|
PR CLOSED TX TALUS FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28435
|
| Min. Negotiated Rate |
$219.82 |
| Max. Negotiated Rate |
$1,149.05 |
| Rate for Payer: Aetna Commercial |
$390.08
|
| Rate for Payer: Aetna Medicare |
$404.00
|
| Rate for Payer: BCBS Complete |
$230.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.05
|
| Rate for Payer: BCN Commercial |
$553.67
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Meridian Medicaid |
$230.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$519.03
|
| Rate for Payer: Priority Health Narrow Network |
$519.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.44
|
| Rate for Payer: UHC Exchange |
$336.44
|
| Rate for Payer: UHCCP Medicaid |
$219.82
|
|
|
PR CLOSED TX TALUS FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 28430
|
| Min. Negotiated Rate |
$141.01 |
| Max. Negotiated Rate |
$540.45 |
| Rate for Payer: Aetna Commercial |
$277.32
|
| Rate for Payer: Aetna Medicare |
$336.50
|
| Rate for Payer: BCBS Complete |
$148.06
|
| Rate for Payer: BCBS Trust/PPO |
$540.45
|
| Rate for Payer: BCN Commercial |
$358.20
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Meridian Medicaid |
$148.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.30
|
| Rate for Payer: Priority Health Narrow Network |
$333.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.76
|
| Rate for Payer: UHC Exchange |
$224.76
|
| Rate for Payer: UHCCP Medicaid |
$141.01
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28605
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$2,031.31 |
| Rate for Payer: Aetna Commercial |
$398.51
|
| Rate for Payer: Aetna Medicare |
$404.00
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.31
|
| Rate for Payer: BCN Commercial |
$511.16
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.42
|
| Rate for Payer: Priority Health Narrow Network |
$483.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.67
|
| Rate for Payer: UHC Exchange |
$292.67
|
| Rate for Payer: UHCCP Medicaid |
$205.33
|
|
|
PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 28600
|
| Min. Negotiated Rate |
$124.39 |
| Max. Negotiated Rate |
$1,628.75 |
| Rate for Payer: Aetna Commercial |
$242.75
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: BCBS Complete |
$130.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.75
|
| Rate for Payer: BCN Commercial |
$324.48
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Meridian Medicaid |
$130.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.88
|
| Rate for Payer: Priority Health Narrow Network |
$251.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.13
|
| Rate for Payer: UHC Exchange |
$207.13
|
| Rate for Payer: UHCCP Medicaid |
$124.39
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 21485
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,428.40 |
| Rate for Payer: Aetna Commercial |
$1,032.91
|
| Rate for Payer: Aetna Medicare |
$544.00
|
| Rate for Payer: BCBS Complete |
$517.52
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$1,428.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Meridian Medicaid |
$517.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,194.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,194.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$621.25
|
| Rate for Payer: UHC Exchange |
$621.25
|
| Rate for Payer: UHCCP Medicaid |
$492.88
|
|
|
PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 21480
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$42.88
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.33
|
| Rate for Payer: Priority Health Narrow Network |
$47.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.44
|
| Rate for Payer: UHC Exchange |
$38.44
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 24675
|
| Min. Negotiated Rate |
$277.97 |
| Max. Negotiated Rate |
$1,365.66 |
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: Aetna Medicare |
$627.50
|
| Rate for Payer: BCBS Complete |
$291.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.66
|
| Rate for Payer: BCN Commercial |
$690.01
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Meridian Medicaid |
$291.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$659.99
|
| Rate for Payer: Priority Health Narrow Network |
$659.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.70
|
| Rate for Payer: UHC Exchange |
$459.70
|
| Rate for Payer: UHCCP Medicaid |
$277.97
|
|
|
PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 24670
|
| Min. Negotiated Rate |
$181.05 |
| Max. Negotiated Rate |
$1,283.24 |
| Rate for Payer: Aetna Commercial |
$353.21
|
| Rate for Payer: Aetna Medicare |
$398.50
|
| Rate for Payer: BCBS Complete |
$190.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.24
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Meridian Medicaid |
$190.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$427.45
|
| Rate for Payer: Priority Health Narrow Network |
$427.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.93
|
| Rate for Payer: UHC Exchange |
$278.93
|
| Rate for Payer: UHCCP Medicaid |
$181.05
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 25535
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$1,028.60 |
| Rate for Payer: Aetna Commercial |
$608.96
|
| Rate for Payer: Aetna Medicare |
$595.00
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.60
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$722.58
|
| Rate for Payer: Priority Health Narrow Network |
$722.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.56
|
| Rate for Payer: UHC Exchange |
$499.56
|
| Rate for Payer: UHCCP Medicaid |
$304.38
|
|
|
PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 25530
|
| Min. Negotiated Rate |
$165.71 |
| Max. Negotiated Rate |
$1,133.73 |
| Rate for Payer: Aetna Commercial |
$319.74
|
| Rate for Payer: Aetna Medicare |
$327.50
|
| Rate for Payer: BCBS Complete |
$174.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.73
|
| Rate for Payer: BCN Commercial |
$398.76
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Meridian Medicaid |
$174.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.28
|
| Rate for Payer: Priority Health Narrow Network |
$389.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.15
|
| Rate for Payer: UHC Exchange |
$247.15
|
| Rate for Payer: UHCCP Medicaid |
$165.71
|
|
|
PR CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX
|
Professional
|
Both
|
$2,094.00
|
|
|
Service Code
|
HCPCS 21750
|
| Min. Negotiated Rate |
$432.39 |
| Max. Negotiated Rate |
$1,388.14 |
| Rate for Payer: Aetna Commercial |
$910.89
|
| Rate for Payer: Aetna Medicare |
$1,047.00
|
| Rate for Payer: BCBS Complete |
$454.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.14
|
| Rate for Payer: BCN Commercial |
$981.75
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Meridian Medicaid |
$454.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,361.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,027.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.80
|
| Rate for Payer: UHC Exchange |
$848.80
|
| Rate for Payer: UHCCP Medicaid |
$432.39
|
|
|
PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 51880
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,691.09 |
| Rate for Payer: Aetna Commercial |
$598.61
|
| Rate for Payer: Aetna Medicare |
$710.00
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.09
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.65
|
| Rate for Payer: Priority Health Narrow Network |
$745.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.12
|
| Rate for Payer: UHC Exchange |
$556.12
|
| Rate for Payer: UHCCP Medicaid |
$298.84
|
|
|
PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 44620
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$1,542.78 |
| Rate for Payer: Aetna Commercial |
$1,162.18
|
| Rate for Payer: Aetna Medicare |
$1,130.50
|
| Rate for Payer: BCBS Complete |
$581.04
|
| Rate for Payer: BCBS Trust/PPO |
$210.79
|
| Rate for Payer: BCN Commercial |
$1,258.83
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Meridian Medicaid |
$581.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,042.50
|
| Rate for Payer: UHC Exchange |
$1,042.50
|
| Rate for Payer: UHCCP Medicaid |
$553.37
|
|
|
PR CLOSURE GASTROCOLIC FISTULA
|
Professional
|
Both
|
$3,893.00
|
|
|
Service Code
|
HCPCS 43880
|
| Min. Negotiated Rate |
$198.11 |
| Max. Negotiated Rate |
$2,873.80 |
| Rate for Payer: Aetna Commercial |
$2,144.57
|
| Rate for Payer: Aetna Medicare |
$1,946.50
|
| Rate for Payer: BCBS Complete |
$1,083.14
|
| Rate for Payer: BCBS Trust/PPO |
$198.11
|
| Rate for Payer: BCN Commercial |
$2,311.45
|
| Rate for Payer: Cash Price |
$3,114.40
|
| Rate for Payer: Cash Price |
$3,114.40
|
| Rate for Payer: Meridian Medicaid |
$1,083.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,031.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,530.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,873.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,873.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,935.45
|
| Rate for Payer: UHC Exchange |
$1,935.45
|
| Rate for Payer: UHCCP Medicaid |
$1,031.56
|
|
|
PR CLOSURE GASTROSTOMY SURG
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
HCPCS 43870
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$1,273.14 |
| Rate for Payer: Aetna Commercial |
$958.29
|
| Rate for Payer: Aetna Medicare |
$977.50
|
| Rate for Payer: BCBS Complete |
$479.50
|
| Rate for Payer: BCBS Trust/PPO |
$202.87
|
| Rate for Payer: BCN Commercial |
$1,038.93
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Meridian Medicaid |
$479.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,273.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,273.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.85
|
| Rate for Payer: UHC Exchange |
$850.85
|
| Rate for Payer: UHCCP Medicaid |
$456.67
|
|
|
PR CLOSURE INTESTINAL CUTANEOUS FISTULA
|
Professional
|
Both
|
$2,546.00
|
|
|
Service Code
|
HCPCS 44640
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$2,484.81 |
| Rate for Payer: Aetna Commercial |
$1,881.85
|
| Rate for Payer: Aetna Medicare |
$1,273.00
|
| Rate for Payer: BCBS Complete |
$935.53
|
| Rate for Payer: BCBS Trust/PPO |
$175.40
|
| Rate for Payer: BCN Commercial |
$2,026.06
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Meridian Medicaid |
$935.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$890.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,484.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,484.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,704.75
|
| Rate for Payer: UHC Exchange |
$1,704.75
|
| Rate for Payer: UHCCP Medicaid |
$890.98
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 40830
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$805.66 |
| Rate for Payer: Aetna Commercial |
$217.18
|
| Rate for Payer: Aetna Medicare |
$268.50
|
| Rate for Payer: BCBS Complete |
$99.53
|
| Rate for Payer: BCBS Trust/PPO |
$805.66
|
| Rate for Payer: BCN Commercial |
$332.79
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Meridian Medicaid |
$99.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.72
|
| Rate for Payer: Priority Health Narrow Network |
$260.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.81
|
| Rate for Payer: UHC Exchange |
$189.81
|
| Rate for Payer: UHCCP Medicaid |
$94.79
|
|
|
PR CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 40831
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$949.88 |
| Rate for Payer: Aetna Commercial |
$299.67
|
| Rate for Payer: Aetna Medicare |
$345.50
|
| Rate for Payer: BCBS Complete |
$137.55
|
| Rate for Payer: BCBS Trust/PPO |
$949.88
|
| Rate for Payer: BCN Commercial |
$436.39
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Meridian Medicaid |
$137.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.74
|
| Rate for Payer: Priority Health Narrow Network |
$359.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.29
|
| Rate for Payer: UHC Exchange |
$264.29
|
| Rate for Payer: UHCCP Medicaid |
$131.00
|
|
|
PR CLOSURE RECTOURETHRAL FISTULA
|
Professional
|
Both
|
$3,283.00
|
|
|
Service Code
|
HCPCS 45820
|
| Min. Negotiated Rate |
$527.24 |
| Max. Negotiated Rate |
$2,281.98 |
| Rate for Payer: Aetna Commercial |
$1,722.58
|
| Rate for Payer: Aetna Medicare |
$1,641.50
|
| Rate for Payer: BCBS Complete |
$861.27
|
| Rate for Payer: BCBS Trust/PPO |
$527.24
|
| Rate for Payer: BCN Commercial |
$1,862.35
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Cash Price |
$2,626.40
|
| Rate for Payer: Meridian Medicaid |
$861.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,133.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,281.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,281.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,414.69
|
| Rate for Payer: UHC Exchange |
$1,414.69
|
| Rate for Payer: UHCCP Medicaid |
$820.26
|
|
|
PR CLOSURE RECTOVESICAL FISTULA
|
Professional
|
Both
|
$2,859.00
|
|
|
Service Code
|
HCPCS 45800
|
| Min. Negotiated Rate |
$818.35 |
| Max. Negotiated Rate |
$2,276.01 |
| Rate for Payer: Aetna Commercial |
$1,718.44
|
| Rate for Payer: Aetna Medicare |
$1,429.50
|
| Rate for Payer: BCBS Complete |
$859.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.43
|
| Rate for Payer: BCN Commercial |
$1,857.46
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Meridian Medicaid |
$859.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$818.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,858.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,276.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,276.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,477.64
|
| Rate for Payer: UHC Exchange |
$1,477.64
|
| Rate for Payer: UHCCP Medicaid |
$818.35
|
|
|
PR CLOSURE SALIVARY FISTULA
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 42600
|
| Min. Negotiated Rate |
$231.11 |
| Max. Negotiated Rate |
$808.27 |
| Rate for Payer: Aetna Commercial |
$464.04
|
| Rate for Payer: Aetna Medicare |
$409.00
|
| Rate for Payer: BCBS Complete |
$242.67
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$808.27
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Meridian Medicaid |
$242.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$645.51
|
| Rate for Payer: Priority Health Narrow Network |
$645.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$428.51
|
| Rate for Payer: UHC Exchange |
$428.51
|
| Rate for Payer: UHCCP Medicaid |
$231.11
|
|
|
PR CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
HCPCS 57320
|
| Min. Negotiated Rate |
$362.31 |
| Max. Negotiated Rate |
$1,656.75 |
| Rate for Payer: Aetna Commercial |
$662.82
|
| Rate for Payer: Aetna Medicare |
$481.50
|
| Rate for Payer: BCBS Complete |
$380.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.75
|
| Rate for Payer: BCN Commercial |
$831.73
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Meridian Medicaid |
$380.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$847.74
|
| Rate for Payer: Priority Health Narrow Network |
$847.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$626.07
|
| Rate for Payer: UHC Exchange |
$626.07
|
| Rate for Payer: UHCCP Medicaid |
$362.31
|
|
|
PR CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 23540
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$393.06 |
| Rate for Payer: Aetna Commercial |
$308.76
|
| Rate for Payer: Aetna Medicare |
$299.00
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS Trust/PPO |
$393.06
|
| Rate for Payer: BCN Commercial |
$361.13
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.09
|
| Rate for Payer: Priority Health Narrow Network |
$378.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.61
|
| Rate for Payer: UHC Exchange |
$237.61
|
| Rate for Payer: UHCCP Medicaid |
$159.54
|
|
|
PR CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 23500
|
| Min. Negotiated Rate |
$155.49 |
| Max. Negotiated Rate |
$365.36 |
| Rate for Payer: Aetna Commercial |
$299.45
|
| Rate for Payer: Aetna Medicare |
$258.00
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS Trust/PPO |
$226.26
|
| Rate for Payer: BCN Commercial |
$337.19
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.36
|
| Rate for Payer: Priority Health Narrow Network |
$365.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.62
|
| Rate for Payer: UHC Exchange |
$232.62
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
|
|
PR CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 24500
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$548.60 |
| Rate for Payer: Aetna Commercial |
$439.50
|
| Rate for Payer: Aetna Medicare |
$422.00
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: BCN Commercial |
$544.87
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Cash Price |
$675.20
|
| Rate for Payer: Meridian Medicaid |
$236.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.28
|
| Rate for Payer: Priority Health Narrow Network |
$533.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$344.95
|
| Rate for Payer: UHC Exchange |
$344.95
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
|
