|
PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 31652
|
| Min. Negotiated Rate |
$138.02 |
| Max. Negotiated Rate |
$1,843.29 |
| Rate for Payer: Aetna Commercial |
$286.67
|
| Rate for Payer: Aetna Medicare |
$241.00
|
| Rate for Payer: BCBS Complete |
$144.92
|
| Rate for Payer: BCBS Trust/PPO |
$853.73
|
| Rate for Payer: BCN Commercial |
$1,843.29
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Meridian Medicaid |
$144.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.93
|
| Rate for Payer: Priority Health Narrow Network |
$298.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.14
|
| Rate for Payer: UHC Exchange |
$285.14
|
| Rate for Payer: UHCCP Medicaid |
$138.02
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 31653
|
| Min. Negotiated Rate |
$152.93 |
| Max. Negotiated Rate |
$1,916.10 |
| Rate for Payer: Aetna Commercial |
$316.88
|
| Rate for Payer: Aetna Medicare |
$266.00
|
| Rate for Payer: BCBS Complete |
$160.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.30
|
| Rate for Payer: BCN Commercial |
$1,916.10
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Meridian Medicaid |
$160.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.38
|
| Rate for Payer: Priority Health Narrow Network |
$331.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.77
|
| Rate for Payer: UHC Exchange |
$314.77
|
| Rate for Payer: UHCCP Medicaid |
$152.93
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$397.64 |
| Rate for Payer: Aetna Commercial |
$169.32
|
| Rate for Payer: Aetna Medicare |
$298.00
|
| Rate for Payer: BCBS Complete |
$87.22
|
| Rate for Payer: BCBS Trust/PPO |
$372.29
|
| Rate for Payer: BCN Commercial |
$397.64
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Meridian Medicaid |
$87.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.75
|
| Rate for Payer: Priority Health Narrow Network |
$180.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.75
|
| Rate for Payer: UHC Exchange |
$169.75
|
| Rate for Payer: UHCCP Medicaid |
$83.07
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$1,147.47 |
| Rate for Payer: Aetna Commercial |
$172.05
|
| Rate for Payer: Aetna Medicare |
$302.50
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.47
|
| Rate for Payer: BCN Commercial |
$371.40
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.68
|
| Rate for Payer: Priority Health Narrow Network |
$181.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.24
|
| Rate for Payer: UHC Exchange |
$171.24
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
|
|
PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 31630
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$786.64 |
| Rate for Payer: Aetna Commercial |
$255.59
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$283.43
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Meridian Medicaid |
$130.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.73
|
| Rate for Payer: Priority Health Narrow Network |
$269.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.25
|
| Rate for Payer: UHC Exchange |
$237.25
|
| Rate for Payer: UHCCP Medicaid |
$124.61
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 94070
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$1,284.30 |
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.30
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.63
|
| Rate for Payer: Priority Health Narrow Network |
$36.63
|
| Rate for Payer: Priority Health Narrow Network |
$36.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.87
|
| Rate for Payer: UHC Exchange |
$59.87
|
| Rate for Payer: UHC Exchange |
$59.87
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
|
|
PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 31654
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$791.92 |
| Rate for Payer: Aetna Commercial |
$86.57
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$43.84
|
| Rate for Payer: BCBS Trust/PPO |
$791.92
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Meridian Medicaid |
$43.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.83
|
| Rate for Payer: Priority Health Narrow Network |
$90.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.47
|
| Rate for Payer: UHC Exchange |
$82.47
|
| Rate for Payer: UHCCP Medicaid |
$41.75
|
|
|
PR BRONCHOPLASTY GRAFT REPAIR
|
Professional
|
Both
|
$2,953.00
|
|
|
Service Code
|
HCPCS 31770
|
| Min. Negotiated Rate |
$838.58 |
| Max. Negotiated Rate |
$1,919.45 |
| Rate for Payer: Aetna Commercial |
$1,717.54
|
| Rate for Payer: Aetna Medicare |
$1,476.50
|
| Rate for Payer: BCBS Complete |
$880.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.92
|
| Rate for Payer: BCN Commercial |
$1,909.76
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Cash Price |
$2,362.40
|
| Rate for Payer: Meridian Medicaid |
$880.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$838.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,919.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,818.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,818.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,578.59
|
| Rate for Payer: UHC Exchange |
$1,578.59
|
| Rate for Payer: UHCCP Medicaid |
$838.58
|
|
|
PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
HCPCS 31625
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$508.71 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Aetna Medicare |
$324.00
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS Trust/PPO |
$463.32
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Meridian Medicaid |
$102.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.27
|
| Rate for Payer: Priority Health Narrow Network |
$212.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.73
|
| Rate for Payer: UHC Exchange |
$198.73
|
| Rate for Payer: UHCCP Medicaid |
$97.55
|
|
|
PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 31629
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$240.07
|
| Rate for Payer: Aetna Medicare |
$629.50
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS Trust/PPO |
$499.77
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.51
|
| Rate for Payer: Priority Health Narrow Network |
$253.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.95
|
| Rate for Payer: UHC Exchange |
$237.95
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
|
|
PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 31627
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$1,591.62 |
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$63.07
|
| Rate for Payer: BCBS Trust/PPO |
$684.15
|
| Rate for Payer: BCN Commercial |
$1,591.62
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Meridian Medicaid |
$63.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.70
|
| Rate for Payer: Priority Health Narrow Network |
$130.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.17
|
| Rate for Payer: UHC Exchange |
$119.17
|
| Rate for Payer: UHCCP Medicaid |
$60.07
|
|
|
PR BRONCHOSCOPY W/EXCISION TUMOR
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 31640
|
| Min. Negotiated Rate |
$154.21 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$320.57
|
| Rate for Payer: Aetna Medicare |
$260.50
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$852.15
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.55
|
| Rate for Payer: Priority Health Narrow Network |
$335.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.84
|
| Rate for Payer: UHC Exchange |
$302.84
|
| Rate for Payer: UHCCP Medicaid |
$154.21
|
|
|
PR BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 31631
|
| Min. Negotiated Rate |
$142.07 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$292.80
|
| Rate for Payer: Aetna Medicare |
$382.50
|
| Rate for Payer: BCBS Complete |
$149.17
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Meridian Medicaid |
$149.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.28
|
| Rate for Payer: Priority Health Narrow Network |
$307.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.35
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHCCP Medicaid |
$142.07
|
|
|
PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 31635
|
| Min. Negotiated Rate |
$109.91 |
| Max. Negotiated Rate |
$972.60 |
| Rate for Payer: Aetna Commercial |
$225.61
|
| Rate for Payer: Aetna Medicare |
$568.50
|
| Rate for Payer: BCBS Complete |
$115.41
|
| Rate for Payer: BCBS Trust/PPO |
$972.60
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Meridian Medicaid |
$115.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.68
|
| Rate for Payer: Priority Health Narrow Network |
$238.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.74
|
| Rate for Payer: UHC Exchange |
$220.74
|
| Rate for Payer: UHCCP Medicaid |
$109.91
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 31645
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$188.88
|
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$397.30
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.21
|
| Rate for Payer: Priority Health Narrow Network |
$200.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.88
|
| Rate for Payer: UHC Exchange |
$186.88
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
HCPCS 31646
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$182.25
|
| Rate for Payer: Aetna Medicare |
$307.00
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.00
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Cash Price |
$491.20
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.27
|
| Rate for Payer: Priority Health Narrow Network |
$193.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.00
|
| Rate for Payer: UHC Exchange |
$162.00
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 31628
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$915.54 |
| Rate for Payer: Aetna Commercial |
$226.30
|
| Rate for Payer: Aetna Medicare |
$380.00
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS Trust/PPO |
$915.54
|
| Rate for Payer: BCN Commercial |
$597.26
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.68
|
| Rate for Payer: Priority Health Narrow Network |
$238.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.59
|
| Rate for Payer: UHC Exchange |
$220.59
|
| Rate for Payer: UHCCP Medicaid |
$109.70
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 31632
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$996.90 |
| Rate for Payer: Aetna Commercial |
$63.94
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: BCBS Complete |
$31.76
|
| Rate for Payer: BCBS Trust/PPO |
$996.90
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Meridian Medicaid |
$31.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.27
|
| Rate for Payer: Priority Health Narrow Network |
$66.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.98
|
| Rate for Payer: UHC Exchange |
$56.98
|
| Rate for Payer: UHCCP Medicaid |
$30.25
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 31633
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$724.83 |
| Rate for Payer: Aetna Commercial |
$82.12
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS Complete |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$724.83
|
| Rate for Payer: BCN Commercial |
$115.82
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Meridian Medicaid |
$41.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.28
|
| Rate for Payer: Priority Health Narrow Network |
$85.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.88
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UHCCP Medicaid |
$39.41
|
|
|
PR BROWLIFT
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 00532
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
|
|
PR BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY
|
Professional
|
Both
|
$5,993.00
|
|
|
Service Code
|
HCPCS 58954
|
| Min. Negotiated Rate |
$131.02 |
| Max. Negotiated Rate |
$3,895.45 |
| Rate for Payer: Aetna Commercial |
$2,579.73
|
| Rate for Payer: Aetna Medicare |
$2,996.50
|
| Rate for Payer: BCBS Complete |
$1,459.98
|
| Rate for Payer: BCBS Trust/PPO |
$131.02
|
| Rate for Payer: BCN Commercial |
$3,158.81
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Cash Price |
$4,794.40
|
| Rate for Payer: Meridian Medicaid |
$1,459.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,390.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,895.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,235.71
|
| Rate for Payer: Priority Health Narrow Network |
$3,235.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,395.50
|
| Rate for Payer: UHC Exchange |
$2,395.50
|
| Rate for Payer: UHCCP Medicaid |
$1,390.46
|
|
|
PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$5,240.00
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$3,406.00 |
| Rate for Payer: Aetna Commercial |
$2,383.00
|
| Rate for Payer: Aetna Medicare |
$2,620.00
|
| Rate for Payer: BCBS Complete |
$1,349.06
|
| Rate for Payer: BCBS Trust/PPO |
$131.55
|
| Rate for Payer: BCN Commercial |
$2,921.81
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Meridian Medicaid |
$1,349.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,284.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,990.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,990.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,208.56
|
| Rate for Payer: UHC Exchange |
$2,208.56
|
| Rate for Payer: UHCCP Medicaid |
$1,284.82
|
|
|
PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 58956
|
| Min. Negotiated Rate |
$502.94 |
| Max. Negotiated Rate |
$2,035.29 |
| Rate for Payer: Aetna Commercial |
$1,617.38
|
| Rate for Payer: Aetna Medicare |
$1,215.00
|
| Rate for Payer: BCBS Complete |
$918.31
|
| Rate for Payer: BCBS Trust/PPO |
$502.94
|
| Rate for Payer: BCN Commercial |
$1,986.47
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Meridian Medicaid |
$918.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,579.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,035.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,035.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,506.43
|
| Rate for Payer: UHC Exchange |
$1,506.43
|
| Rate for Payer: UHCCP Medicaid |
$874.58
|
|
|
PR BUDESONIDE NON-COMP UNIT
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J7626
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna Commercial |
$1.04
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
|
|
PR BURR HOLE FOR VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$1,871.00
|
|
|
Service Code
|
HCPCS 61120
|
| Min. Negotiated Rate |
$493.73 |
| Max. Negotiated Rate |
$1,670.48 |
| Rate for Payer: Aetna Commercial |
$965.51
|
| Rate for Payer: Aetna Medicare |
$935.50
|
| Rate for Payer: BCBS Complete |
$518.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.48
|
| Rate for Payer: BCN Commercial |
$1,112.23
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Meridian Medicaid |
$518.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,309.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$841.90
|
| Rate for Payer: UHC Exchange |
$841.90
|
| Rate for Payer: UHCCP Medicaid |
$493.73
|
|
