|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$301.82 |
| Max. Negotiated Rate |
$966.55 |
| Rate for Payer: Aetna Commercial |
$641.72
|
| Rate for Payer: Aetna Medicare |
$743.50
|
| Rate for Payer: BCBS Complete |
$316.91
|
| Rate for Payer: BCBS Trust/PPO |
$841.58
|
| Rate for Payer: BCN Commercial |
$688.54
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Meridian Medicaid |
$316.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$966.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.37
|
| Rate for Payer: Priority Health Narrow Network |
$845.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.99
|
| Rate for Payer: UHC Exchange |
$663.99
|
| Rate for Payer: UHCCP Medicaid |
$301.82
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$1,693.20 |
| Rate for Payer: Aetna Commercial |
$577.10
|
| Rate for Payer: Aetna Medicare |
$952.50
|
| Rate for Payer: BCBS Complete |
$284.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.20
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Meridian Medicaid |
$284.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.06
|
| Rate for Payer: Priority Health Narrow Network |
$760.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$729.48
|
| Rate for Payer: UHC Exchange |
$729.48
|
| Rate for Payer: UHCCP Medicaid |
$271.15
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$949.92 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Aetna Medicare |
$552.00
|
| Rate for Payer: BCBS Complete |
$212.69
|
| Rate for Payer: BCBS Trust/PPO |
$949.92
|
| Rate for Payer: BCN Commercial |
$460.83
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Meridian Medicaid |
$212.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.76
|
| Rate for Payer: Priority Health Narrow Network |
$566.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.88
|
| Rate for Payer: UHC Exchange |
$437.88
|
| Rate for Payer: UHCCP Medicaid |
$202.56
|
|
|
PR ERCP,INSERT STENT,BILIARY/PANC
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 43268
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$1,108.25 |
| Rate for Payer: Aetna Medicare |
$852.50
|
| Rate for Payer: BCBS Complete |
$682.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,108.25
|
|
|
PR ERCP,NASOBILIARY DRAIN TUBE
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
HCPCS 43267
|
| Min. Negotiated Rate |
$659.60 |
| Max. Negotiated Rate |
$1,071.85 |
| Rate for Payer: Aetna Medicare |
$824.50
|
| Rate for Payer: BCBS Complete |
$659.60
|
| Rate for Payer: Cash Price |
$1,319.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.85
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$484.52
|
| Rate for Payer: Aetna Medicare |
$919.50
|
| Rate for Payer: BCBS Complete |
$240.20
|
| Rate for Payer: BCBS Trust/PPO |
$216.92
|
| Rate for Payer: BCN Commercial |
$520.44
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Meridian Medicaid |
$240.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.95
|
| Rate for Payer: Priority Health Narrow Network |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$649.21
|
| Rate for Payer: UHC Exchange |
$649.21
|
| Rate for Payer: UHCCP Medicaid |
$228.76
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$933.51 |
| Rate for Payer: Aetna Commercial |
$501.03
|
| Rate for Payer: Aetna Medicare |
$409.00
|
| Rate for Payer: BCBS Complete |
$248.03
|
| Rate for Payer: BCBS Trust/PPO |
$933.51
|
| Rate for Payer: BCN Commercial |
$537.55
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Meridian Medicaid |
$248.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$660.42
|
| Rate for Payer: Priority Health Narrow Network |
$660.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$526.29
|
| Rate for Payer: UHC Exchange |
$526.29
|
| Rate for Payer: UHCCP Medicaid |
$236.22
|
|
|
PR ERCP,RMV F.B./CHANGE STENT
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 43269
|
| Min. Negotiated Rate |
$677.20 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Medicare |
$846.50
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$1,429.00
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$290.11 |
| Max. Negotiated Rate |
$928.85 |
| Rate for Payer: Aetna Commercial |
$616.54
|
| Rate for Payer: Aetna Medicare |
$714.50
|
| Rate for Payer: BCBS Complete |
$304.62
|
| Rate for Payer: BCBS Trust/PPO |
$813.05
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Cash Price |
$1,143.20
|
| Rate for Payer: Meridian Medicaid |
$304.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$811.96
|
| Rate for Payer: Priority Health Narrow Network |
$811.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$638.31
|
| Rate for Payer: UHC Exchange |
$638.31
|
| Rate for Payer: UHCCP Medicaid |
$290.11
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$876.20 |
| Rate for Payer: Aetna Commercial |
$575.78
|
| Rate for Payer: Aetna Medicare |
$674.00
|
| Rate for Payer: BCBS Complete |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$618.18
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Meridian Medicaid |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.06
|
| Rate for Payer: Priority Health Narrow Network |
$760.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$602.04
|
| Rate for Payer: UHC Exchange |
$602.04
|
| Rate for Payer: UHCCP Medicaid |
$271.58
|
|
|
PR ERCP W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43261
|
| Min. Negotiated Rate |
$212.36 |
| Max. Negotiated Rate |
$1,040.08 |
| Rate for Payer: Aetna Commercial |
$450.13
|
| Rate for Payer: Aetna Medicare |
$585.00
|
| Rate for Payer: BCBS Complete |
$222.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.08
|
| Rate for Payer: BCN Commercial |
$484.28
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Meridian Medicaid |
$222.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$594.81
|
| Rate for Payer: Priority Health Narrow Network |
$594.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$460.31
|
| Rate for Payer: UHC Exchange |
$460.31
|
| Rate for Payer: UHCCP Medicaid |
$212.36
|
|
|
PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 43263
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$1,054.30 |
| Rate for Payer: Aetna Commercial |
$475.49
|
| Rate for Payer: Aetna Medicare |
$811.00
|
| Rate for Payer: BCBS Complete |
$235.72
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$511.16
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Meridian Medicaid |
$235.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.61
|
| Rate for Payer: Priority Health Narrow Network |
$627.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$534.16
|
| Rate for Payer: UHC Exchange |
$534.16
|
| Rate for Payer: UHCCP Medicaid |
$224.50
|
|
|
PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 43262
|
| Min. Negotiated Rate |
$224.08 |
| Max. Negotiated Rate |
$1,187.83 |
| Rate for Payer: Aetna Commercial |
$475.36
|
| Rate for Payer: Aetna Medicare |
$844.00
|
| Rate for Payer: BCBS Complete |
$235.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,187.83
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Meridian Medicaid |
$235.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$626.43
|
| Rate for Payer: Priority Health Narrow Network |
$626.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.04
|
| Rate for Payer: UHC Exchange |
$541.04
|
| Rate for Payer: UHCCP Medicaid |
$224.08
|
|
|
PR ESCHAROTOMY EACH ADDITIONAL INCISION
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 16036
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$282.10 |
| Rate for Payer: Aetna Commercial |
$86.23
|
| Rate for Payer: Aetna Medicare |
$217.00
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS Trust/PPO |
$119.96
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.62
|
| Rate for Payer: Priority Health Narrow Network |
$110.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.48
|
| Rate for Payer: UHC Exchange |
$91.48
|
| Rate for Payer: UHCCP Medicaid |
$52.61
|
|
|
PR ESCHAROTOMY FIRST INCISION
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna Commercial |
$212.15
|
| Rate for Payer: Aetna Medicare |
$430.00
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCBS Trust/PPO |
$23.70
|
| Rate for Payer: BCN Commercial |
$281.48
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Meridian Medicaid |
$130.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.24
|
| Rate for Payer: Priority Health Narrow Network |
$263.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.74
|
| Rate for Payer: UHC Exchange |
$225.74
|
| Rate for Payer: UHCCP Medicaid |
$124.61
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
|
Professional
|
Both
|
$3,466.00
|
|
|
Service Code
|
HCPCS 43325
|
| Min. Negotiated Rate |
$873.30 |
| Max. Negotiated Rate |
$2,431.72 |
| Rate for Payer: Aetna Commercial |
$1,838.43
|
| Rate for Payer: Aetna Medicare |
$1,733.00
|
| Rate for Payer: BCBS Complete |
$916.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.90
|
| Rate for Payer: BCN Commercial |
$1,983.05
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Cash Price |
$2,772.80
|
| Rate for Payer: Meridian Medicaid |
$916.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$873.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,252.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,431.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,431.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,639.20
|
| Rate for Payer: UHC Exchange |
$1,639.20
|
| Rate for Payer: UHCCP Medicaid |
$873.30
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY
|
Professional
|
Both
|
$2,096.00
|
|
|
Service Code
|
HCPCS 43327
|
| Min. Negotiated Rate |
$537.19 |
| Max. Negotiated Rate |
$2,023.92 |
| Rate for Payer: Aetna Commercial |
$1,105.09
|
| Rate for Payer: Aetna Medicare |
$1,048.00
|
| Rate for Payer: BCBS Complete |
$564.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,023.92
|
| Rate for Payer: BCN Commercial |
$1,197.26
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Meridian Medicaid |
$564.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$537.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,461.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,461.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,117.11
|
| Rate for Payer: UHC Exchange |
$1,117.11
|
| Rate for Payer: UHCCP Medicaid |
$537.19
|
|
|
PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 43460
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$1,198.18 |
| Rate for Payer: Aetna Commercial |
$282.44
|
| Rate for Payer: Aetna Medicare |
$443.00
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.18
|
| Rate for Payer: BCN Commercial |
$304.45
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.47
|
| Rate for Payer: Priority Health Narrow Network |
$373.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.68
|
| Rate for Payer: UHC Exchange |
$276.68
|
| Rate for Payer: UHCCP Medicaid |
$134.19
|
|
|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 91013
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$1,265.81 |
| Rate for Payer: Aetna Commercial |
$28.42
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,265.81
|
| Rate for Payer: BCN Commercial |
$37.63
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.22
|
| Rate for Payer: Priority Health Narrow Network |
$12.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.68
|
| Rate for Payer: UHC Exchange |
$25.68
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 91010
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$323.99 |
| Rate for Payer: Aetna Commercial |
$236.76
|
| Rate for Payer: Aetna Commercial |
$236.76
|
| Rate for Payer: Aetna Medicare |
$192.00
|
| Rate for Payer: Aetna Medicare |
$61.50
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$47.55
|
| Rate for Payer: BCBS Trust/PPO |
$47.55
|
| Rate for Payer: BCN Commercial |
$323.99
|
| Rate for Payer: BCN Commercial |
$323.99
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.94
|
| Rate for Payer: Priority Health Narrow Network |
$85.94
|
| Rate for Payer: Priority Health Narrow Network |
$85.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.60
|
| Rate for Payer: UHC Exchange |
$187.60
|
| Rate for Payer: UHC Exchange |
$187.60
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 43287
|
| Min. Negotiated Rate |
$994.79 |
| Max. Negotiated Rate |
$6,270.21 |
| Rate for Payer: Aetna Commercial |
$4,797.22
|
| Rate for Payer: Aetna Medicare |
$3,261.50
|
| Rate for Payer: BCBS Complete |
$2,354.81
|
| Rate for Payer: BCBS Trust/PPO |
$994.79
|
| Rate for Payer: BCN Commercial |
$5,110.10
|
| Rate for Payer: Cash Price |
$5,218.40
|
| Rate for Payer: Cash Price |
$5,218.40
|
| Rate for Payer: Meridian Medicaid |
$2,354.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,242.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,239.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,270.21
|
| Rate for Payer: Priority Health Narrow Network |
$6,270.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,793.34
|
| Rate for Payer: UHC Exchange |
$4,793.34
|
| Rate for Payer: UHCCP Medicaid |
$2,242.68
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ
|
Professional
|
Both
|
$6,605.00
|
|
|
Service Code
|
HCPCS 43286
|
| Min. Negotiated Rate |
$817.81 |
| Max. Negotiated Rate |
$5,610.97 |
| Rate for Payer: Aetna Commercial |
$4,282.47
|
| Rate for Payer: Aetna Medicare |
$3,302.50
|
| Rate for Payer: BCBS Complete |
$2,119.31
|
| Rate for Payer: BCBS Trust/PPO |
$817.81
|
| Rate for Payer: BCN Commercial |
$4,596.01
|
| Rate for Payer: Cash Price |
$5,284.00
|
| Rate for Payer: Cash Price |
$5,284.00
|
| Rate for Payer: Meridian Medicaid |
$2,119.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,018.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,293.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,610.97
|
| Rate for Payer: Priority Health Narrow Network |
$5,610.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,193.80
|
| Rate for Payer: UHC Exchange |
$4,193.80
|
| Rate for Payer: UHCCP Medicaid |
$2,018.39
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ
|
Professional
|
Both
|
$6,487.00
|
|
|
Service Code
|
HCPCS 43288
|
| Min. Negotiated Rate |
$1,474.49 |
| Max. Negotiated Rate |
$6,612.65 |
| Rate for Payer: Aetna Commercial |
$5,050.41
|
| Rate for Payer: Aetna Medicare |
$3,243.50
|
| Rate for Payer: BCBS Complete |
$2,486.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.49
|
| Rate for Payer: BCN Commercial |
$5,396.47
|
| Rate for Payer: Cash Price |
$5,189.60
|
| Rate for Payer: Cash Price |
$5,189.60
|
| Rate for Payer: Meridian Medicaid |
$2,486.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,367.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,216.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,612.65
|
| Rate for Payer: Priority Health Narrow Network |
$6,612.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,998.63
|
| Rate for Payer: UHC Exchange |
$4,998.63
|
| Rate for Payer: UHCCP Medicaid |
$2,367.71
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 43236
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$590.33 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: Aetna Medicare |
$337.50
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: BCN Commercial |
$590.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.61
|
| Rate for Payer: Priority Health Narrow Network |
$244.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.56
|
| Rate for Payer: UHC Exchange |
$220.56
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
43235
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$469.95 |
| Rate for Payer: Aetna Commercial |
$162.76
|
| Rate for Payer: Aetna Medicare |
$361.50
|
| Rate for Payer: BCBS Complete |
$81.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: BCN Commercial |
$423.20
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Meridian Medicaid |
$81.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.56
|
| Rate for Payer: Priority Health Narrow Network |
$216.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.16
|
| Rate for Payer: UHC Exchange |
$182.16
|
| Rate for Payer: UHCCP Medicaid |
$77.75
|
|
