payer: Aetna Medicare |
$819.32
|
| Rate for Payer: BCBS Complete |
$565.83
|
| Rate for Payer: BCBS MAPPO |
$819.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.25
|
| Rate for Payer: BCN Commercial |
$1,478.74
|
| Rate for Payer: BCN Medicare Advantage |
$819.32
|
| Rate for Payer: Cash Price |
$1,359.20
|
| Rate for Payer: Cash Price |
$1,359.20
|
| Rate for Payer: Cofinity Commercial |
$1,179.82
|
| Rate for Payer: Cofinity Commercial |
$1,097.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.32
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Healthscope Whirlpool |
$983.18
|
| Rate for Payer: Meridian Medicaid |
$565.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$860.29
|
| Rate for Payer: PACE SWMI |
$819.32
|
| Rate for Payer: PHP Medicare Advantage |
$819.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,189.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.47
|
| Rate for Payer: Priority Health Medicare |
$819.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.47
|
| Rate for Payer: UHC Medicare Advantage |
$843.90
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$1,393.66 |
| Rate for Payer: Aetna Commercial |
$44.92
|
| Rate for Payer: Aetna Medicare |
$33.52
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.66
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$44.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$40.22
|
| Rate for Payer: Healthscope Whirlpool |
$40.22
|
| Rate for Payer: Meridian Medicaid |
$22.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.94
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$40.94
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$14.68
|
| Rate for Payer: Aetna Medicare |
$10.95
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$13.14
|
| Rate for Payer: Healthscope Whirlpool |
$13.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health Medicare |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$11.28
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$20.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$53.36
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$190.90 |
| Rate for Payer: Aetna Commercial |
$121.09
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCN Commercial |
$190.90
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
|
|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Aetna Commercial |
$44.42
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCN Commercial |
$65.84
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$48.29 |
| Rate for Payer: Aetna Commercial |
$30.64
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCN Commercial |
$48.29
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCN Commercial |
$56.76
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$590.45 |
| Rate for Payer: Aetna Commercial |
$374.53
|
| Rate for Payer: BCBS Complete |
$250.00
|
| Rate for Payer: BCN Commercial |
$590.45
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.50
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$637.30 |
| Max. Negotiated Rate |
$1,643.91 |
| Rate for Payer: Aetna Commercial |
$1,305.59
|
| Rate for Payer: Aetna Medicare |
$974.32
|
| Rate for Payer: BCBS Complete |
$669.16
|
| Rate for Payer: BCBS MAPPO |
$974.32
|
| Rate for Payer: BCBS Trust/PPO |
$852.18
|
| Rate for Payer: BCN Commercial |
$1,643.91
|
| Rate for Payer: BCN Medicare Advantage |
$974.32
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,403.02
|
| Rate for Payer: Cofinity Commercial |
$1,305.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.32
|
| Rate for Payer: Healthscope Commercial |
$1,169.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,169.18
|
| Rate for Payer: Meridian Medicaid |
$669.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,023.04
|
| Rate for Payer: PACE SWMI |
$974.32
|
| Rate for Payer: PHP Medicare Advantage |
$974.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.66
|
| Rate for Payer: Priority Health Medicare |
$974.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,223.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.55
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,562.18 |
| Rate for Payer: Aetna Commercial |
$75.07
|
| Rate for Payer: Aetna Medicare |
$56.02
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$56.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.18
|
| Rate for Payer: BCN Commercial |
$99.20
|
| Rate for Payer: BCN Medicare Advantage |
$56.02
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$80.67
|
| Rate for Payer: Cofinity Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.02
|
| Rate for Payer: Healthscope Commercial |
$67.22
|
| Rate for Payer: Healthscope Whirlpool |
$67.22
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.82
|
| Rate for Payer: PACE SWMI |
$56.02
|
| Rate for Payer: PHP Medicare Advantage |
$56.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.78
|
| Rate for Payer: Priority Health Medicare |
$56.02
|
| Rate for Payer: Priority Health Narrow Network |
$90.78
|
| Rate for Payer: UHC Medicare Advantage |
$57.70
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Aetna Commercial |
$116.96
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCN Commercial |
$184.38
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 00100
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
|
