|
PR BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 24065
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$380.19 |
| Rate for Payer: Aetna Commercial |
$215.45
|
| Rate for Payer: Aetna Medicare |
$233.50
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS Trust/PPO |
$126.93
|
| Rate for Payer: BCN Commercial |
$380.19
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.87
|
| Rate for Payer: Priority Health Narrow Network |
$250.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.51
|
| Rate for Payer: UHC Exchange |
$190.51
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE
|
Professional
|
Both
|
$2,545.00
|
|
|
Service Code
|
HCPCS 62269
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$1,654.25 |
| Rate for Payer: Aetna Commercial |
$336.41
|
| Rate for Payer: Aetna Medicare |
$1,272.50
|
| Rate for Payer: BCBS Complete |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCN Commercial |
$375.79
|
| Rate for Payer: Cash Price |
$2,036.00
|
| Rate for Payer: Cash Price |
$2,036.00
|
| Rate for Payer: Meridian Medicaid |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.07
|
| Rate for Payer: Priority Health Narrow Network |
$435.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.37
|
| Rate for Payer: UHC Exchange |
$318.37
|
| Rate for Payer: UHCCP Medicaid |
$165.08
|
|
|
PR BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 54505
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$1,963.16 |
| Rate for Payer: Aetna Commercial |
$269.15
|
| Rate for Payer: Aetna Medicare |
$340.50
|
| Rate for Payer: BCBS Complete |
$141.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,963.16
|
| Rate for Payer: BCN Commercial |
$303.46
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Meridian Medicaid |
$141.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.48
|
| Rate for Payer: Priority Health Narrow Network |
$334.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$253.71
|
| Rate for Payer: UHC Exchange |
$253.71
|
| Rate for Payer: UHCCP Medicaid |
$135.04
|
|
|
PR BIOPSY THYROID PERCUTANEOUS CORE NEEDLE
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 60100
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$172.75 |
| Rate for Payer: Aetna Commercial |
$99.74
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: BCN Commercial |
$161.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.70
|
| Rate for Payer: Priority Health Narrow Network |
$121.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.09
|
| Rate for Payer: UHC Exchange |
$94.09
|
| Rate for Payer: UHCCP Medicaid |
$48.14
|
|
|
PR BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 41100
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$824.68 |
| Rate for Payer: Aetna Commercial |
$140.82
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS Trust/PPO |
$824.68
|
| Rate for Payer: BCN Commercial |
$276.59
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.29
|
| Rate for Payer: Priority Health Narrow Network |
$193.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.03
|
| Rate for Payer: UHC Exchange |
$131.03
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
|
|
PR BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 41105
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$144.46
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: BCBS Complete |
$74.93
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$276.59
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Meridian Medicaid |
$74.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.67
|
| Rate for Payer: Priority Health Narrow Network |
$198.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.78
|
| Rate for Payer: UHC Exchange |
$133.78
|
| Rate for Payer: UHCCP Medicaid |
$71.36
|
|
|
PR BIOPSY URETHRA
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 53200
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$181.70
|
| Rate for Payer: Aetna Medicare |
$193.00
|
| Rate for Payer: BCBS Complete |
$95.28
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$230.17
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Meridian Medicaid |
$95.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.30
|
| Rate for Payer: Priority Health Narrow Network |
$225.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.00
|
| Rate for Payer: UHC Exchange |
$170.00
|
| Rate for Payer: UHCCP Medicaid |
$90.74
|
|
|
PR BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 57105
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$3,594.02 |
| Rate for Payer: Aetna Commercial |
$167.82
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,594.02
|
| Rate for Payer: BCN Commercial |
$260.95
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.74
|
| Rate for Payer: Priority Health Narrow Network |
$220.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.54
|
| Rate for Payer: UHC Exchange |
$140.54
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
|
|
PR BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 57100
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$3,206.78 |
| Rate for Payer: Aetna Commercial |
$78.63
|
| Rate for Payer: Aetna Medicare |
$84.50
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,206.78
|
| Rate for Payer: BCN Commercial |
$151.98
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.22
|
| Rate for Payer: Priority Health Narrow Network |
$97.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.73
|
| Rate for Payer: UHC Exchange |
$75.73
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
|
|
PR BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 20251
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$862.55 |
| Rate for Payer: Aetna Commercial |
$569.56
|
| Rate for Payer: Aetna Medicare |
$663.50
|
| Rate for Payer: BCBS Complete |
$293.87
|
| Rate for Payer: BCBS Trust/PPO |
$106.88
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Meridian Medicaid |
$293.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.22
|
| Rate for Payer: Priority Health Narrow Network |
$644.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.65
|
| Rate for Payer: UHC Exchange |
$476.65
|
| Rate for Payer: UHCCP Medicaid |
$279.88
|
|
|
PR BIOPSY VERTEBRAL BODY OPEN THORACIC
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 20250
|
| Min. Negotiated Rate |
$254.54 |
| Max. Negotiated Rate |
$602.48 |
| Rate for Payer: Aetna Commercial |
$521.70
|
| Rate for Payer: Aetna Medicare |
$401.50
|
| Rate for Payer: BCBS Complete |
$267.27
|
| Rate for Payer: BCBS Trust/PPO |
$556.70
|
| Rate for Payer: BCN Commercial |
$569.80
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Meridian Medicaid |
$267.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.48
|
| Rate for Payer: Priority Health Narrow Network |
$602.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.25
|
| Rate for Payer: UHC Exchange |
$433.25
|
| Rate for Payer: UHCCP Medicaid |
$254.54
|
|
|
PR BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 40808
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$113.82
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.48
|
| Rate for Payer: Priority Health Narrow Network |
$160.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.65
|
| Rate for Payer: UHC Exchange |
$124.65
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
PR BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 56605
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$2,173.43 |
| Rate for Payer: Aetna Commercial |
$70.93
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,173.43
|
| Rate for Payer: BCN Commercial |
$114.27
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.80
|
| Rate for Payer: Priority Health Narrow Network |
$87.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.33
|
| Rate for Payer: UHC Exchange |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
|
|
PR BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 56606
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$35.11
|
| Rate for Payer: Aetna Medicare |
$96.00
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.96
|
| Rate for Payer: BCN Commercial |
$56.68
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.16
|
| Rate for Payer: Priority Health Narrow Network |
$43.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.83
|
| Rate for Payer: UHC Exchange |
$33.83
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
|
|
PR BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 33933
|
| Min. Negotiated Rate |
$251.71 |
| Max. Negotiated Rate |
$1,305.43 |
| Rate for Payer: Aetna Commercial |
$536.72
|
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: BCBS Complete |
$264.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.43
|
| Rate for Payer: BCN Commercial |
$627.12
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Meridian Medicaid |
$264.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.49
|
| Rate for Payer: Priority Health Narrow Network |
$676.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.74
|
| Rate for Payer: UHC Exchange |
$497.74
|
| Rate for Payer: UHCCP Medicaid |
$251.71
|
|
|
PR BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 51720
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$56.30
|
| Rate for Payer: Aetna Medicare |
$136.00
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.35
|
| Rate for Payer: BCN Commercial |
$102.88
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.70
|
| Rate for Payer: Priority Health Narrow Network |
$68.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.38
|
| Rate for Payer: UHC Exchange |
$98.38
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 51726
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$3,274.93 |
| Rate for Payer: Aetna Commercial |
$380.17
|
| Rate for Payer: Aetna Medicare |
$350.00
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,274.93
|
| Rate for Payer: BCN Commercial |
$441.76
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.08
|
| Rate for Payer: Priority Health Narrow Network |
$132.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.64
|
| Rate for Payer: UHC Exchange |
$356.64
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
|
|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 38206
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$1,117.35 |
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna Medicare |
$230.50
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.35
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.44
|
| Rate for Payer: Priority Health Narrow Network |
$162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.58
|
| Rate for Payer: UHC Exchange |
$92.58
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.16
|
| Rate for Payer: BCN Commercial |
$89.53
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.41
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.94
|
| Rate for Payer: UHC Exchange |
$53.94
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR BLEPHAROPLASTY LOWER EYELID W/HERNIATED FAT PAD
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$312.59 |
| Max. Negotiated Rate |
$903.57 |
| Rate for Payer: Aetna Commercial |
$582.43
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: BCBS Complete |
$368.57
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$903.57
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Meridian Medicaid |
$368.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.46
|
| Rate for Payer: Priority Health Narrow Network |
$745.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.38
|
| Rate for Payer: UHC Exchange |
$555.38
|
| Rate for Payer: UHCCP Medicaid |
$351.02
|
|
|
PR BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 15822
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$422.37
|
| Rate for Payer: Aetna Medicare |
$472.00
|
| Rate for Payer: BCBS Complete |
$267.27
|
| Rate for Payer: BCBS Trust/PPO |
$31.71
|
| Rate for Payer: BCN Commercial |
$675.35
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Meridian Medicaid |
$267.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.37
|
| Rate for Payer: Priority Health Narrow Network |
$541.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.23
|
| Rate for Payer: UHC Exchange |
$393.23
|
| Rate for Payer: UHCCP Medicaid |
$254.54
|
|
|
PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15823
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$905.03 |
| Rate for Payer: Aetna Commercial |
$584.27
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: BCBS Complete |
$368.57
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Meridian Medicaid |
$368.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.91
|
| Rate for Payer: Priority Health Narrow Network |
$745.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$659.11
|
| Rate for Payer: UHC Exchange |
$659.11
|
| Rate for Payer: UHCCP Medicaid |
$351.02
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$498.19 |
| Rate for Payer: Aetna Commercial |
$149.98
|
| Rate for Payer: Aetna Medicare |
$221.50
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$416.84
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.97
|
| Rate for Payer: Priority Health Narrow Network |
$202.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.01
|
| Rate for Payer: UHC Exchange |
$121.01
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
|
|
PR BLUE TIDAL
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00072
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$373.38
|
| Rate for Payer: Aetna Medicare |
$626.50
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$400.72
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.28
|
| Rate for Payer: Priority Health Narrow Network |
$418.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.69
|
| Rate for Payer: UHC Exchange |
$388.69
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
|
