|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 24073
|
| Min. Negotiated Rate |
$293.21 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Commercial |
$928.71
|
| Rate for Payer: Aetna Medicare |
$846.50
|
| Rate for Payer: BCBS Complete |
$473.69
|
| Rate for Payer: BCBS Trust/PPO |
$293.21
|
| Rate for Payer: BCN Commercial |
$1,017.43
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Meridian Medicaid |
$473.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,067.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,067.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$826.90
|
| Rate for Payer: UHC Exchange |
$826.90
|
| Rate for Payer: UHCCP Medicaid |
$451.13
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Min. Negotiated Rate |
$293.21 |
| Max. Negotiated Rate |
$846.74 |
| Rate for Payer: Aetna Commercial |
$725.09
|
| Rate for Payer: Aetna Medicare |
$577.50
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS Trust/PPO |
$293.21
|
| Rate for Payer: BCN Commercial |
$806.80
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$846.74
|
| Rate for Payer: Priority Health Narrow Network |
$846.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.04
|
| Rate for Payer: UHC Exchange |
$598.04
|
| Rate for Payer: UHCCP Medicaid |
$357.84
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
24076
|
| Min. Negotiated Rate |
$293.21 |
| Max. Negotiated Rate |
$846.74 |
| Rate for Payer: Aetna Commercial |
$725.09
|
| Rate for Payer: Aetna Medicare |
$577.50
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS Trust/PPO |
$293.21
|
| Rate for Payer: BCN Commercial |
$806.80
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$846.74
|
| Rate for Payer: Priority Health Narrow Network |
$846.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.04
|
| Rate for Payer: UHC Exchange |
$598.04
|
| Rate for Payer: UHCCP Medicaid |
$357.84
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$750.75 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: ASR ASR |
$1,120.35
|
| Rate for Payer: ASR Commercial |
$1,120.35
|
| Rate for Payer: BCBS Trust/PPO |
$941.21
|
| Rate for Payer: BCN Commercial |
$895.47
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Healthscope Commercial |
$1,155.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.35
|
| Rate for Payer: Mclaren Commercial |
$1,039.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: Nomi Health Commercial |
$947.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.40
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$750.75 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$1,120.35
|
| Rate for Payer: ASR Commercial |
$1,120.35
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$945.83
|
| Rate for Payer: BCN Commercial |
$895.47
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$1,155.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,120.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$1,039.50
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: Nomi Health Commercial |
$947.10
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.01
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$809.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$814.14 |
| Rate for Payer: Aetna Commercial |
$438.57
|
| Rate for Payer: Aetna Medicare |
$544.50
|
| Rate for Payer: BCBS Complete |
$231.03
|
| Rate for Payer: BCBS Trust/PPO |
$108.67
|
| Rate for Payer: BCN Commercial |
$814.14
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Meridian Medicaid |
$231.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$519.03
|
| Rate for Payer: Priority Health Narrow Network |
$519.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.56
|
| Rate for Payer: UHC Exchange |
$389.56
|
| Rate for Payer: UHCCP Medicaid |
$220.03
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$1,056.33
|
| Rate for Payer: ASR Commercial |
$1,056.33
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$891.78
|
| Rate for Payer: BCN Commercial |
$844.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,023.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$980.10
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$954.18
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$763.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
26115
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$814.14 |
| Rate for Payer: Aetna Commercial |
$438.57
|
| Rate for Payer: Aetna Medicare |
$544.50
|
| Rate for Payer: BCBS Complete |
$231.03
|
| Rate for Payer: BCBS Trust/PPO |
$108.67
|
| Rate for Payer: BCN Commercial |
$814.14
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Meridian Medicaid |
$231.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$519.03
|
| Rate for Payer: Priority Health Narrow Network |
$519.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.56
|
| Rate for Payer: UHC Exchange |
$389.56
|
| Rate for Payer: UHCCP Medicaid |
$220.03
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: ASR ASR |
$1,056.33
|
| Rate for Payer: ASR Commercial |
$1,056.33
|
| Rate for Payer: BCBS Trust/PPO |
$887.43
|
| Rate for Payer: BCN Commercial |
$844.30
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$1,023.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,056.33
|
| Rate for Payer: Mclaren Commercial |
$980.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.32
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$697.72
|
| Rate for Payer: Aetna Medicare |
$840.00
|
| Rate for Payer: BCBS Complete |
$363.44
|
| Rate for Payer: BCBS Trust/PPO |
$149.00
|
| Rate for Payer: BCN Commercial |
$776.51
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Meridian Medicaid |
$363.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.71
|
| Rate for Payer: Priority Health Narrow Network |
$816.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.98
|
| Rate for Payer: UHC Exchange |
$588.98
|
| Rate for Payer: UHCCP Medicaid |
$346.13
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$5,537.00
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$409.81 |
| Max. Negotiated Rate |
$3,599.05 |
| Rate for Payer: Aetna Commercial |
$817.18
|
| Rate for Payer: Aetna Medicare |
$2,768.50
|
| Rate for Payer: BCBS Complete |
$430.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,025.57
|
| Rate for Payer: BCN Commercial |
$920.67
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Meridian Medicaid |
$430.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,599.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,016.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,016.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.29
|
| Rate for Payer: UHC Exchange |
$744.29
|
| Rate for Payer: UHCCP Medicaid |
$409.81
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,149.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$974.66 |
| Rate for Payer: Aetna Commercial |
$782.17
|
| Rate for Payer: Aetna Medicare |
$574.50
|
| Rate for Payer: BCBS Complete |
$411.52
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: BCN Commercial |
$882.06
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Meridian Medicaid |
$411.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$974.66
|
| Rate for Payer: Priority Health Narrow Network |
$974.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.95
|
| Rate for Payer: UHC Exchange |
$726.95
|
| Rate for Payer: UHCCP Medicaid |
$391.92
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$277.54 |
| Max. Negotiated Rate |
$1,511.99 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Medicare |
$1,071.50
|
| Rate for Payer: BCBS Complete |
$291.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,511.99
|
| Rate for Payer: BCN Commercial |
$623.55
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Meridian Medicaid |
$291.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.71
|
| Rate for Payer: Priority Health Narrow Network |
$689.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$512.28
|
| Rate for Payer: UHC Exchange |
$512.28
|
| Rate for Payer: UHCCP Medicaid |
$277.54
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$227.48 |
| Max. Negotiated Rate |
$1,577.50 |
| Rate for Payer: Aetna Commercial |
$450.95
|
| Rate for Payer: Aetna Medicare |
$327.50
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.50
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Meridian Medicaid |
$238.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.09
|
| Rate for Payer: Priority Health Narrow Network |
$565.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$422.41
|
| Rate for Payer: UHC Exchange |
$422.41
|
| Rate for Payer: UHCCP Medicaid |
$227.48
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$1,332.37 |
| Rate for Payer: Aetna Commercial |
$718.72
|
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: BCBS Complete |
$378.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.37
|
| Rate for Payer: BCN Commercial |
$814.14
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Meridian Medicaid |
$378.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.24
|
| Rate for Payer: Priority Health Narrow Network |
$894.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.72
|
| Rate for Payer: UHC Exchange |
$592.72
|
| Rate for Payer: UHCCP Medicaid |
$360.40
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$346.55 |
| Max. Negotiated Rate |
$1,954.18 |
| Rate for Payer: Aetna Commercial |
$692.89
|
| Rate for Payer: Aetna Medicare |
$556.00
|
| Rate for Payer: BCBS Complete |
$363.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,954.18
|
| Rate for Payer: BCN Commercial |
$776.51
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Meridian Medicaid |
$363.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$859.09
|
| Rate for Payer: Priority Health Narrow Network |
$859.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.28
|
| Rate for Payer: UHC Exchange |
$644.28
|
| Rate for Payer: UHCCP Medicaid |
$346.55
|
|
|
PR EXERCISE EQUIPMENT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A9300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$767.00
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$236.43 |
| Max. Negotiated Rate |
$696.86 |
| Rate for Payer: Aetna Commercial |
$478.95
|
| Rate for Payer: Aetna Medicare |
$383.50
|
| Rate for Payer: BCBS Complete |
$248.25
|
| Rate for Payer: BCBS Trust/PPO |
$563.70
|
| Rate for Payer: BCN Commercial |
$696.86
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Meridian Medicaid |
$248.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$659.24
|
| Rate for Payer: Priority Health Narrow Network |
$659.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.93
|
| Rate for Payer: UHC Exchange |
$433.93
|
| Rate for Payer: UHCCP Medicaid |
$236.43
|
|
|
PR EXPL CONGENITAL ATRESIA BILE DUCTS
|
Professional
|
Both
|
$2,902.00
|
|
|
Service Code
|
HCPCS 47700
|
| Min. Negotiated Rate |
$678.34 |
| Max. Negotiated Rate |
$1,901.95 |
| Rate for Payer: Aetna Commercial |
$1,432.99
|
| Rate for Payer: Aetna Medicare |
$1,451.00
|
| Rate for Payer: BCBS Complete |
$715.90
|
| Rate for Payer: BCBS Trust/PPO |
$678.34
|
| Rate for Payer: BCN Commercial |
$1,550.58
|
| Rate for Payer: Cash Price |
$2,321.60
|
| Rate for Payer: Cash Price |
$2,321.60
|
| Rate for Payer: Meridian Medicaid |
$715.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,901.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,901.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,255.15
|
| Rate for Payer: UHC Exchange |
$1,255.15
|
| Rate for Payer: UHCCP Medicaid |
$681.81
|
|
|
PR EXPLORATION EPIDIDYMIS W/WO BIOPSY
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 54865
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$1,488.22 |
| Rate for Payer: Aetna Commercial |
$459.23
|
| Rate for Payer: Aetna Medicare |
$336.50
|
| Rate for Payer: BCBS Complete |
$244.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.22
|
| Rate for Payer: BCN Commercial |
$522.39
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Meridian Medicaid |
$244.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.40
|
| Rate for Payer: Priority Health Narrow Network |
$578.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.67
|
| Rate for Payer: UHC Exchange |
$426.67
|
| Rate for Payer: UHCCP Medicaid |
$233.24
|
|
|
PR EXPLORATION, FEMORAL ARTERY
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 35721
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$1,015.95 |
| Rate for Payer: Aetna Medicare |
$781.50
|
| Rate for Payer: BCBS Complete |
$625.20
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.95
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$263.27 |
| Max. Negotiated Rate |
$2,000.67 |
| Rate for Payer: Aetna Commercial |
$562.28
|
| Rate for Payer: Aetna Medicare |
$435.50
|
| Rate for Payer: BCBS Complete |
$276.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.67
|
| Rate for Payer: BCN Commercial |
$598.14
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Meridian Medicaid |
$276.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.95
|
| Rate for Payer: Priority Health Narrow Network |
$650.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.24
|
| Rate for Payer: UHC Exchange |
$558.24
|
| Rate for Payer: UHCCP Medicaid |
$263.27
|
|
|
PR EXPLORATION N/FLWD SURG NECK ARTERY
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 35701
|
| Min. Negotiated Rate |
$279.24 |
| Max. Negotiated Rate |
$2,119.54 |
| Rate for Payer: Aetna Commercial |
$586.02
|
| Rate for Payer: Aetna Medicare |
$454.00
|
| Rate for Payer: BCBS Complete |
$293.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.54
|
| Rate for Payer: BCN Commercial |
$638.21
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Meridian Medicaid |
$293.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.90
|
| Rate for Payer: Priority Health Narrow Network |
$691.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$708.95
|
| Rate for Payer: UHC Exchange |
$708.95
|
| Rate for Payer: UHCCP Medicaid |
$279.24
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$259.43 |
| Max. Negotiated Rate |
$1,869.13 |
| Rate for Payer: Aetna Commercial |
$551.92
|
| Rate for Payer: Aetna Medicare |
$452.50
|
| Rate for Payer: BCBS Complete |
$272.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.13
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Meridian Medicaid |
$272.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.51
|
| Rate for Payer: Priority Health Narrow Network |
$643.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$548.76
|
| Rate for Payer: UHC Exchange |
$548.76
|
| Rate for Payer: UHCCP Medicaid |
$259.43
|
|
|
PR EXPLORATION OF ARTERY/VEIN
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 35761
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$850.20 |
| Rate for Payer: Aetna Medicare |
$654.00
|
| Rate for Payer: BCBS Complete |
$523.20
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.20
|
|
