|
PR ESOPHAGOSCOPY,INSERT TUBE/STENT
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 43219
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$972.40 |
| Rate for Payer: Aetna Medicare |
$748.00
|
| Rate for Payer: BCBS Complete |
$598.40
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$972.40
|
|
|
PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 43232
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$672.10 |
| Rate for Payer: Aetna Commercial |
$264.70
|
| Rate for Payer: Aetna Medicare |
$517.00
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$81.89
|
| Rate for Payer: BCN Commercial |
$282.95
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Cash Price |
$827.20
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.20
|
| Rate for Payer: Priority Health Narrow Network |
$350.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.36
|
| Rate for Payer: UHC Exchange |
$330.36
|
| Rate for Payer: UHCCP Medicaid |
$124.82
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
HCPCS 43195
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$330.51 |
| Rate for Payer: Aetna Commercial |
$242.98
|
| Rate for Payer: Aetna Medicare |
$190.50
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCN Commercial |
$269.26
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Meridian Medicaid |
$125.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.51
|
| Rate for Payer: Priority Health Narrow Network |
$330.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.71
|
| Rate for Payer: UHC Exchange |
$236.71
|
| Rate for Payer: UHCCP Medicaid |
$119.07
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 43191
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$278.01 |
| Rate for Payer: Aetna Commercial |
$204.70
|
| Rate for Payer: Aetna Medicare |
$201.00
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS Trust/PPO |
$63.92
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$278.01
|
| Rate for Payer: Priority Health Narrow Network |
$278.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.08
|
| Rate for Payer: UHC Exchange |
$166.08
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 43192
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$303.66 |
| Rate for Payer: Aetna Commercial |
$224.57
|
| Rate for Payer: Aetna Medicare |
$172.00
|
| Rate for Payer: BCBS Complete |
$114.28
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$247.27
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Meridian Medicaid |
$114.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.66
|
| Rate for Payer: Priority Health Narrow Network |
$303.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.18
|
| Rate for Payer: UHC Exchange |
$198.18
|
| Rate for Payer: UHCCP Medicaid |
$108.84
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$345.15 |
| Rate for Payer: Aetna Commercial |
$223.22
|
| Rate for Payer: Aetna Medicare |
$265.50
|
| Rate for Payer: BCBS Complete |
$114.51
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: BCN Commercial |
$246.29
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Meridian Medicaid |
$114.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.48
|
| Rate for Payer: Priority Health Narrow Network |
$302.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.28
|
| Rate for Payer: UHC Exchange |
$236.28
|
| Rate for Payer: UHCCP Medicaid |
$109.06
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$338.86 |
| Rate for Payer: Aetna Commercial |
$256.30
|
| Rate for Payer: Aetna Medicare |
$240.50
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS Trust/PPO |
$54.94
|
| Rate for Payer: BCN Commercial |
$279.53
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.86
|
| Rate for Payer: Priority Health Narrow Network |
$338.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.99
|
| Rate for Payer: UHC Exchange |
$214.99
|
| Rate for Payer: UHCCP Medicaid |
$123.11
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$373.10 |
| Rate for Payer: Aetna Commercial |
$253.36
|
| Rate for Payer: Aetna Medicare |
$287.00
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCBS Trust/PPO |
$156.91
|
| Rate for Payer: BCN Commercial |
$272.68
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.89
|
| Rate for Payer: Priority Health Narrow Network |
$332.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.96
|
| Rate for Payer: UHC Exchange |
$255.96
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$981.40 |
| Rate for Payer: Aetna Commercial |
$724.74
|
| Rate for Payer: Aetna Medicare |
$661.00
|
| Rate for Payer: BCBS Complete |
$370.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.57
|
| Rate for Payer: BCN Commercial |
$799.97
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Meridian Medicaid |
$370.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$981.40
|
| Rate for Payer: Priority Health Narrow Network |
$981.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.94
|
| Rate for Payer: UHC Exchange |
$741.94
|
| Rate for Payer: UHCCP Medicaid |
$352.52
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$680.32 |
| Max. Negotiated Rate |
$1,895.98 |
| Rate for Payer: Aetna Commercial |
$1,431.41
|
| Rate for Payer: Aetna Medicare |
$1,194.50
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.75
|
| Rate for Payer: BCN Commercial |
$1,543.73
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,895.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,895.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,358.50
|
| Rate for Payer: UHC Exchange |
$1,358.50
|
| Rate for Payer: UHCCP Medicaid |
$680.32
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$840.07 |
| Max. Negotiated Rate |
$2,342.82 |
| Rate for Payer: Aetna Commercial |
$1,767.68
|
| Rate for Payer: Aetna Medicare |
$1,768.50
|
| Rate for Payer: BCBS Complete |
$882.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.94
|
| Rate for Payer: BCN Commercial |
$1,905.35
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Meridian Medicaid |
$882.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,342.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,342.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,668.40
|
| Rate for Payer: UHC Exchange |
$1,668.40
|
| Rate for Payer: UHCCP Medicaid |
$840.07
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$272.07 |
| Max. Negotiated Rate |
$2,314.79 |
| Rate for Payer: Aetna Commercial |
$1,746.60
|
| Rate for Payer: Aetna Medicare |
$1,638.00
|
| Rate for Payer: BCBS Complete |
$871.34
|
| Rate for Payer: BCBS Trust/PPO |
$272.07
|
| Rate for Payer: BCN Commercial |
$1,883.86
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Cash Price |
$2,620.80
|
| Rate for Payer: Meridian Medicaid |
$871.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,314.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,314.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,659.95
|
| Rate for Payer: UHC Exchange |
$1,659.95
|
| Rate for Payer: UHCCP Medicaid |
$829.85
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$200.46 |
| Rate for Payer: Aetna Commercial |
$155.95
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.46
|
| Rate for Payer: Priority Health Narrow Network |
$200.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.46
|
| Rate for Payer: UHC Exchange |
$184.46
|
| Rate for Payer: UHCCP Medicaid |
$71.78
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$932.98 |
| Rate for Payer: Aetna Commercial |
$474.97
|
| Rate for Payer: Aetna Commercial |
$474.97
|
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCBS Trust/PPO |
$932.98
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: BCN Commercial |
$599.12
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.73
|
| Rate for Payer: Priority Health Narrow Network |
$73.73
|
| Rate for Payer: Priority Health Narrow Network |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.41
|
| Rate for Payer: UHC Exchange |
$140.41
|
| Rate for Payer: UHC Exchange |
$140.41
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$177.41
|
| Rate for Payer: Aetna Medicare |
$585.00
|
| Rate for Payer: BCBS Complete |
$89.01
|
| Rate for Payer: BCBS Trust/PPO |
$137.36
|
| Rate for Payer: BCN Commercial |
$603.52
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Meridian Medicaid |
$89.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.66
|
| Rate for Payer: Priority Health Narrow Network |
$235.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.46
|
| Rate for Payer: UHC Exchange |
$179.46
|
| Rate for Payer: UHCCP Medicaid |
$84.77
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$187.01
|
| Rate for Payer: Aetna Medicare |
$552.00
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS Trust/PPO |
$278.94
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.78
|
| Rate for Payer: Priority Health Narrow Network |
$248.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.60
|
| Rate for Payer: UHC Exchange |
$281.60
|
| Rate for Payer: UHCCP Medicaid |
$88.82
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,658.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$1,290.11 |
| Max. Negotiated Rate |
$5,185.60 |
| Rate for Payer: Aetna Commercial |
$3,673.09
|
| Rate for Payer: Aetna Medicare |
$3,329.00
|
| Rate for Payer: BCBS Complete |
$1,955.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.11
|
| Rate for Payer: BCN Commercial |
$4,222.66
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Cash Price |
$5,326.40
|
| Rate for Payer: Meridian Medicaid |
$1,955.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,862.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,327.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,185.60
|
| Rate for Payer: Priority Health Narrow Network |
$5,185.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,451.96
|
| Rate for Payer: UHC Exchange |
$3,451.96
|
| Rate for Payer: UHCCP Medicaid |
$1,862.26
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,567.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$5,547.72 |
| Rate for Payer: Aetna Commercial |
$3,959.46
|
| Rate for Payer: Aetna Medicare |
$3,783.50
|
| Rate for Payer: BCBS Complete |
$2,089.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,288.00
|
| Rate for Payer: BCN Commercial |
$4,525.16
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Cash Price |
$6,053.60
|
| Rate for Payer: Meridian Medicaid |
$2,089.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,990.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,918.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,547.72
|
| Rate for Payer: Priority Health Narrow Network |
$5,547.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,776.23
|
| Rate for Payer: UHC Exchange |
$3,776.23
|
| Rate for Payer: UHCCP Medicaid |
$1,990.27
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$1,573.28 |
| Rate for Payer: Aetna Commercial |
$820.41
|
| Rate for Payer: Aetna Medicare |
$1,036.00
|
| Rate for Payer: BCBS Complete |
$425.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.28
|
| Rate for Payer: BCN Commercial |
$919.69
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Meridian Medicaid |
$425.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,130.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$750.19
|
| Rate for Payer: UHC Exchange |
$750.19
|
| Rate for Payer: UHCCP Medicaid |
$405.13
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$703.75 |
| Max. Negotiated Rate |
$1,965.18 |
| Rate for Payer: Aetna Commercial |
$1,456.07
|
| Rate for Payer: Aetna Medicare |
$1,156.50
|
| Rate for Payer: BCBS Complete |
$738.94
|
| Rate for Payer: BCN Commercial |
$1,603.35
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Meridian Medicaid |
$738.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,965.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,965.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.30
|
| Rate for Payer: UHC Exchange |
$1,356.30
|
| Rate for Payer: UHCCP Medicaid |
$703.75
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,977.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$937.84 |
| Max. Negotiated Rate |
$3,235.05 |
| Rate for Payer: Aetna Commercial |
$1,993.99
|
| Rate for Payer: Aetna Medicare |
$2,488.50
|
| Rate for Payer: BCBS Complete |
$984.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$2,135.52
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Cash Price |
$3,981.60
|
| Rate for Payer: Meridian Medicaid |
$984.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$937.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,235.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,618.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,618.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,928.09
|
| Rate for Payer: UHC Exchange |
$1,928.09
|
| Rate for Payer: UHCCP Medicaid |
$937.84
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,000.04 |
| Max. Negotiated Rate |
$2,795.64 |
| Rate for Payer: Aetna Commercial |
$2,140.84
|
| Rate for Payer: Aetna Medicare |
$1,677.00
|
| Rate for Payer: BCBS Complete |
$1,050.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.03
|
| Rate for Payer: BCN Commercial |
$2,281.14
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Meridian Medicaid |
$1,050.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,180.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,795.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,795.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,106.99
|
| Rate for Payer: UHC Exchange |
$2,106.99
|
| Rate for Payer: UHCCP Medicaid |
$1,000.04
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$77.13 |
| Rate for Payer: Aetna Commercial |
$10.62
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.66
|
| Rate for Payer: Priority Health Narrow Network |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.44
|
| Rate for Payer: UHC Exchange |
$8.44
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$291.25 |
| Rate for Payer: Aetna Commercial |
$222.67
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: BCBS Complete |
$135.98
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Meridian Medicaid |
$135.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.29
|
| Rate for Payer: Priority Health Narrow Network |
$272.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.41
|
| Rate for Payer: UHC Exchange |
$177.41
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$326.25
|
| Rate for Payer: Aetna Medicare |
$207.00
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$423.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.42
|
| Rate for Payer: Priority Health Narrow Network |
$394.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.90
|
| Rate for Payer: UHC Exchange |
$245.90
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
|
