|
PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 36593
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$549.96 |
| Rate for Payer: Aetna Commercial |
$41.26
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$549.96
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.31
|
| Rate for Payer: Priority Health Narrow Network |
$55.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.98
|
| Rate for Payer: UHC Exchange |
$31.98
|
|
|
PR DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI
|
Professional
|
Both
|
$1,834.00
|
|
|
Service Code
|
HCPCS 27027
|
| Min. Negotiated Rate |
$573.40 |
| Max. Negotiated Rate |
$1,362.73 |
| Rate for Payer: Aetna Commercial |
$1,179.09
|
| Rate for Payer: Aetna Medicare |
$917.00
|
| Rate for Payer: BCBS Complete |
$602.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.34
|
| Rate for Payer: BCN Commercial |
$1,310.63
|
| Rate for Payer: Cash Price |
$1,467.20
|
| Rate for Payer: Cash Price |
$1,467.20
|
| Rate for Payer: Meridian Medicaid |
$602.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,362.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,362.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.60
|
| Rate for Payer: UHC Exchange |
$952.60
|
| Rate for Payer: UHCCP Medicaid |
$573.40
|
|
|
PR DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 27496
|
| Min. Negotiated Rate |
$361.89 |
| Max. Negotiated Rate |
$1,098.34 |
| Rate for Payer: Aetna Commercial |
$728.83
|
| Rate for Payer: Aetna Medicare |
$474.00
|
| Rate for Payer: BCBS Complete |
$379.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.34
|
| Rate for Payer: BCN Commercial |
$811.21
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Meridian Medicaid |
$379.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$855.91
|
| Rate for Payer: Priority Health Narrow Network |
$855.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$584.48
|
| Rate for Payer: UHC Exchange |
$584.48
|
| Rate for Payer: UHCCP Medicaid |
$361.89
|
|
|
PR DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
HCPCS 24495
|
| Min. Negotiated Rate |
$501.36 |
| Max. Negotiated Rate |
$1,419.21 |
| Rate for Payer: Aetna Commercial |
$1,009.58
|
| Rate for Payer: Aetna Medicare |
$846.00
|
| Rate for Payer: BCBS Complete |
$619.51
|
| Rate for Payer: BCBS Trust/PPO |
$501.36
|
| Rate for Payer: BCN Commercial |
$1,369.28
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Cash Price |
$1,353.60
|
| Rate for Payer: Meridian Medicaid |
$619.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$590.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,419.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,419.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$749.94
|
| Rate for Payer: UHC Exchange |
$749.94
|
| Rate for Payer: UHCCP Medicaid |
$590.01
|
|
|
PR DECOMPRESSION FINGERS&/HAND INJECTION INJURY
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 26035
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$1,420.90 |
| Rate for Payer: Aetna Commercial |
$1,146.22
|
| Rate for Payer: Aetna Medicare |
$1,093.00
|
| Rate for Payer: BCBS Complete |
$591.11
|
| Rate for Payer: BCBS Trust/PPO |
$89.15
|
| Rate for Payer: BCN Commercial |
$1,268.12
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Meridian Medicaid |
$591.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$562.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,420.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,333.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.43
|
| Rate for Payer: UHC Exchange |
$952.43
|
| Rate for Payer: UHCCP Medicaid |
$562.96
|
|
|
PR DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH
|
Professional
|
Both
|
$5,746.00
|
|
|
Service Code
|
HCPCS 61330
|
| Min. Negotiated Rate |
$322.79 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: Aetna Commercial |
$2,316.66
|
| Rate for Payer: Aetna Medicare |
$2,873.00
|
| Rate for Payer: BCBS Complete |
$1,229.18
|
| Rate for Payer: BCBS Trust/PPO |
$322.79
|
| Rate for Payer: BCN Commercial |
$2,648.64
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Meridian Medicaid |
$1,229.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,170.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,112.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,112.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,011.66
|
| Rate for Payer: UHC Exchange |
$2,011.66
|
| Rate for Payer: UHCCP Medicaid |
$1,170.65
|
|
|
PR DECOMPRESSION PLANTAR DIGITAL NERVE
|
Professional
|
Both
|
$1,573.00
|
|
|
Service Code
|
HCPCS 64726
|
| Min. Negotiated Rate |
$175.73 |
| Max. Negotiated Rate |
$1,254.71 |
| Rate for Payer: Aetna Commercial |
$341.98
|
| Rate for Payer: Aetna Medicare |
$786.50
|
| Rate for Payer: BCBS Complete |
$184.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.71
|
| Rate for Payer: BCN Commercial |
$393.87
|
| Rate for Payer: Cash Price |
$1,258.40
|
| Rate for Payer: Cash Price |
$1,258.40
|
| Rate for Payer: Meridian Medicaid |
$184.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.37
|
| Rate for Payer: Priority Health Narrow Network |
$462.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.29
|
| Rate for Payer: UHC Exchange |
$323.29
|
| Rate for Payer: UHCCP Medicaid |
$175.73
|
|
|
PR DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 64722
|
| Min. Negotiated Rate |
$242.82 |
| Max. Negotiated Rate |
$5,909.56 |
| Rate for Payer: Aetna Commercial |
$455.08
|
| Rate for Payer: Aetna Medicare |
$891.50
|
| Rate for Payer: BCBS Complete |
$254.96
|
| Rate for Payer: BCBS Trust/PPO |
$5,909.56
|
| Rate for Payer: BCN Commercial |
$537.55
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Meridian Medicaid |
$254.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.65
|
| Rate for Payer: Priority Health Narrow Network |
$642.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.68
|
| Rate for Payer: UHC Exchange |
$390.68
|
| Rate for Payer: UHCCP Medicaid |
$242.82
|
|
|
PR DECOMPRESSIVE FASCIOTOMY HAND
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 26037
|
| Min. Negotiated Rate |
$109.10 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Commercial |
$751.25
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: BCBS Complete |
$387.81
|
| Rate for Payer: BCBS Trust/PPO |
$109.10
|
| Rate for Payer: BCN Commercial |
$829.77
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Meridian Medicaid |
$387.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.67
|
| Rate for Payer: Priority Health Narrow Network |
$871.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$645.40
|
| Rate for Payer: UHC Exchange |
$645.40
|
| Rate for Payer: UHCCP Medicaid |
$369.34
|
|
|
PR DECORTICATION & PARIETAL PLEURECTOMY
|
Professional
|
Both
|
$4,013.00
|
|
|
Service Code
|
HCPCS 32320
|
| Min. Negotiated Rate |
$518.79 |
| Max. Negotiated Rate |
$2,608.45 |
| Rate for Payer: Aetna Commercial |
$2,067.00
|
| Rate for Payer: Aetna Medicare |
$2,006.50
|
| Rate for Payer: BCBS Complete |
$1,067.93
|
| Rate for Payer: BCBS Trust/PPO |
$518.79
|
| Rate for Payer: BCN Commercial |
$2,313.89
|
| Rate for Payer: Cash Price |
$3,210.40
|
| Rate for Payer: Cash Price |
$3,210.40
|
| Rate for Payer: Meridian Medicaid |
$1,067.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,204.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,204.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,881.81
|
| Rate for Payer: UHC Exchange |
$1,881.81
|
| Rate for Payer: UHCCP Medicaid |
$1,017.08
|
|
|
PR DECORTICATION PULMONARY PARTIAL SEPARATE PROC
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 32225
|
| Min. Negotiated Rate |
$468.07 |
| Max. Negotiated Rate |
$1,437.69 |
| Rate for Payer: Aetna Commercial |
$1,281.01
|
| Rate for Payer: Aetna Medicare |
$1,031.00
|
| Rate for Payer: BCBS Complete |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$468.07
|
| Rate for Payer: BCN Commercial |
$1,437.69
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Meridian Medicaid |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$632.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,368.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,368.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,170.09
|
| Rate for Payer: UHC Exchange |
$1,170.09
|
| Rate for Payer: UHCCP Medicaid |
$632.18
|
|
|
PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,963.00
|
|
|
Service Code
|
HCPCS 32220
|
| Min. Negotiated Rate |
$758.11 |
| Max. Negotiated Rate |
$2,302.65 |
| Rate for Payer: Aetna Commercial |
$2,051.72
|
| Rate for Payer: Aetna Medicare |
$1,481.50
|
| Rate for Payer: BCBS Complete |
$1,065.47
|
| Rate for Payer: BCBS Trust/PPO |
$758.11
|
| Rate for Payer: BCN Commercial |
$2,302.65
|
| Rate for Payer: Cash Price |
$2,370.40
|
| Rate for Payer: Cash Price |
$2,370.40
|
| Rate for Payer: Meridian Medicaid |
$1,065.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,014.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,197.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,197.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,874.63
|
| Rate for Payer: UHC Exchange |
$1,874.63
|
| Rate for Payer: UHCCP Medicaid |
$1,014.73
|
|
|
PR DEGARELIX INJECTION
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J9155
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.31
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCN Commercial |
$4.06
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
| Rate for Payer: UHC Exchange |
$4.75
|
|
|
PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 49436
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$2,493.58 |
| Rate for Payer: Aetna Commercial |
$252.08
|
| Rate for Payer: Aetna Medicare |
$645.00
|
| Rate for Payer: BCBS Complete |
$126.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,493.58
|
| Rate for Payer: BCN Commercial |
$801.43
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Meridian Medicaid |
$126.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.68
|
| Rate for Payer: Priority Health Narrow Network |
$334.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.10
|
| Rate for Payer: UHC Exchange |
$223.10
|
| Rate for Payer: UHCCP Medicaid |
$120.13
|
|
|
PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 15630
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$362.89
|
| Rate for Payer: Aetna Medicare |
$453.00
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,918.45
|
| Rate for Payer: BCN Commercial |
$677.79
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.67
|
| Rate for Payer: Priority Health Narrow Network |
$468.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.37
|
| Rate for Payer: UHC Exchange |
$361.37
|
| Rate for Payer: UHCCP Medicaid |
$223.01
|
|
|
PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 15620
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$657.27 |
| Rate for Payer: Aetna Commercial |
$345.81
|
| Rate for Payer: Aetna Medicare |
$362.00
|
| Rate for Payer: BCBS Complete |
$222.98
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$657.27
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Meridian Medicaid |
$222.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.65
|
| Rate for Payer: Priority Health Narrow Network |
$445.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$331.85
|
| Rate for Payer: UHC Exchange |
$331.85
|
| Rate for Payer: UHCCP Medicaid |
$212.36
|
|
|
PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 15610
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$2,032.46 |
| Rate for Payer: Aetna Commercial |
$257.64
|
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,032.46
|
| Rate for Payer: BCN Commercial |
$541.46
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.13
|
| Rate for Payer: Priority Health Narrow Network |
$334.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.08
|
| Rate for Payer: UHC Exchange |
$245.08
|
| Rate for Payer: UHCCP Medicaid |
$159.54
|
|
|
PR DELAY FLAP/SECTIONING FLAP TRUNK
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 15600
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$852.18 |
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna Medicare |
$264.50
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS Trust/PPO |
$852.18
|
| Rate for Payer: BCN Commercial |
$497.47
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.33
|
| Rate for Payer: Priority Health Narrow Network |
$290.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.54
|
| Rate for Payer: UHC Exchange |
$208.54
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
|
|
PR DELIVERY/BIRTHING ROOM RESUSCITATION
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 99465
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$143.87
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS Trust/PPO |
$115.04
|
| Rate for Payer: BCN Commercial |
$204.27
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.91
|
| Rate for Payer: Priority Health Narrow Network |
$188.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.28
|
| Rate for Payer: UHC Exchange |
$165.28
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
|
|
PR DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 59414
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Commercial |
$100.38
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$89.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$132.43
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Meridian Medicaid |
$89.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.68
|
| Rate for Payer: Priority Health Narrow Network |
$126.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.86
|
| Rate for Payer: UHC Exchange |
$105.86
|
| Rate for Payer: UHCCP Medicaid |
$84.85
|
|
|
PR DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 94664
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$379.32 |
| Rate for Payer: Aetna Commercial |
$17.47
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$379.32
|
| Rate for Payer: BCN Commercial |
$24.92
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.43
|
| Rate for Payer: Priority Health Narrow Network |
$24.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$24.59
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.78
|
| Rate for Payer: UHC Exchange |
$29.78
|
|
|
PR DEPO-ESTRADIOL CYPIONATE INJ
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J1000
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.42
|
| Rate for Payer: BCN Commercial |
$29.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.33
|
| Rate for Payer: UHC Exchange |
$39.33
|
|
|
PR DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0444
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$1,280.07 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.07
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.80
|
| Rate for Payer: Priority Health Narrow Network |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.36
|
| Rate for Payer: UHC Exchange |
$10.36
|
|
|
PR DERMAGRAFT
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$281.06 |
| Rate for Payer: Aetna Commercial |
$46.29
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$281.06
|
| Rate for Payer: BCN Commercial |
$33.86
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.94
|
| Rate for Payer: UHC Exchange |
$50.94
|
|
