|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$619.21 |
| Max. Negotiated Rate |
$1,790.62 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: Aetna Medicare |
$1,155.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,185.77
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,155.24
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$1,270.76
|
| Rate for Payer: PHP Medicaid |
$619.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,268.74
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$1,790.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP DNSP |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$303.80
|
| Rate for Payer: Aetna Medicare |
$724.00
|
| Rate for Payer: BCBS Complete |
$151.41
|
| Rate for Payer: BCBS Trust/PPO |
$302.72
|
| Rate for Payer: BCN Commercial |
$717.86
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Meridian Medicaid |
$151.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.11
|
| Rate for Payer: Priority Health Narrow Network |
$402.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.68
|
| Rate for Payer: UHC Exchange |
$340.68
|
| Rate for Payer: UHCCP Medicaid |
$144.20
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
45384
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,448.00 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.98
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$619.21 |
| Max. Negotiated Rate |
$1,790.62 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: Aetna Medicare |
$1,155.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,185.77
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,155.24
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$1,270.76
|
| Rate for Payer: PHP Medicaid |
$619.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,268.74
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$1,790.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP DNSP |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
45385
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$1,448.00 |
| Rate for Payer: Aetna Commercial |
$1,303.20
|
| Rate for Payer: ASR ASR |
$1,404.56
|
| Rate for Payer: ASR Commercial |
$1,404.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.98
|
| Rate for Payer: BCN Commercial |
$1,122.63
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cofinity Commercial |
$1,361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.40
|
| Rate for Payer: Healthscope Commercial |
$1,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.56
|
| Rate for Payer: Mclaren Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,230.80
|
| Rate for Payer: Nomi Health Commercial |
$1,187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,274.24
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
45385
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$337.92
|
| Rate for Payer: Aetna Medicare |
$724.00
|
| Rate for Payer: BCBS Complete |
$167.96
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Meridian Medicaid |
$167.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.84
|
| Rate for Payer: Priority Health Narrow Network |
$446.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.69
|
| Rate for Payer: UHC Exchange |
$387.69
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,448.00
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$941.20 |
| Rate for Payer: Aetna Commercial |
$337.92
|
| Rate for Payer: Aetna Medicare |
$724.00
|
| Rate for Payer: BCBS Complete |
$167.96
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Meridian Medicaid |
$167.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.84
|
| Rate for Payer: Priority Health Narrow Network |
$446.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.69
|
| Rate for Payer: UHC Exchange |
$387.69
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
|
|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$191.06 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$405.72
|
| Rate for Payer: Aetna Medicare |
$497.50
|
| Rate for Payer: BCBS Complete |
$200.61
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: BCN Commercial |
$435.90
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Meridian Medicaid |
$200.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$534.56
|
| Rate for Payer: Priority Health Narrow Network |
$534.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.54
|
| Rate for Payer: UHC Exchange |
$478.54
|
| Rate for Payer: UHCCP Medicaid |
$191.06
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS G0071
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$1,575.92 |
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.92
|
| Rate for Payer: BCN Commercial |
$34.21
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.52
|
| Rate for Payer: Priority Health Narrow Network |
$23.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
| Rate for Payer: UHC Exchange |
$12.87
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$480.86 |
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Medicare |
$201.00
|
| Rate for Payer: BCBS Complete |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$38.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.94
|
| Rate for Payer: Priority Health Narrow Network |
$90.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.79
|
| Rate for Payer: UHC Exchange |
$86.79
|
| Rate for Payer: UHCCP Medicaid |
$37.06
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$1,712.22 |
| Rate for Payer: Aetna Commercial |
$298.31
|
| Rate for Payer: Aetna Medicare |
$181.50
|
| Rate for Payer: BCBS Complete |
$40.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,712.22
|
| Rate for Payer: BCN Commercial |
$322.04
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Meridian Medicaid |
$40.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.75
|
| Rate for Payer: Priority Health Narrow Network |
$84.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.58
|
| Rate for Payer: UHC Exchange |
$252.58
|
| Rate for Payer: UHCCP Medicaid |
$38.34
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$50.45 |
| Max. Negotiated Rate |
$2,901.95 |
| Rate for Payer: Aetna Commercial |
$50.45
|
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,901.95
|
| Rate for Payer: BCN Commercial |
$140.79
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.26
|
| Rate for Payer: Priority Health Narrow Network |
$120.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
| Rate for Payer: UHC Exchange |
$95.88
|
| Rate for Payer: UHCCP Medicaid |
$57.30
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$3,367.38 |
| Rate for Payer: Aetna Commercial |
$457.56
|
| Rate for Payer: Aetna Medicare |
$342.50
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,367.38
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.70
|
| Rate for Payer: Priority Health Narrow Network |
$166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.06
|
| Rate for Payer: UHC Exchange |
$333.06
|
| Rate for Payer: UHCCP Medicaid |
$66.67
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$2,796.82 |
| Rate for Payer: Aetna Commercial |
$461.60
|
| Rate for Payer: Aetna Medicare |
$330.00
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,796.82
|
| Rate for Payer: BCN Commercial |
$534.61
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.45
|
| Rate for Payer: Priority Health Narrow Network |
$162.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.27
|
| Rate for Payer: UHC Exchange |
$331.27
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G2211
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.32
|
| Rate for Payer: Priority Health Narrow Network |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.72
|
| Rate for Payer: UHC Exchange |
$19.72
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,304.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,721.60 |
| Max. Negotiated Rate |
$2,797.60 |
| Rate for Payer: Aetna Medicare |
$2,152.00
|
| Rate for Payer: BCBS Complete |
$1,721.60
|
| Rate for Payer: Cash Price |
$3,443.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.60
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$2,933.12 |
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,933.12
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow Network |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.19
|
| Rate for Payer: UHC Exchange |
$97.19
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
PR COMPL OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 92018
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$7,723.22 |
| Rate for Payer: Aetna Commercial |
$150.76
|
| Rate for Payer: Aetna Medicare |
$107.00
|
| Rate for Payer: BCBS Complete |
$93.48
|
| Rate for Payer: BCBS Trust/PPO |
$7,723.22
|
| Rate for Payer: BCN Commercial |
$146.17
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Meridian Medicaid |
$93.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.66
|
| Rate for Payer: Priority Health Narrow Network |
$170.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.59
|
| Rate for Payer: UHC Exchange |
$149.59
|
| Rate for Payer: UHCCP Medicaid |
$89.03
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$2,879.24 |
| Rate for Payer: Aetna Commercial |
$491.15
|
| Rate for Payer: Aetna Medicare |
$358.00
|
| Rate for Payer: BCBS Complete |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.24
|
| Rate for Payer: BCN Commercial |
$565.89
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Meridian Medicaid |
$83.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.06
|
| Rate for Payer: Priority Health Narrow Network |
$197.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.18
|
| Rate for Payer: UHC Exchange |
$363.18
|
| Rate for Payer: UHCCP Medicaid |
$79.45
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,302.00
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$736.98 |
| Max. Negotiated Rate |
$8,609.74 |
| Rate for Payer: Aetna Commercial |
$5,432.97
|
| Rate for Payer: Aetna Medicare |
$5,151.00
|
| Rate for Payer: BCBS Complete |
$2,866.52
|
| Rate for Payer: BCBS Trust/PPO |
$736.98
|
| Rate for Payer: BCN Commercial |
$8,609.74
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Cash Price |
$8,241.60
|
| Rate for Payer: Meridian Medicaid |
$2,866.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,730.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,696.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,271.60
|
| Rate for Payer: Priority Health Narrow Network |
$7,271.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,923.88
|
| Rate for Payer: UHC Exchange |
$4,923.88
|
| Rate for Payer: UHCCP Medicaid |
$2,730.02
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$36.02
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$196.00
|
| Rate for Payer: BCN Commercial |
$53.75
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.52
|
| Rate for Payer: Priority Health Narrow Network |
$42.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.71
|
| Rate for Payer: UHC Exchange |
$39.71
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX SVT
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
HCPCS 93653
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$2,938.40 |
| Rate for Payer: Aetna Commercial |
$1,121.18
|
| Rate for Payer: Aetna Medicare |
$877.00
|
| Rate for Payer: BCBS Complete |
$547.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,938.40
|
| Rate for Payer: BCN Commercial |
$1,207.03
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Meridian Medicaid |
$547.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,149.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,149.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,116.64
|
| Rate for Payer: UHC Exchange |
$1,116.64
|
| Rate for Payer: UHCCP Medicaid |
$521.00
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX VT
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 93654
|
| Min. Negotiated Rate |
$627.92 |
| Max. Negotiated Rate |
$3,268.06 |
| Rate for Payer: Aetna Commercial |
$1,500.62
|
| Rate for Payer: Aetna Medicare |
$1,175.00
|
| Rate for Payer: BCBS Complete |
$659.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,268.06
|
| Rate for Payer: BCN Commercial |
$1,454.79
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Meridian Medicaid |
$659.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,385.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,385.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,490.19
|
| Rate for Payer: UHC Exchange |
$1,490.19
|
| Rate for Payer: UHCCP Medicaid |
$627.92
|
|
|
PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
HCPCS 93656
|
| Min. Negotiated Rate |
$590.44 |
| Max. Negotiated Rate |
$3,385.35 |
| Rate for Payer: Aetna Commercial |
$1,505.46
|
| Rate for Payer: Aetna Medicare |
$921.00
|
| Rate for Payer: BCBS Complete |
$619.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.35
|
| Rate for Payer: BCN Commercial |
$1,368.79
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Meridian Medicaid |
$619.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,303.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,303.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,490.66
|
| Rate for Payer: UHC Exchange |
$1,490.66
|
| Rate for Payer: UHCCP Medicaid |
$590.44
|
|
|
PR COMPRE EP EVAL R ATR VNTRC PACG&REC HIS BNDL REC
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
HCPCS 93620
|
| Min. Negotiated Rate |
$383.61 |
| Max. Negotiated Rate |
$7,115.72 |
| Rate for Payer: Aetna Commercial |
$1,103.18
|
| Rate for Payer: Aetna Medicare |
$659.50
|
| Rate for Payer: BCBS Complete |
$402.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.30
|
| Rate for Payer: BCN Commercial |
$7,115.72
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Meridian Medicaid |
$402.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$846.10
|
| Rate for Payer: Priority Health Narrow Network |
$846.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,019.76
|
| Rate for Payer: UHC Exchange |
$1,019.76
|
| Rate for Payer: UHCCP Medicaid |
$383.61
|
|
