|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$2,292.50 |
| Rate for Payer: Aetna Commercial |
$1,127.03
|
| Rate for Payer: Aetna Medicare |
$841.07
|
| Rate for Payer: BCBS Complete |
$573.67
|
| Rate for Payer: BCBS MAPPO |
$841.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.03
|
| Rate for Payer: BCN Commercial |
$1,240.27
|
| Rate for Payer: BCN Medicare Advantage |
$841.07
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,211.14
|
| Rate for Payer: Cofinity Commercial |
$1,127.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$841.07
|
| Rate for Payer: Healthscope Commercial |
$1,009.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,009.28
|
| Rate for Payer: Meridian Medicaid |
$573.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$883.12
|
| Rate for Payer: PACE SWMI |
$841.07
|
| Rate for Payer: PHP Medicare Advantage |
$841.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$546.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,371.43
|
| Rate for Payer: Priority Health Medicare |
$841.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,371.43
|
| Rate for Payer: UHC Medicare Advantage |
$866.30
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$685.21 |
| Max. Negotiated Rate |
$1,858.29 |
| Rate for Payer: Aetna Commercial |
$1,528.06
|
| Rate for Payer: Aetna Medicare |
$1,140.34
|
| Rate for Payer: BCBS Complete |
$778.97
|
| Rate for Payer: BCBS MAPPO |
$1,140.34
|
| Rate for Payer: BCBS Trust/PPO |
$685.21
|
| Rate for Payer: BCN Commercial |
$1,680.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,140.34
|
| Rate for Payer: Cash Price |
$2,010.40
|
| Rate for Payer: Cash Price |
$2,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,642.09
|
| Rate for Payer: Cofinity Commercial |
$1,528.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,140.34
|
| Rate for Payer: Healthscope Commercial |
$1,368.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,368.41
|
| Rate for Payer: Meridian Medicaid |
$778.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,197.36
|
| Rate for Payer: PACE SWMI |
$1,140.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,140.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,858.29
|
| Rate for Payer: Priority Health Medicare |
$1,140.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,858.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,174.55
|
|
|
PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES
|
Professional
|
Both
|
$3,205.00
|
|
|
Service Code
|
HCPCS 55821
|
| Min. Negotiated Rate |
$532.93 |
| Max. Negotiated Rate |
$2,243.50 |
| Rate for Payer: Aetna Commercial |
$1,097.37
|
| Rate for Payer: Aetna Medicare |
$818.93
|
| Rate for Payer: BCBS Complete |
$559.58
|
| Rate for Payer: BCBS MAPPO |
$818.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.99
|
| Rate for Payer: BCN Commercial |
$1,208.01
|
| Rate for Payer: BCN Medicare Advantage |
$818.93
|
| Rate for Payer: Cash Price |
$2,564.00
|
| Rate for Payer: Cash Price |
$2,564.00
|
| Rate for Payer: Cofinity Commercial |
$1,179.26
|
| Rate for Payer: Cofinity Commercial |
$1,097.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$818.93
|
| Rate for Payer: Healthscope Commercial |
$982.72
|
| Rate for Payer: Healthscope Whirlpool |
$982.72
|
| Rate for Payer: Meridian Medicaid |
$559.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$859.88
|
| Rate for Payer: PACE SWMI |
$818.93
|
| Rate for Payer: PHP Medicare Advantage |
$818.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,243.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,335.76
|
| Rate for Payer: Priority Health Medicare |
$818.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,335.76
|
| Rate for Payer: UHC Medicare Advantage |
$843.50
|
|
|
PR PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
HCPCS 55700
|
| Min. Negotiated Rate |
$82.22 |
| Max. Negotiated Rate |
$2,508.90 |
| Rate for Payer: Aetna Commercial |
$169.97
|
| Rate for Payer: Aetna Medicare |
$126.84
|
| Rate for Payer: BCBS Complete |
$86.33
|
| Rate for Payer: BCBS MAPPO |
$126.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,508.90
|
| Rate for Payer: BCN Commercial |
$352.33
|
| Rate for Payer: BCN Medicare Advantage |
$126.84
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cash Price |
$395.20
|
| Rate for Payer: Cofinity Commercial |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$182.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.84
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Healthscope Whirlpool |
$152.21
|
| Rate for Payer: Meridian Medicaid |
$86.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.18
|
| Rate for Payer: PACE SWMI |
$126.84
|
| Rate for Payer: PHP Medicare Advantage |
$126.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.88
|
| Rate for Payer: Priority Health Medicare |
$126.84
|
| Rate for Payer: Priority Health Narrow Network |
$205.88
|
| Rate for Payer: UHC Medicare Advantage |
$130.65
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED
|
Professional
|
Both
|
$1,049.00
|
|
|
Service Code
|
HCPCS 55725
|
| Min. Negotiated Rate |
$381.06 |
| Max. Negotiated Rate |
$1,726.48 |
| Rate for Payer: Aetna Commercial |
$778.92
|
| Rate for Payer: Aetna Medicare |
$581.28
|
| Rate for Payer: BCBS Complete |
$400.11
|
| Rate for Payer: BCBS MAPPO |
$581.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.48
|
| Rate for Payer: BCN Commercial |
$861.54
|
| Rate for Payer: BCN Medicare Advantage |
$581.28
|
| Rate for Payer: Cash Price |
$839.20
|
| Rate for Payer: Cash Price |
$839.20
|
| Rate for Payer: Cofinity Commercial |
$837.04
|
| Rate for Payer: Cofinity Commercial |
$778.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.28
|
| Rate for Payer: Healthscope Commercial |
$697.54
|
| Rate for Payer: Healthscope Whirlpool |
$697.54
|
| Rate for Payer: Meridian Medicaid |
$400.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$610.34
|
| Rate for Payer: PACE SWMI |
$581.28
|
| Rate for Payer: PHP Medicare Advantage |
$581.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.65
|
| Rate for Payer: Priority Health Medicare |
$581.28
|
| Rate for Payer: Priority Health Narrow Network |
$952.65
|
| Rate for Payer: UHC Medicare Advantage |
$598.72
|
|
|
PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX
|
Professional
|
Both
|
$4,130.00
|
|
|
Service Code
|
HCPCS 55842
|
| Min. Negotiated Rate |
$741.45 |
| Max. Negotiated Rate |
$2,891.00 |
| Rate for Payer: Aetna Commercial |
$1,529.03
|
| Rate for Payer: Aetna Medicare |
$1,141.07
|
| Rate for Payer: BCBS Complete |
$778.52
|
| Rate for Payer: BCBS MAPPO |
$1,141.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,404.82
|
| Rate for Payer: BCN Commercial |
$1,681.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.07
|
| Rate for Payer: Cash Price |
$3,304.00
|
| Rate for Payer: Cash Price |
$3,304.00
|
| Rate for Payer: Cofinity Commercial |
$1,529.03
|
| Rate for Payer: Cofinity Commercial |
$1,643.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.07
|
| Rate for Payer: Healthscope Commercial |
$1,369.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,369.28
|
| Rate for Payer: Meridian Medicaid |
$778.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,198.12
|
| Rate for Payer: PACE SWMI |
$1,141.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,891.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,859.37
|
| Rate for Payer: Priority Health Medicare |
$1,141.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,859.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,175.30
|
|
|
PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM
|
Professional
|
Both
|
$2,782.22
|
|
|
Service Code
|
HCPCS 55845
|
| Min. Negotiated Rate |
$862.01 |
| Max. Negotiated Rate |
$2,161.43 |
| Rate for Payer: Aetna Commercial |
$1,779.09
|
| Rate for Payer: Aetna Medicare |
$1,327.68
|
| Rate for Payer: BCBS Complete |
$905.11
|
| Rate for Payer: BCBS MAPPO |
$1,327.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.15
|
| Rate for Payer: BCN Commercial |
$1,954.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,327.68
|
| Rate for Payer: Cash Price |
$2,225.78
|
| Rate for Payer: Cash Price |
$2,225.78
|
| Rate for Payer: Cofinity Commercial |
$1,911.86
|
| Rate for Payer: Cofinity Commercial |
$1,779.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,327.68
|
| Rate for Payer: Healthscope Commercial |
$1,593.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,593.22
|
| Rate for Payer: Meridian Medicaid |
$905.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,394.06
|
| Rate for Payer: PACE SWMI |
$1,327.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,327.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$862.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,161.43
|
| Rate for Payer: Priority Health Medicare |
$1,327.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,161.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,367.51
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 23335
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$1,935.36 |
| Rate for Payer: Aetna Commercial |
$1,672.11
|
| Rate for Payer: Aetna Medicare |
$1,247.84
|
| Rate for Payer: BCBS Complete |
$853.67
|
| Rate for Payer: BCBS MAPPO |
$1,247.84
|
| Rate for Payer: BCBS Trust/PPO |
$47.12
|
| Rate for Payer: BCN Commercial |
$1,852.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,247.84
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,672.11
|
| Rate for Payer: Cofinity Commercial |
$1,796.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,247.84
|
| Rate for Payer: Healthscope Commercial |
$1,497.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,497.41
|
| Rate for Payer: Meridian Medicaid |
$853.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,310.23
|
| Rate for Payer: PACE SWMI |
$1,247.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,247.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$813.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,349.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.36
|
| Rate for Payer: Priority Health Medicare |
$1,247.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,935.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,285.28
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$2,012.00
|
|
|
Service Code
|
HCPCS 24160
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$1,920.05 |
| Rate for Payer: Aetna Commercial |
$1,657.53
|
| Rate for Payer: Aetna Medicare |
$1,236.96
|
| Rate for Payer: BCBS Complete |
$847.18
|
| Rate for Payer: BCBS MAPPO |
$1,236.96
|
| Rate for Payer: BCBS Trust/PPO |
$87.70
|
| Rate for Payer: BCN Commercial |
$1,837.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,236.96
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,781.22
|
| Rate for Payer: Cofinity Commercial |
$1,657.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,236.96
|
| Rate for Payer: Healthscope Commercial |
$1,484.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.35
|
| Rate for Payer: Meridian Medicaid |
$847.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,298.81
|
| Rate for Payer: PACE SWMI |
$1,236.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,236.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$806.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,408.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.05
|
| Rate for Payer: Priority Health Medicare |
$1,236.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.07
|
|
|
PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
|
Professional
|
Both
|
$2,483.00
|
|
|
Service Code
|
HCPCS 23334
|
| Min. Negotiated Rate |
$89.15 |
| Max. Negotiated Rate |
$1,738.10 |
| Rate for Payer: Aetna Commercial |
$1,395.05
|
| Rate for Payer: Aetna Medicare |
$1,041.08
|
| Rate for Payer: BCBS Complete |
$715.01
|
| Rate for Payer: BCBS MAPPO |
$1,041.08
|
| Rate for Payer: BCBS Trust/PPO |
$89.15
|
| Rate for Payer: BCN Commercial |
$1,548.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.08
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cash Price |
$1,986.40
|
| Rate for Payer: Cofinity Commercial |
$1,395.05
|
| Rate for Payer: Cofinity Commercial |
$1,499.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.08
|
| Rate for Payer: Healthscope Commercial |
$1,249.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.30
|
| Rate for Payer: Meridian Medicaid |
$715.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,093.13
|
| Rate for Payer: PACE SWMI |
$1,041.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,738.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,617.74
|
| Rate for Payer: Priority Health Medicare |
$1,041.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,617.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,072.31
|
|
|
PR PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 24164
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,569.40 |
| Rate for Payer: Aetna Commercial |
$959.35
|
| Rate for Payer: Aetna Medicare |
$715.93
|
| Rate for Payer: BCBS Complete |
$493.15
|
| Rate for Payer: BCBS MAPPO |
$715.93
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$1,067.76
|
| Rate for Payer: BCN Medicare Advantage |
$715.93
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cofinity Commercial |
$959.35
|
| Rate for Payer: Cofinity Commercial |
$1,030.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.93
|
| Rate for Payer: Healthscope Commercial |
$859.12
|
| Rate for Payer: Healthscope Whirlpool |
$859.12
|
| Rate for Payer: Meridian Medicaid |
$493.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$751.73
|
| Rate for Payer: PACE SWMI |
$715.93
|
| Rate for Payer: PHP Medicare Advantage |
$715.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$469.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,569.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$715.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.78
|
| Rate for Payer: UHC Medicare Advantage |
$737.41
|
|
|
PR PROSTHESIS SERVICE APHAKIA TEMPORARY
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92358
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$897.05 |
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$13.25
|
|
|
PR PROTECTOR HEEL OR ELBOW
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS E0191
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$10.47
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$959.70 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Aetna Medicare |
$151.13
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$151.13
|
| Rate for Payer: BCBS Trust/PPO |
$552.60
|
| Rate for Payer: BCN Commercial |
$391.43
|
| Rate for Payer: BCN Medicare Advantage |
$151.13
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cofinity Commercial |
$217.63
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.13
|
| Rate for Payer: Healthscope Commercial |
$181.36
|
| Rate for Payer: Healthscope Whirlpool |
$181.36
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.69
|
| Rate for Payer: PACE SWMI |
$151.13
|
| Rate for Payer: PHP Medicare Advantage |
$151.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.64
|
| Rate for Payer: Priority Health Medicare |
$151.13
|
| Rate for Payer: Priority Health Narrow Network |
$257.64
|
| Rate for Payer: UHC Medicare Advantage |
$155.66
|
|
|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$2,627.00
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$384.07 |
| Max. Negotiated Rate |
$1,889.23 |
| Rate for Payer: Aetna Commercial |
$1,727.98
|
| Rate for Payer: Aetna Medicare |
$1,289.54
|
| Rate for Payer: BCBS Complete |
$871.78
|
| Rate for Payer: BCBS MAPPO |
$1,289.54
|
| Rate for Payer: BCBS Trust/PPO |
$384.07
|
| Rate for Payer: BCN Commercial |
$1,889.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.54
|
| Rate for Payer: Cash Price |
$2,101.60
|
| Rate for Payer: Cash Price |
$2,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,856.94
|
| Rate for Payer: Cofinity Commercial |
$1,727.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.54
|
| Rate for Payer: Healthscope Commercial |
$1,547.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,547.45
|
| Rate for Payer: Meridian Medicaid |
$871.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,354.02
|
| Rate for Payer: PACE SWMI |
$1,289.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$830.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,828.11
|
| Rate for Payer: Priority Health Medicare |
$1,289.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,828.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,328.23
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 64561
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Aetna Medicare |
$297.66
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$297.66
|
| Rate for Payer: BCBS Trust/PPO |
$449.58
|
| Rate for Payer: BCN Commercial |
$1,084.87
|
| Rate for Payer: BCN Medicare Advantage |
$297.66
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cofinity Commercial |
$428.63
|
| Rate for Payer: Cofinity Commercial |
$398.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.66
|
| Rate for Payer: Healthscope Commercial |
$357.19
|
| Rate for Payer: Healthscope Whirlpool |
$357.19
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.54
|
| Rate for Payer: PACE SWMI |
$297.66
|
| Rate for Payer: PHP Medicare Advantage |
$297.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.47
|
| Rate for Payer: Priority Health Medicare |
$297.66
|
| Rate for Payer: Priority Health Narrow Network |
$508.47
|
| Rate for Payer: UHC Medicare Advantage |
$306.59
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64553
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$3,712.00 |
| Rate for Payer: Aetna Commercial |
$513.94
|
| Rate for Payer: Aetna Medicare |
$383.54
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$383.54
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$3,712.00
|
| Rate for Payer: BCN Medicare Advantage |
$383.54
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$552.30
|
| Rate for Payer: Cofinity Commercial |
$513.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.54
|
| Rate for Payer: Healthscope Commercial |
$460.25
|
| Rate for Payer: Healthscope Whirlpool |
$460.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.72
|
| Rate for Payer: PACE SWMI |
$383.54
|
| Rate for Payer: PHP Medicare Advantage |
$383.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.34
|
| Rate for Payer: Priority Health Medicare |
$383.54
|
| Rate for Payer: Priority Health Narrow Network |
$661.34
|
| Rate for Payer: UHC Medicare Advantage |
$395.05
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$200.23 |
| Max. Negotiated Rate |
$3,168.10 |
| Rate for Payer: Aetna Commercial |
$427.27
|
| Rate for Payer: Aetna Medicare |
$318.86
|
| Rate for Payer: BCBS Complete |
$216.49
|
| Rate for Payer: BCBS MAPPO |
$318.86
|
| Rate for Payer: BCBS Trust/PPO |
$200.23
|
| Rate for Payer: BCN Commercial |
$3,168.10
|
| Rate for Payer: BCN Medicare Advantage |
$318.86
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cofinity Commercial |
$459.16
|
| Rate for Payer: Cofinity Commercial |
$427.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.86
|
| Rate for Payer: Healthscope Commercial |
$382.63
|
| Rate for Payer: Healthscope Whirlpool |
$382.63
|
| Rate for Payer: Meridian Medicaid |
$216.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$334.80
|
| Rate for Payer: PACE SWMI |
$318.86
|
| Rate for Payer: PHP Medicare Advantage |
$318.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.40
|
| Rate for Payer: Priority Health Medicare |
$318.86
|
| Rate for Payer: Priority Health Narrow Network |
$546.40
|
| Rate for Payer: UHC Medicare Advantage |
$328.43
|
|
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$5,241.00
|
|
|
Service Code
|
HCPCS 63650
|
| Min. Negotiated Rate |
$227.17 |
| Max. Negotiated Rate |
$3,668.70 |
| Rate for Payer: Aetna Commercial |
$542.39
|
| Rate for Payer: Aetna Medicare |
$404.77
|
| Rate for Payer: BCBS Complete |
$277.78
|
| Rate for Payer: BCBS MAPPO |
$404.77
|
| Rate for Payer: BCBS Trust/PPO |
$227.17
|
| Rate for Payer: BCN Commercial |
$3,375.79
|
| Rate for Payer: BCN Medicare Advantage |
$404.77
|
| Rate for Payer: Cash Price |
$4,192.80
|
| Rate for Payer: Cash Price |
$4,192.80
|
| Rate for Payer: Cofinity Commercial |
$542.39
|
| Rate for Payer: Cofinity Commercial |
$582.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.77
|
| Rate for Payer: Healthscope Commercial |
$485.72
|
| Rate for Payer: Healthscope Whirlpool |
$485.72
|
| Rate for Payer: Meridian Medicaid |
$277.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$425.01
|
| Rate for Payer: PACE SWMI |
$404.77
|
| Rate for Payer: PHP Medicare Advantage |
$404.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,668.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$694.76
|
| Rate for Payer: Priority Health Medicare |
$404.77
|
| Rate for Payer: Priority Health Narrow Network |
$694.76
|
| Rate for Payer: UHC Medicare Advantage |
$416.91
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Professional
|
Both
|
$2,422.00
|
|
|
Service Code
|
HCPCS 47533
|
| Min. Negotiated Rate |
$162.73 |
| Max. Negotiated Rate |
$2,075.16 |
| Rate for Payer: Aetna Commercial |
$344.39
|
| Rate for Payer: Aetna Medicare |
$257.01
|
| Rate for Payer: BCBS Complete |
$170.87
|
| Rate for Payer: BCBS MAPPO |
$257.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,075.16
|
| Rate for Payer: BCN Commercial |
$1,723.56
|
| Rate for Payer: BCN Medicare Advantage |
$257.01
|
| Rate for Payer: Cash Price |
$1,937.60
|
| Rate for Payer: Cash Price |
$1,937.60
|
| Rate for Payer: Cofinity Commercial |
$370.09
|
| Rate for Payer: Cofinity Commercial |
$344.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.01
|
| Rate for Payer: Healthscope Commercial |
$308.41
|
| Rate for Payer: Healthscope Whirlpool |
$308.41
|
| Rate for Payer: Meridian Medicaid |
$170.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$269.86
|
| Rate for Payer: PACE SWMI |
$257.01
|
| Rate for Payer: PHP Medicare Advantage |
$257.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,695.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.74
|
| Rate for Payer: Priority Health Medicare |
$257.01
|
| Rate for Payer: Priority Health Narrow Network |
$452.74
|
| Rate for Payer: UHC Medicare Advantage |
$264.72
|
|
|
PR PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 28436
|
| Min. Negotiated Rate |
$324.61 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$650.97
|
| Rate for Payer: Aetna Medicare |
$485.80
|
| Rate for Payer: BCBS Complete |
$340.84
|
| Rate for Payer: BCBS MAPPO |
$485.80
|
| Rate for Payer: BCBS Trust/PPO |
$387.77
|
| Rate for Payer: BCN Commercial |
$736.93
|
| Rate for Payer: BCN Medicare Advantage |
$485.80
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$699.55
|
| Rate for Payer: Cofinity Commercial |
$650.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.80
|
| Rate for Payer: Healthscope Commercial |
$582.96
|
| Rate for Payer: Healthscope Whirlpool |
$582.96
|
| Rate for Payer: Meridian Medicaid |
$340.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$510.09
|
| Rate for Payer: PACE SWMI |
$485.80
|
| Rate for Payer: PHP Medicare Advantage |
$485.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.06
|
| Rate for Payer: Priority Health Medicare |
$485.80
|
| Rate for Payer: Priority Health Narrow Network |
$770.06
|
| Rate for Payer: UHC Medicare Advantage |
$500.37
|
|
|
PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 27756
|
| Min. Negotiated Rate |
$375.95 |
| Max. Negotiated Rate |
$2,701.20 |
| Rate for Payer: Aetna Commercial |
$763.25
|
| Rate for Payer: Aetna Medicare |
$569.59
|
| Rate for Payer: BCBS Complete |
$394.75
|
| Rate for Payer: BCBS MAPPO |
$569.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,701.20
|
| Rate for Payer: BCN Commercial |
$853.23
|
| Rate for Payer: BCN Medicare Advantage |
$569.59
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cofinity Commercial |
$820.21
|
| Rate for Payer: Cofinity Commercial |
$763.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.59
|
| Rate for Payer: Healthscope Commercial |
$683.51
|
| Rate for Payer: Healthscope Whirlpool |
$683.51
|
| Rate for Payer: Meridian Medicaid |
$394.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$598.07
|
| Rate for Payer: PACE SWMI |
$569.59
|
| Rate for Payer: PHP Medicare Advantage |
$569.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$891.59
|
| Rate for Payer: Priority Health Medicare |
$569.59
|
| Rate for Payer: Priority Health Narrow Network |
$891.59
|
| Rate for Payer: UHC Medicare Advantage |
$586.68
|
|
|
PR PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 25651
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$1,380.45 |
| Rate for Payer: Aetna Commercial |
$647.80
|
| Rate for Payer: Aetna Medicare |
$483.43
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$483.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.45
|
| Rate for Payer: BCN Commercial |
$727.64
|
| Rate for Payer: BCN Medicare Advantage |
$483.43
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$696.14
|
| Rate for Payer: Cofinity Commercial |
$647.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.43
|
| Rate for Payer: Healthscope Commercial |
$580.12
|
| Rate for Payer: Healthscope Whirlpool |
$580.12
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$507.60
|
| Rate for Payer: PACE SWMI |
$483.43
|
| Rate for Payer: PHP Medicare Advantage |
$483.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.36
|
| Rate for Payer: Priority Health Medicare |
$483.43
|
| Rate for Payer: Priority Health Narrow Network |
$760.36
|
| Rate for Payer: UHC Medicare Advantage |
$497.93
|
|
|
PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 26650
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$1,057.00 |
| Rate for Payer: Aetna Commercial |
$636.23
|
| Rate for Payer: Aetna Medicare |
$474.80
|
| Rate for Payer: BCBS Complete |
$331.67
|
| Rate for Payer: BCBS MAPPO |
$474.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.87
|
| Rate for Payer: BCN Commercial |
$717.37
|
| Rate for Payer: BCN Medicare Advantage |
$474.80
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cofinity Commercial |
$683.71
|
| Rate for Payer: Cofinity Commercial |
$636.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.80
|
| Rate for Payer: Healthscope Commercial |
$569.76
|
| Rate for Payer: Healthscope Whirlpool |
$569.76
|
| Rate for Payer: Meridian Medicaid |
$331.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$498.54
|
| Rate for Payer: PACE SWMI |
$474.80
|
| Rate for Payer: PHP Medicare Advantage |
$474.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$315.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$749.63
|
| Rate for Payer: Priority Health Medicare |
$474.80
|
| Rate for Payer: Priority Health Narrow Network |
$749.63
|
| Rate for Payer: UHC Medicare Advantage |
$489.04
|
|
|
PR PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 28406
|
| Min. Negotiated Rate |
$384.89 |
| Max. Negotiated Rate |
$1,368.30 |
| Rate for Payer: Aetna Commercial |
$741.15
|
| Rate for Payer: Aetna Medicare |
$553.10
|
| Rate for Payer: BCBS Complete |
$404.13
|
| Rate for Payer: BCBS MAPPO |
$553.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,368.30
|
| Rate for Payer: BCN Commercial |
$833.68
|
| Rate for Payer: BCN Medicare Advantage |
$553.10
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cofinity Commercial |
$741.15
|
| Rate for Payer: Cofinity Commercial |
$796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$553.10
|
| Rate for Payer: Healthscope Commercial |
$663.72
|
| Rate for Payer: Healthscope Whirlpool |
$663.72
|
| Rate for Payer: Meridian Medicaid |
$404.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$580.76
|
| Rate for Payer: PACE SWMI |
$553.10
|
| Rate for Payer: PHP Medicare Advantage |
$553.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$384.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.18
|
| Rate for Payer: Priority Health Medicare |
$553.10
|
| Rate for Payer: Priority Health Narrow Network |
$871.18
|
| Rate for Payer: UHC Medicare Advantage |
$569.69
|
|
