|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$542.75 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: Aetna Commercial |
$751.50
|
| Rate for Payer: ASR ASR |
$809.95
|
| Rate for Payer: ASR Commercial |
$809.95
|
| Rate for Payer: BCBS Trust/PPO |
$680.44
|
| Rate for Payer: BCN Commercial |
$647.38
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$784.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.00
|
| Rate for Payer: Healthscope Commercial |
$835.00
|
| Rate for Payer: Healthscope Whirlpool |
$809.95
|
| Rate for Payer: Mclaren Commercial |
$751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.75
|
| Rate for Payer: Nomi Health Commercial |
$684.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.80
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 43760
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$542.75 |
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: Aetna Commercial |
$751.50
|
| Rate for Payer: Aetna Medicare |
$417.50
|
| Rate for Payer: ASR ASR |
$809.95
|
| Rate for Payer: ASR Commercial |
$809.95
|
| Rate for Payer: BCBS Complete |
$334.00
|
| Rate for Payer: BCBS Trust/PPO |
$683.78
|
| Rate for Payer: BCN Commercial |
$647.38
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$784.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.00
|
| Rate for Payer: Healthscope Commercial |
$835.00
|
| Rate for Payer: Healthscope Whirlpool |
$809.95
|
| Rate for Payer: Mclaren Commercial |
$751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$709.75
|
| Rate for Payer: Nomi Health Commercial |
$684.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.63
|
| Rate for Payer: Priority Health Narrow Network |
$585.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$734.80
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$38.93
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,160.00
|
| Rate for Payer: BCN Commercial |
$128.52
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.01
|
| Rate for Payer: Priority Health Narrow Network |
$51.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
| Rate for Payer: UHC Exchange |
$37.70
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
|
|
PR CHEMICAL PEEL FACIAL EPIDERMAL
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
HCPCS 15788
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$579.15 |
| Rate for Payer: Aetna Commercial |
$232.57
|
| Rate for Payer: Aetna Medicare |
$445.50
|
| Rate for Payer: BCBS Complete |
$147.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.00
|
| Rate for Payer: BCN Commercial |
$459.42
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Meridian Medicaid |
$147.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.29
|
| Rate for Payer: Priority Health Narrow Network |
$295.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.03
|
| Rate for Payer: UHC Exchange |
$246.03
|
| Rate for Payer: UHCCP Medicaid |
$140.37
|
|
|
PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 64644
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$896.53 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$896.53
|
| Rate for Payer: BCN Commercial |
$258.02
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.91
|
| Rate for Payer: Priority Health Narrow Network |
$197.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.00
|
| Rate for Payer: UHC Exchange |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$74.55
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 64643
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$151.09 |
| Rate for Payer: Aetna Commercial |
$91.59
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$151.09
|
| Rate for Payer: BCN Commercial |
$135.36
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.86
|
| Rate for Payer: Priority Health Narrow Network |
$118.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.49
|
| Rate for Payer: UHC Exchange |
$90.49
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64645
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$831.02 |
| Rate for Payer: Aetna Commercial |
$106.16
|
| Rate for Payer: Aetna Medicare |
$158.50
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS Trust/PPO |
$831.02
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Narrow Network |
$138.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.76
|
| Rate for Payer: UHC Exchange |
$103.76
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 64614
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Aetna Medicare |
$234.50
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.85
|
|
|
PR CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 46505
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$3,709.19 |
| Rate for Payer: Aetna Commercial |
$332.13
|
| Rate for Payer: Aetna Medicare |
$372.50
|
| Rate for Payer: BCBS Complete |
$168.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.19
|
| Rate for Payer: BCN Commercial |
$463.76
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Meridian Medicaid |
$168.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.43
|
| Rate for Payer: Priority Health Narrow Network |
$450.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.89
|
| Rate for Payer: UHC Exchange |
$274.89
|
| Rate for Payer: UHCCP Medicaid |
$160.60
|
|
|
PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 64617
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$525.13 |
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$161.00
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS Trust/PPO |
$525.13
|
| Rate for Payer: BCN Commercial |
$238.96
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.26
|
| Rate for Payer: Priority Health Narrow Network |
$184.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.20
|
| Rate for Payer: UHC Exchange |
$143.20
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
|
|
PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$3,744.06 |
| Rate for Payer: Aetna Commercial |
$139.45
|
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,744.06
|
| Rate for Payer: BCN Commercial |
$200.85
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.24
|
| Rate for Payer: Priority Health Narrow Network |
$188.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.55
|
| Rate for Payer: UHC Exchange |
$135.55
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
|
|
PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 64646
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$2,036.60 |
| Rate for Payer: Aetna Commercial |
$148.68
|
| Rate for Payer: Aetna Medicare |
$154.50
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,036.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.48
|
| Rate for Payer: Priority Health Narrow Network |
$198.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.69
|
| Rate for Payer: UHC Exchange |
$145.69
|
| Rate for Payer: UHCCP Medicaid |
$74.98
|
|
|
PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 64642
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$805.66 |
| Rate for Payer: Aetna Commercial |
$137.53
|
| Rate for Payer: Aetna Medicare |
$199.00
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS Trust/PPO |
$805.66
|
| Rate for Payer: BCN Commercial |
$220.39
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.13
|
| Rate for Payer: Priority Health Narrow Network |
$183.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.69
|
| Rate for Payer: UHC Exchange |
$134.69
|
| Rate for Payer: UHCCP Medicaid |
$68.80
|
|
|
PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 64611
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$939.85 |
| Rate for Payer: Aetna Commercial |
$137.09
|
| Rate for Payer: Aetna Medicare |
$107.00
|
| Rate for Payer: BCBS Complete |
$76.71
|
| Rate for Payer: BCBS Trust/PPO |
$939.85
|
| Rate for Payer: BCN Commercial |
$190.10
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Meridian Medicaid |
$76.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.08
|
| Rate for Payer: Priority Health Narrow Network |
$195.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.94
|
| Rate for Payer: UHC Exchange |
$116.94
|
| Rate for Payer: UHCCP Medicaid |
$73.06
|
|
|
PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$2,950.03 |
| Rate for Payer: Aetna Commercial |
$158.88
|
| Rate for Payer: Aetna Medicare |
$209.00
|
| Rate for Payer: BCBS Complete |
$82.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,950.03
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Meridian Medicaid |
$82.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.42
|
| Rate for Payer: Priority Health Narrow Network |
$210.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.50
|
| Rate for Payer: UHC Exchange |
$168.50
|
| Rate for Payer: UHCCP Medicaid |
$79.02
|
|
|
PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$2,247.92 |
| Rate for Payer: Aetna Commercial |
$148.68
|
| Rate for Payer: Aetna Medicare |
$162.50
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,247.92
|
| Rate for Payer: BCN Commercial |
$160.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.75
|
| Rate for Payer: Priority Health Narrow Network |
$204.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.79
|
| Rate for Payer: UHC Exchange |
$175.79
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 96415
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$1,570.64 |
| Rate for Payer: Aetna Commercial |
$36.56
|
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,570.64
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$37.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.12
|
| Rate for Payer: UHC Exchange |
$33.12
|
|
|
PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 96450
|
| Min. Negotiated Rate |
$48.78 |
| Max. Negotiated Rate |
$889.66 |
| Rate for Payer: Aetna Commercial |
$96.12
|
| Rate for Payer: Aetna Medicare |
$366.50
|
| Rate for Payer: BCBS Complete |
$51.22
|
| Rate for Payer: BCBS Trust/PPO |
$889.66
|
| Rate for Payer: BCN Commercial |
$240.92
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Meridian Medicaid |
$51.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.22
|
| Rate for Payer: Priority Health Narrow Network |
$102.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.01
|
| Rate for Payer: UHC Exchange |
$96.01
|
| Rate for Payer: UHCCP Medicaid |
$48.78
|
|
|
PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 96417
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna Commercial |
$82.79
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.41
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.39
|
| Rate for Payer: Priority Health Narrow Network |
$86.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.34
|
| Rate for Payer: UHC Exchange |
$75.34
|
|
|
PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 96413
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$1,457.05 |
| Rate for Payer: Aetna Commercial |
$170.23
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: BCBS Complete |
$99.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.05
|
| Rate for Payer: BCN Commercial |
$190.59
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.50
|
| Rate for Payer: Priority Health Narrow Network |
$175.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.02
|
| Rate for Payer: UHC Exchange |
$152.02
|
|
|
PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 96409
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$1,506.18 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,506.18
|
| Rate for Payer: BCN Commercial |
$147.09
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.69
|
| Rate for Payer: Priority Health Narrow Network |
$135.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.46
|
| Rate for Payer: UHC Exchange |
$116.46
|
|
|
PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 96411
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$1,466.56 |
| Rate for Payer: Aetna Commercial |
$71.62
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,466.56
|
| Rate for Payer: BCN Commercial |
$80.63
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.73
|
| Rate for Payer: Priority Health Narrow Network |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.57
|
| Rate for Payer: UHC Exchange |
$65.57
|
|
|
PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 96402
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$1,217.73 |
| Rate for Payer: Aetna Commercial |
$38.54
|
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.73
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.94
|
| Rate for Payer: Priority Health Narrow Network |
$47.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.19
|
| Rate for Payer: UHC Exchange |
$38.19
|
|
