|
PR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 49423
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$1,009.05 |
| Rate for Payer: Aetna Commercial |
$94.51
|
| Rate for Payer: Aetna Medicare |
$637.00
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.05
|
| Rate for Payer: BCN Commercial |
$875.23
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.89
|
| Rate for Payer: Priority Health Narrow Network |
$122.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.06
|
| Rate for Payer: UHC Exchange |
$97.06
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
PR EXC HYDROCELE SPRMATIC CORD UNI SPX
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 55500
|
| Min. Negotiated Rate |
$252.83 |
| Max. Negotiated Rate |
$2,419.09 |
| Rate for Payer: Aetna Commercial |
$504.41
|
| Rate for Payer: Aetna Medicare |
$362.50
|
| Rate for Payer: BCBS Complete |
$265.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,419.09
|
| Rate for Payer: BCN Commercial |
$570.77
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Meridian Medicaid |
$265.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$629.01
|
| Rate for Payer: Priority Health Narrow Network |
$629.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.82
|
| Rate for Payer: UHC Exchange |
$458.82
|
| Rate for Payer: UHCCP Medicaid |
$252.83
|
|
|
PR EXC ILEOANAL RSVR W/ILEOSTOMY
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 45136
|
| Min. Negotiated Rate |
$1,131.88 |
| Max. Negotiated Rate |
$3,163.14 |
| Rate for Payer: Aetna Commercial |
$2,383.65
|
| Rate for Payer: Aetna Medicare |
$1,627.00
|
| Rate for Payer: BCBS Complete |
$1,188.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.07
|
| Rate for Payer: BCN Commercial |
$2,582.17
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Meridian Medicaid |
$1,188.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,131.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,163.14
|
| Rate for Payer: Priority Health Narrow Network |
$3,163.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,182.18
|
| Rate for Payer: UHC Exchange |
$2,182.18
|
| Rate for Payer: UHCCP Medicaid |
$1,131.88
|
|
|
PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,392.00
|
|
|
Service Code
|
HCPCS 33120
|
| Min. Negotiated Rate |
$1,008.52 |
| Max. Negotiated Rate |
$3,268.59 |
| Rate for Payer: Aetna Commercial |
$2,813.37
|
| Rate for Payer: Aetna Medicare |
$2,196.00
|
| Rate for Payer: BCBS Complete |
$1,379.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.52
|
| Rate for Payer: BCN Commercial |
$2,991.68
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Meridian Medicaid |
$1,379.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,314.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,268.59
|
| Rate for Payer: Priority Health Narrow Network |
$3,268.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,025.08
|
| Rate for Payer: UHC Exchange |
$2,025.08
|
| Rate for Payer: UHCCP Medicaid |
$1,314.00
|
|
|
PR EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 19260
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$1,472.25 |
| Rate for Payer: Aetna Medicare |
$1,132.50
|
| Rate for Payer: BCBS Complete |
$906.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.25
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
HCPCS 15940
|
| Min. Negotiated Rate |
$459.65 |
| Max. Negotiated Rate |
$1,038.93 |
| Rate for Payer: Aetna Commercial |
$765.28
|
| Rate for Payer: Aetna Medicare |
$624.00
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$1,038.93
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$811.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$965.35
|
| Rate for Payer: Priority Health Narrow Network |
$965.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.47
|
| Rate for Payer: UHC Exchange |
$727.47
|
| Rate for Payer: UHCCP Medicaid |
$459.65
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 15944
|
| Min. Negotiated Rate |
$604.28 |
| Max. Negotiated Rate |
$2,275.40 |
| Rate for Payer: Aetna Commercial |
$992.75
|
| Rate for Payer: Aetna Medicare |
$808.50
|
| Rate for Payer: BCBS Complete |
$634.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,275.40
|
| Rate for Payer: BCN Commercial |
$1,369.28
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Meridian Medicaid |
$634.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$930.33
|
| Rate for Payer: UHC Exchange |
$930.33
|
| Rate for Payer: UHCCP Medicaid |
$604.28
|
|
|
PR EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$3,352.00
|
|
|
Service Code
|
HCPCS 15946
|
| Min. Negotiated Rate |
$1,030.92 |
| Max. Negotiated Rate |
$2,363.25 |
| Rate for Payer: Aetna Commercial |
$1,757.75
|
| Rate for Payer: Aetna Medicare |
$1,676.00
|
| Rate for Payer: BCBS Complete |
$1,082.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.35
|
| Rate for Payer: BCN Commercial |
$2,363.25
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Meridian Medicaid |
$1,082.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,030.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,178.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,182.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,730.03
|
| Rate for Payer: UHC Exchange |
$1,730.03
|
| Rate for Payer: UHCCP Medicaid |
$1,030.92
|
|
|
PR EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 15941
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,372.69 |
| Rate for Payer: Aetna Commercial |
$1,001.30
|
| Rate for Payer: Aetna Medicare |
$808.00
|
| Rate for Payer: BCBS Complete |
$643.22
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$1,372.69
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Meridian Medicaid |
$643.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,261.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,261.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$943.45
|
| Rate for Payer: UHC Exchange |
$943.45
|
| Rate for Payer: UHCCP Medicaid |
$612.59
|
|
|
PR EXCISION 1ST &/CERVICAL RIB
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 21615
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$825.88
|
| Rate for Payer: Aetna Medicare |
$601.00
|
| Rate for Payer: BCBS Complete |
$420.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$904.54
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Meridian Medicaid |
$420.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.53
|
| Rate for Payer: Priority Health Narrow Network |
$949.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.45
|
| Rate for Payer: UHC Exchange |
$793.45
|
| Rate for Payer: UHCCP Medicaid |
$400.23
|
|
|
PR EXCISION AMPULLA VATER
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 48148
|
| Min. Negotiated Rate |
$804.29 |
| Max. Negotiated Rate |
$2,241.40 |
| Rate for Payer: Aetna Commercial |
$1,692.66
|
| Rate for Payer: Aetna Medicare |
$923.50
|
| Rate for Payer: BCBS Complete |
$844.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.41
|
| Rate for Payer: BCN Commercial |
$1,828.14
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Meridian Medicaid |
$844.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$804.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,241.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,241.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,491.00
|
| Rate for Payer: UHC Exchange |
$1,491.00
|
| Rate for Payer: UHCCP Medicaid |
$804.29
|
|
|
PR EXCISION AURAL POLYP
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 69540
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$2,401.65 |
| Rate for Payer: Aetna Commercial |
$142.01
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,401.65
|
| Rate for Payer: BCN Commercial |
$313.73
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.12
|
| Rate for Payer: Priority Health Narrow Network |
$192.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.06
|
| Rate for Payer: UHC Exchange |
$138.06
|
| Rate for Payer: UHCCP Medicaid |
$83.28
|
|
|
PR EXCISION BARTHOLINS GLAND OR CYST
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$1,879.16 |
| Rate for Payer: Aetna Commercial |
$372.87
|
| Rate for Payer: Aetna Medicare |
$464.50
|
| Rate for Payer: BCBS Complete |
$211.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.16
|
| Rate for Payer: BCN Commercial |
$463.27
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Meridian Medicaid |
$211.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.24
|
| Rate for Payer: Priority Health Narrow Network |
$472.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.56
|
| Rate for Payer: UHC Exchange |
$338.56
|
| Rate for Payer: UHCCP Medicaid |
$201.71
|
|
|
PR EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 21040
|
| Min. Negotiated Rate |
$235.58 |
| Max. Negotiated Rate |
$681.71 |
| Rate for Payer: Aetna Commercial |
$492.36
|
| Rate for Payer: Aetna Medicare |
$488.00
|
| Rate for Payer: BCBS Complete |
$247.36
|
| Rate for Payer: BCBS Trust/PPO |
$332.62
|
| Rate for Payer: BCN Commercial |
$681.71
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Meridian Medicaid |
$247.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.64
|
| Rate for Payer: Priority Health Narrow Network |
$553.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.42
|
| Rate for Payer: UHC Exchange |
$459.42
|
| Rate for Payer: UHCCP Medicaid |
$235.58
|
|
|
PR EXCISION BONE CYST/BENIGN TUMOR DEEP
|
Professional
|
Both
|
$1,497.00
|
|
|
Service Code
|
HCPCS 27066
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$1,259.94 |
| Rate for Payer: Aetna Commercial |
$1,089.99
|
| Rate for Payer: Aetna Medicare |
$748.50
|
| Rate for Payer: BCBS Complete |
$560.91
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: BCN Commercial |
$1,207.52
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Meridian Medicaid |
$560.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,259.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,259.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$926.08
|
| Rate for Payer: UHC Exchange |
$926.08
|
| Rate for Payer: UHCCP Medicaid |
$534.20
|
|
|
PR EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 27065
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$4,717.19 |
| Rate for Payer: Aetna Commercial |
$699.39
|
| Rate for Payer: Aetna Medicare |
$452.50
|
| Rate for Payer: BCBS Complete |
$361.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,717.19
|
| Rate for Payer: BCN Commercial |
$780.42
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Meridian Medicaid |
$361.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.67
|
| Rate for Payer: Priority Health Narrow Network |
$813.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.10
|
| Rate for Payer: UHC Exchange |
$571.10
|
| Rate for Payer: UHCCP Medicaid |
$344.00
|
|
|
PR EXCISION BONE MANDIBLE
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 21025
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Aetna Commercial |
$883.19
|
| Rate for Payer: Aetna Medicare |
$798.00
|
| Rate for Payer: BCBS Complete |
$453.56
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$1,154.25
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Meridian Medicaid |
$453.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.30
|
| Rate for Payer: UHC Exchange |
$851.30
|
| Rate for Payer: UHCCP Medicaid |
$431.96
|
|
|
PR EXCISION CHALAZION MULTIPLE SAME LID
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 67801
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$552.60 |
| Rate for Payer: Aetna Commercial |
$171.99
|
| Rate for Payer: Aetna Medicare |
$145.50
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS Trust/PPO |
$552.60
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.11
|
| Rate for Payer: Priority Health Narrow Network |
$228.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.02
|
| Rate for Payer: UHC Exchange |
$146.02
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
|
|
PR EXCISION CHALAZION SINGLE
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 67800
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$133.72
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$150.39
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.80
|
| Rate for Payer: Priority Health Narrow Network |
$177.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.30
|
| Rate for Payer: UHC Exchange |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR EXCISION CHEST WALL TUMOR INCLUDING RIBS
|
Professional
|
Both
|
$2,439.00
|
|
|
Service Code
|
HCPCS 21601
|
| Min. Negotiated Rate |
$267.70 |
| Max. Negotiated Rate |
$1,753.54 |
| Rate for Payer: Aetna Commercial |
$1,569.63
|
| Rate for Payer: Aetna Medicare |
$1,219.50
|
| Rate for Payer: BCBS Complete |
$770.92
|
| Rate for Payer: BCBS Trust/PPO |
$267.70
|
| Rate for Payer: BCN Commercial |
$1,664.93
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Meridian Medicaid |
$770.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$734.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,753.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,506.60
|
| Rate for Payer: UHC Exchange |
$1,506.60
|
| Rate for Payer: UHCCP Medicaid |
$734.21
|
|
|
PR EXCISION CHOLEDOCHAL CYST
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
HCPCS 47715
|
| Min. Negotiated Rate |
$380.38 |
| Max. Negotiated Rate |
$2,383.99 |
| Rate for Payer: Aetna Commercial |
$1,802.67
|
| Rate for Payer: Aetna Medicare |
$1,153.50
|
| Rate for Payer: BCBS Complete |
$897.96
|
| Rate for Payer: BCBS Trust/PPO |
$380.38
|
| Rate for Payer: BCN Commercial |
$1,944.45
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Meridian Medicaid |
$897.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,499.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,383.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,383.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.88
|
| Rate for Payer: UHC Exchange |
$1,585.88
|
| Rate for Payer: UHCCP Medicaid |
$855.20
|
|
|
PR EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMPHADEC
|
Professional
|
Both
|
$3,746.00
|
|
|
Service Code
|
HCPCS 21603
|
| Min. Negotiated Rate |
$1,073.09 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$2,301.46
|
| Rate for Payer: Aetna Medicare |
$1,873.00
|
| Rate for Payer: BCBS Complete |
$1,126.74
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: BCN Commercial |
$2,446.32
|
| Rate for Payer: Cash Price |
$2,996.80
|
| Rate for Payer: Cash Price |
$2,996.80
|
| Rate for Payer: Meridian Medicaid |
$1,126.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,073.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,559.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,559.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,232.54
|
| Rate for Payer: UHC Exchange |
$2,232.54
|
| Rate for Payer: UHCCP Medicaid |
$1,073.09
|
|
|
PR EXCISION CH WAL TUM W/RIB W/O MEDSTNL LYMPHADEC
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 21602
|
| Min. Negotiated Rate |
$989.60 |
| Max. Negotiated Rate |
$32,076.33 |
| Rate for Payer: Aetna Commercial |
$2,106.91
|
| Rate for Payer: Aetna Medicare |
$1,562.50
|
| Rate for Payer: BCBS Complete |
$1,039.08
|
| Rate for Payer: BCBS Trust/PPO |
$32,076.33
|
| Rate for Payer: BCN Commercial |
$2,244.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Meridian Medicaid |
$1,039.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$989.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,031.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,335.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,335.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,015.10
|
| Rate for Payer: UHC Exchange |
$2,015.10
|
| Rate for Payer: UHCCP Medicaid |
$989.60
|
|
|
PR EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$2,082.00
|
|
|
Service Code
|
HCPCS 27635
|
| Min. Negotiated Rate |
$376.37 |
| Max. Negotiated Rate |
$1,353.30 |
| Rate for Payer: Aetna Commercial |
$776.29
|
| Rate for Payer: Aetna Medicare |
$1,041.00
|
| Rate for Payer: BCBS Complete |
$395.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.54
|
| Rate for Payer: BCN Commercial |
$852.26
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Meridian Medicaid |
$395.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$376.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$896.10
|
| Rate for Payer: Priority Health Narrow Network |
$896.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$677.46
|
| Rate for Payer: UHC Exchange |
$677.46
|
| Rate for Payer: UHCCP Medicaid |
$376.37
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES
|
Professional
|
Both
|
$1,621.00
|
|
|
Service Code
|
HCPCS 25130
|
| Min. Negotiated Rate |
$299.27 |
| Max. Negotiated Rate |
$1,161.73 |
| Rate for Payer: Aetna Commercial |
$598.30
|
| Rate for Payer: Aetna Medicare |
$810.50
|
| Rate for Payer: BCBS Complete |
$314.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,161.73
|
| Rate for Payer: BCN Commercial |
$669.98
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Meridian Medicaid |
$314.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$705.79
|
| Rate for Payer: Priority Health Narrow Network |
$705.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.38
|
| Rate for Payer: UHC Exchange |
$506.38
|
| Rate for Payer: UHCCP Medicaid |
$299.27
|
|
