|
PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 45190
|
| Min. Negotiated Rate |
$448.79 |
| Max. Negotiated Rate |
$1,251.06 |
| Rate for Payer: Aetna Commercial |
$942.76
|
| Rate for Payer: Aetna Medicare |
$782.50
|
| Rate for Payer: BCBS Complete |
$471.23
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$1,018.41
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Meridian Medicaid |
$471.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,251.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,251.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.38
|
| Rate for Payer: UHC Exchange |
$809.38
|
| Rate for Payer: UHCCP Medicaid |
$448.79
|
|
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 57065
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$2,603.46 |
| Rate for Payer: Aetna Commercial |
$218.65
|
| Rate for Payer: Aetna Medicare |
$364.00
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,603.46
|
| Rate for Payer: BCN Commercial |
$365.04
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.28
|
| Rate for Payer: Priority Health Narrow Network |
$279.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.57
|
| Rate for Payer: UHC Exchange |
$193.57
|
| Rate for Payer: UHCCP Medicaid |
$119.49
|
|
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$2,929.42 |
| Rate for Payer: Aetna Commercial |
$131.70
|
| Rate for Payer: Aetna Medicare |
$181.00
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,929.42
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.39
|
| Rate for Payer: UHC Exchange |
$109.39
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
|
|
PR DETERMINATION REFRACTIVE STATE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 92015
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$1,164.90 |
| Rate for Payer: Aetna Commercial |
$21.33
|
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.90
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.84
|
| Rate for Payer: Priority Health Narrow Network |
$22.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.36
|
| Rate for Payer: UHC Exchange |
$21.36
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$974.19 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$974.19
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.50
|
| Rate for Payer: UHC Exchange |
$7.50
|
|
|
PR DEVELOPMENTAL TESTING W/INTERP & REPORT
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 96111
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1100
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.11
|
| Rate for Payer: UHC Exchange |
$0.11
|
|
|
PR DIABETES PREVENTION PROGRAM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00268
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 0403T
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$131.11 |
| Rate for Payer: Aetna Commercial |
$32.06
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.11
|
| Rate for Payer: BCN Commercial |
$58.68
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.66
|
| Rate for Payer: UHC Exchange |
$73.66
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$308.64 |
| Max. Negotiated Rate |
$841.10 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: Aetna Medicare |
$647.00
|
| Rate for Payer: BCBS Complete |
$324.07
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Meridian Medicaid |
$324.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$725.64
|
| Rate for Payer: Priority Health Narrow Network |
$725.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$532.82
|
| Rate for Payer: UHC Exchange |
$532.82
|
| Rate for Payer: UHCCP Medicaid |
$308.64
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$437.96 |
| Rate for Payer: Aetna Commercial |
$85.82
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Trust/PPO |
$437.96
|
| Rate for Payer: BCN Commercial |
$226.75
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.48
|
| Rate for Payer: Priority Health Narrow Network |
$132.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.28
|
| Rate for Payer: UHC Exchange |
$70.28
|
| Rate for Payer: UHCCP Medicaid |
$42.81
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$85.90
|
| Rate for Payer: Aetna Medicare |
$183.50
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS Trust/PPO |
$400.45
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.48
|
| Rate for Payer: Priority Health Narrow Network |
$138.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.95
|
| Rate for Payer: UHC Exchange |
$86.95
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$367.17 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: Aetna Medicare |
$194.00
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS Trust/PPO |
$367.17
|
| Rate for Payer: BCN Commercial |
$255.58
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.80
|
| Rate for Payer: Priority Health Narrow Network |
$147.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.21
|
| Rate for Payer: UHC Exchange |
$94.21
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$874.34 |
| Rate for Payer: Aetna Commercial |
$79.39
|
| Rate for Payer: Aetna Medicare |
$283.00
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS Trust/PPO |
$874.34
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.06
|
| Rate for Payer: Priority Health Narrow Network |
$108.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.31
|
| Rate for Payer: UHC Exchange |
$94.31
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$1,578.56 |
| Rate for Payer: Aetna Commercial |
$114.31
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,578.56
|
| Rate for Payer: BCN Commercial |
$339.63
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.31
|
| Rate for Payer: Priority Health Narrow Network |
$143.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.44
|
| Rate for Payer: UHC Exchange |
$114.44
|
| Rate for Payer: UHCCP Medicaid |
$53.89
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$2,818.21 |
| Rate for Payer: Aetna Commercial |
$270.76
|
| Rate for Payer: Aetna Medicare |
$771.00
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: BCN Commercial |
$2,818.21
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.11
|
| Rate for Payer: Priority Health Narrow Network |
$311.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.24
|
| Rate for Payer: UHC Exchange |
$237.24
|
| Rate for Payer: UHCCP Medicaid |
$124.82
|
|
|
PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 90945
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$94.34
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.89
|
| Rate for Payer: Priority Health Narrow Network |
$114.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.37
|
| Rate for Payer: UHC Exchange |
$74.37
|
| Rate for Payer: UHCCP Medicaid |
$54.74
|
|
|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$77.32 |
| Max. Negotiated Rate |
$319.62 |
| Rate for Payer: Aetna Commercial |
$136.62
|
| Rate for Payer: Aetna Medicare |
$166.00
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: BCBS Trust/PPO |
$319.62
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Meridian Medicaid |
$81.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.74
|
| Rate for Payer: Priority Health Narrow Network |
$163.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.55
|
| Rate for Payer: UHC Exchange |
$120.55
|
| Rate for Payer: UHCCP Medicaid |
$77.32
|
|
|
PR DIAPHRAGM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS A4266
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCN Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$2,039.77 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: BCBS Complete |
$31.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.77
|
| Rate for Payer: BCN Commercial |
$115.33
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Meridian Medicaid |
$31.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.95
|
| Rate for Payer: Priority Health Narrow Network |
$69.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.42
|
| Rate for Payer: UHC Exchange |
$55.42
|
| Rate for Payer: UHCCP Medicaid |
$30.25
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$505.70 |
| Rate for Payer: Aetna Commercial |
$270.69
|
| Rate for Payer: Aetna Medicare |
$389.00
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCBS Trust/PPO |
$346.56
|
| Rate for Payer: BCN Commercial |
$401.69
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.24
|
| Rate for Payer: Priority Health Narrow Network |
$135.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.29
|
| Rate for Payer: UHC Exchange |
$295.29
|
| Rate for Payer: UHCCP Medicaid |
$63.47
|
|
|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$110.33 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: Aetna Medicare |
$179.50
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS Trust/PPO |
$585.88
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.65
|
| Rate for Payer: Priority Health Narrow Network |
$306.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.78
|
| Rate for Payer: UHC Exchange |
$197.78
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$1,102.03 |
| Rate for Payer: Aetna Commercial |
$114.17
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.03
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.12
|
| Rate for Payer: Priority Health Narrow Network |
$155.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.76
|
| Rate for Payer: UHC Exchange |
$94.76
|
| Rate for Payer: UHCCP Medicaid |
$50.91
|
|
|
PR DILATE ESOPHAGUS,BALLOON RETROGRADE
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 43456
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
|
|
PR DILATE ESOPH,BALLN,>30MM ACHALASIA
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 43458
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: Aetna Medicare |
$514.50
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
|
