|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,432.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$1,130.19 |
| Rate for Payer: Aetna Commercial |
$967.98
|
| Rate for Payer: Aetna Medicare |
$716.00
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$1,079.48
|
| Rate for Payer: Cash Price |
$1,145.60
|
| Rate for Payer: Cash Price |
$1,145.60
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$930.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,130.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.28
|
| Rate for Payer: UHC Exchange |
$783.28
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$1,533.35 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna Medicare |
$1,179.50
|
| Rate for Payer: BCBS Complete |
$487.56
|
| Rate for Payer: BCBS Trust/PPO |
$69.19
|
| Rate for Payer: BCN Commercial |
$1,054.56
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Meridian Medicaid |
$487.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$763.91
|
| Rate for Payer: UHC Exchange |
$763.91
|
| Rate for Payer: UHCCP Medicaid |
$464.34
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,746.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: Aetna Commercial |
$1,752.58
|
| Rate for Payer: Aetna Medicare |
$2,873.00
|
| Rate for Payer: BCBS Complete |
$923.90
|
| Rate for Payer: BCBS Trust/PPO |
$170.11
|
| Rate for Payer: BCN Commercial |
$2,197.49
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Cash Price |
$4,596.80
|
| Rate for Payer: Meridian Medicaid |
$923.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$879.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,734.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,334.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,334.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,596.18
|
| Rate for Payer: UHC Exchange |
$1,596.18
|
| Rate for Payer: UHCCP Medicaid |
$879.90
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$1,253.20 |
| Rate for Payer: Aetna Commercial |
$316.56
|
| Rate for Payer: Aetna Medicare |
$964.00
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$389.03
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.62
|
| Rate for Payer: Priority Health Narrow Network |
$410.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.89
|
| Rate for Payer: UHC Exchange |
$299.89
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,692.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$3,699.80 |
| Rate for Payer: Aetna Commercial |
$1,935.47
|
| Rate for Payer: Aetna Medicare |
$2,846.00
|
| Rate for Payer: BCBS Complete |
$989.66
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$2,469.21
|
| Rate for Payer: Cash Price |
$4,553.60
|
| Rate for Payer: Cash Price |
$4,553.60
|
| Rate for Payer: Meridian Medicaid |
$989.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$942.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,699.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,497.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,497.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,752.70
|
| Rate for Payer: UHC Exchange |
$1,752.70
|
| Rate for Payer: UHCCP Medicaid |
$942.53
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.47
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: BCBS Complete |
$65.31
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Meridian Medicaid |
$65.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.61
|
| Rate for Payer: Priority Health Narrow Network |
$173.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.93
|
| Rate for Payer: UHC Exchange |
$151.93
|
| Rate for Payer: UHCCP Medicaid |
$62.20
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.51
|
| Rate for Payer: UHC Exchange |
$309.51
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.19
|
| Rate for Payer: UHC Exchange |
$265.19
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$256.25 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.25
|
| Rate for Payer: UHC Exchange |
$256.25
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$337.82 |
| Max. Negotiated Rate |
$1,052.56 |
| Rate for Payer: Aetna Commercial |
$636.69
|
| Rate for Payer: Aetna Medicare |
$469.00
|
| Rate for Payer: BCBS Complete |
$354.71
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Meridian Medicaid |
$354.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,052.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.92
|
| Rate for Payer: UHC Exchange |
$577.92
|
| Rate for Payer: UHCCP Medicaid |
$337.82
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$337.82 |
| Max. Negotiated Rate |
$1,052.56 |
| Rate for Payer: Aetna Commercial |
$636.69
|
| Rate for Payer: Aetna Medicare |
$469.00
|
| Rate for Payer: BCBS Complete |
$354.71
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Meridian Medicaid |
$354.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,052.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,052.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.92
|
| Rate for Payer: UHC Exchange |
$577.92
|
| Rate for Payer: UHCCP Medicaid |
$337.82
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$609.70 |
| Max. Negotiated Rate |
$938.00 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: ASR ASR |
$909.86
|
| Rate for Payer: ASR Commercial |
$909.86
|
| Rate for Payer: BCBS Trust/PPO |
$764.38
|
| Rate for Payer: BCN Commercial |
$727.23
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$881.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.40
|
| Rate for Payer: Healthscope Commercial |
$938.00
|
| Rate for Payer: Healthscope Whirlpool |
$909.86
|
| Rate for Payer: Mclaren Commercial |
$844.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: Nomi Health Commercial |
$769.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.44
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$609.70 |
| Max. Negotiated Rate |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$909.86
|
| Rate for Payer: ASR Commercial |
$909.86
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$768.13
|
| Rate for Payer: BCN Commercial |
$727.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$881.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$938.00
|
| Rate for Payer: Healthscope Whirlpool |
$909.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$844.20
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$797.30
|
| Rate for Payer: Nomi Health Commercial |
$769.16
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$821.88
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$657.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$825.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$1,080.37 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.37
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.21
|
| Rate for Payer: UHC Exchange |
$102.21
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$1,890.26 |
| Rate for Payer: Aetna Commercial |
$24.41
|
| Rate for Payer: Aetna Medicare |
$43.00
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.26
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.97
|
| Rate for Payer: Priority Health Narrow Network |
$23.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.04
|
| Rate for Payer: UHC Exchange |
$36.04
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$1,499.32 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: Aetna Medicare |
$34.50
|
| Rate for Payer: BCBS Complete |
$19.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.32
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Meridian Medicaid |
$19.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.99
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.08
|
| Rate for Payer: UHC Exchange |
$62.08
|
| Rate for Payer: UHCCP Medicaid |
$18.11
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$2,437.00
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$1,584.05 |
| Rate for Payer: Aetna Commercial |
$1,052.07
|
| Rate for Payer: Aetna Medicare |
$1,218.50
|
| Rate for Payer: BCBS Complete |
$535.65
|
| Rate for Payer: BCBS Trust/PPO |
$85.32
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Cash Price |
$1,949.60
|
| Rate for Payer: Meridian Medicaid |
$535.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,426.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.96
|
| Rate for Payer: UHC Exchange |
$974.96
|
| Rate for Payer: UHCCP Medicaid |
$510.14
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$3,167.00
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$2,595.19 |
| Rate for Payer: Aetna Commercial |
$1,977.64
|
| Rate for Payer: Aetna Medicare |
$1,583.50
|
| Rate for Payer: BCBS Complete |
$976.01
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$2,116.46
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Meridian Medicaid |
$976.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$929.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,058.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,595.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,595.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,885.14
|
| Rate for Payer: UHC Exchange |
$1,885.14
|
| Rate for Payer: UHCCP Medicaid |
$929.53
|
|
|
PR DIVISION ABERRANT VESSEL VASCULAR RING
|
Professional
|
Both
|
$4,233.00
|
|
|
Service Code
|
HCPCS 33802
|
| Min. Negotiated Rate |
$689.69 |
| Max. Negotiated Rate |
$2,751.45 |
| Rate for Payer: Aetna Commercial |
$1,453.89
|
| Rate for Payer: Aetna Medicare |
$2,116.50
|
| Rate for Payer: BCBS Complete |
$724.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,485.05
|
| Rate for Payer: BCN Commercial |
$1,564.26
|
| Rate for Payer: Cash Price |
$3,386.40
|
| Rate for Payer: Cash Price |
$3,386.40
|
| Rate for Payer: Meridian Medicaid |
$724.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,751.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,714.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,714.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.09
|
| Rate for Payer: UHC Exchange |
$1,390.09
|
| Rate for Payer: UHCCP Medicaid |
$689.69
|
|
|
PR DIVISION PLANTAR FASCIA & MUSCLE SPX
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 28250
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$3,050.93 |
| Rate for Payer: Aetna Commercial |
$533.29
|
| Rate for Payer: Aetna Medicare |
$655.50
|
| Rate for Payer: BCBS Complete |
$282.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,050.93
|
| Rate for Payer: BCN Commercial |
$856.16
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Meridian Medicaid |
$282.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.07
|
| Rate for Payer: Priority Health Narrow Network |
$636.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.07
|
| Rate for Payer: UHC Exchange |
$469.07
|
| Rate for Payer: UHCCP Medicaid |
$269.45
|
|
|
PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 21705
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$806.55 |
| Rate for Payer: Aetna Commercial |
$719.58
|
| Rate for Payer: Aetna Medicare |
$559.50
|
| Rate for Payer: BCBS Complete |
$355.82
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Meridian Medicaid |
$355.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$727.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$806.55
|
| Rate for Payer: Priority Health Narrow Network |
$806.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$743.56
|
| Rate for Payer: UHC Exchange |
$743.56
|
| Rate for Payer: UHCCP Medicaid |
$338.88
|
|
|
PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 21700
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$478.91
|
| Rate for Payer: Aetna Medicare |
$774.50
|
| Rate for Payer: BCBS Complete |
$238.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.06
|
| Rate for Payer: BCN Commercial |
$516.04
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Meridian Medicaid |
$238.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.92
|
| Rate for Payer: Priority Health Narrow Network |
$540.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.62
|
| Rate for Payer: UHC Exchange |
$499.62
|
| Rate for Payer: UHCCP Medicaid |
$227.27
|
|
