|
PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 93244
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$533.05 |
| Rate for Payer: Aetna Commercial |
$32.63
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: BCN Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.02
|
| Rate for Payer: Priority Health Narrow Network |
$32.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.91
|
| Rate for Payer: UHC Exchange |
$32.91
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
|
|
PR EXTERNAL ECG REC>7D<15D RECORDING
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 93246
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$607.55 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$607.55
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
| Rate for Payer: UHC Exchange |
$20.01
|
|
|
PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 93248
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$892.83 |
| Rate for Payer: Aetna Commercial |
$35.84
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$892.83
|
| Rate for Payer: BCN Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.32
|
| Rate for Payer: Priority Health Narrow Network |
$35.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.10
|
| Rate for Payer: UHC Exchange |
$36.10
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 32540
|
| Min. Negotiated Rate |
$1,090.77 |
| Max. Negotiated Rate |
$2,481.51 |
| Rate for Payer: Aetna Commercial |
$2,228.79
|
| Rate for Payer: Aetna Medicare |
$1,608.00
|
| Rate for Payer: BCBS Complete |
$1,145.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.07
|
| Rate for Payer: BCN Commercial |
$2,481.51
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Meridian Medicaid |
$1,145.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,090.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,090.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,367.39
|
| Rate for Payer: Priority Health Narrow Network |
$2,367.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,031.68
|
| Rate for Payer: UHC Exchange |
$2,031.68
|
| Rate for Payer: UHCCP Medicaid |
$1,090.77
|
|
|
PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 26111
|
| Min. Negotiated Rate |
$210.98 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$552.97
|
| Rate for Payer: Aetna Medicare |
$602.00
|
| Rate for Payer: BCBS Complete |
$287.40
|
| Rate for Payer: BCBS Trust/PPO |
$210.98
|
| Rate for Payer: BCN Commercial |
$613.77
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Meridian Medicaid |
$287.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$646.76
|
| Rate for Payer: Priority Health Narrow Network |
$646.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$488.06
|
| Rate for Payer: UHC Exchange |
$488.06
|
| Rate for Payer: UHCCP Medicaid |
$273.71
|
|
|
PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 26113
|
| Min. Negotiated Rate |
$254.28 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$726.61
|
| Rate for Payer: Aetna Medicare |
$919.50
|
| Rate for Payer: BCBS Complete |
$378.19
|
| Rate for Payer: BCBS Trust/PPO |
$254.28
|
| Rate for Payer: BCN Commercial |
$807.78
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Meridian Medicaid |
$378.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.30
|
| Rate for Payer: Priority Health Narrow Network |
$850.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$640.93
|
| Rate for Payer: UHC Exchange |
$640.93
|
| Rate for Payer: UHCCP Medicaid |
$360.18
|
|
|
PR FAA PHYSICAL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00180
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
PR FACIAL NERVE FUNCTION STUDIES
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92516
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$2,145.40 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,145.40
|
| Rate for Payer: BCN Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.30
|
| Rate for Payer: Priority Health Narrow Network |
$30.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.19
|
| Rate for Payer: UHC Exchange |
$24.19
|
|
|
PR FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 97156
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$1,096.22 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.22
|
| Rate for Payer: BCN Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.04
|
| Rate for Payer: Priority Health Narrow Network |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.40
|
| Rate for Payer: UHC Exchange |
$39.40
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$346.04 |
| Rate for Payer: Aetna Commercial |
$114.40
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS Trust/PPO |
$346.04
|
| Rate for Payer: BCN Commercial |
$137.81
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.43
|
| Rate for Payer: Priority Health Narrow Network |
$107.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.08
|
| Rate for Payer: UHC Exchange |
$90.08
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$114.40
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS Trust/PPO |
$109.89
|
| Rate for Payer: BCN Commercial |
$115.44
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.88
|
| Rate for Payer: Priority Health Narrow Network |
$127.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.82
|
| Rate for Payer: UHC Exchange |
$107.82
|
| Rate for Payer: UHCCP Medicaid |
$67.52
|
|
|
PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 20922
|
| Min. Negotiated Rate |
$324.19 |
| Max. Negotiated Rate |
$55,000.50 |
| Rate for Payer: Aetna Commercial |
$646.18
|
| Rate for Payer: Aetna Medicare |
$538.50
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$55,000.50
|
| Rate for Payer: BCN Commercial |
$892.81
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Meridian Medicaid |
$340.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$768.88
|
| Rate for Payer: Priority Health Narrow Network |
$768.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.70
|
| Rate for Payer: UHC Exchange |
$577.70
|
| Rate for Payer: UHCCP Medicaid |
$324.19
|
|
|
PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28060
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$2,093.12 |
| Rate for Payer: Aetna Commercial |
$477.23
|
| Rate for Payer: Aetna Medicare |
$487.50
|
| Rate for Payer: BCBS Complete |
$245.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCN Commercial |
$752.07
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Meridian Medicaid |
$245.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.68
|
| Rate for Payer: Priority Health Narrow Network |
$555.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.03
|
| Rate for Payer: UHC Exchange |
$416.03
|
| Rate for Payer: UHCCP Medicaid |
$234.09
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 28008
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$3,296.59 |
| Rate for Payer: Aetna Commercial |
$390.96
|
| Rate for Payer: Aetna Medicare |
$359.50
|
| Rate for Payer: BCBS Complete |
$201.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,296.59
|
| Rate for Payer: BCN Commercial |
$623.06
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Meridian Medicaid |
$201.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.39
|
| Rate for Payer: Priority Health Narrow Network |
$453.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.30
|
| Rate for Payer: UHC Exchange |
$347.30
|
| Rate for Payer: UHCCP Medicaid |
$191.70
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$3,296.59 |
| Rate for Payer: Aetna Commercial |
$390.96
|
| Rate for Payer: Aetna Medicare |
$359.50
|
| Rate for Payer: BCBS Complete |
$201.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,296.59
|
| Rate for Payer: BCN Commercial |
$623.06
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Meridian Medicaid |
$201.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$453.39
|
| Rate for Payer: Priority Health Narrow Network |
$453.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.30
|
| Rate for Payer: UHC Exchange |
$347.30
|
| Rate for Payer: UHCCP Medicaid |
$191.70
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$467.35 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$697.43
|
| Rate for Payer: ASR Commercial |
$697.43
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$588.79
|
| Rate for Payer: BCN Commercial |
$557.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$675.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$719.00
|
| Rate for Payer: Healthscope Whirlpool |
$697.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$647.10
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Nomi Health Commercial |
$589.58
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$629.99
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$504.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$467.35 |
| Max. Negotiated Rate |
$719.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: ASR ASR |
$697.43
|
| Rate for Payer: ASR Commercial |
$697.43
|
| Rate for Payer: BCBS Trust/PPO |
$585.91
|
| Rate for Payer: BCN Commercial |
$557.44
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$675.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Healthscope Commercial |
$719.00
|
| Rate for Payer: Healthscope Whirlpool |
$697.43
|
| Rate for Payer: Mclaren Commercial |
$647.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Nomi Health Commercial |
$589.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.72
|
|
|
PR FASCIOTOMY HIP/THIGH ANY TYPE
|
Professional
|
Both
|
$3,485.00
|
|
|
Service Code
|
HCPCS 27025
|
| Min. Negotiated Rate |
$191.38 |
| Max. Negotiated Rate |
$2,265.25 |
| Rate for Payer: Aetna Commercial |
$1,229.24
|
| Rate for Payer: Aetna Medicare |
$1,742.50
|
| Rate for Payer: BCBS Complete |
$640.09
|
| Rate for Payer: BCBS Trust/PPO |
$191.38
|
| Rate for Payer: BCN Commercial |
$1,352.66
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Meridian Medicaid |
$640.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$609.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,265.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,430.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,430.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,038.48
|
| Rate for Payer: UHC Exchange |
$1,038.48
|
| Rate for Payer: UHCCP Medicaid |
$609.61
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$318.01 |
| Max. Negotiated Rate |
$1,940.97 |
| Rate for Payer: Aetna Commercial |
$642.16
|
| Rate for Payer: Aetna Medicare |
$661.50
|
| Rate for Payer: BCBS Complete |
$333.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.97
|
| Rate for Payer: BCN Commercial |
$715.91
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Meridian Medicaid |
$333.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$318.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.10
|
| Rate for Payer: Priority Health Narrow Network |
$752.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$533.24
|
| Rate for Payer: UHC Exchange |
$533.24
|
| Rate for Payer: UHCCP Medicaid |
$318.01
|
|
|
PR FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$153.67 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna Commercial |
$627.38
|
| Rate for Payer: Aetna Medicare |
$684.00
|
| Rate for Payer: BCBS Complete |
$328.09
|
| Rate for Payer: BCBS Trust/PPO |
$153.67
|
| Rate for Payer: BCN Commercial |
$701.25
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Meridian Medicaid |
$328.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.35
|
| Rate for Payer: Priority Health Narrow Network |
$738.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$521.30
|
| Rate for Payer: UHC Exchange |
$521.30
|
| Rate for Payer: UHCCP Medicaid |
$312.47
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$604.50 |
| Rate for Payer: Aetna Commercial |
$417.73
|
| Rate for Payer: Aetna Medicare |
$465.00
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS Trust/PPO |
$139.24
|
| Rate for Payer: BCN Commercial |
$471.08
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.65
|
| Rate for Payer: Priority Health Narrow Network |
$496.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.60
|
| Rate for Payer: UHC Exchange |
$339.60
|
| Rate for Payer: UHCCP Medicaid |
$210.23
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$250.03 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$797.78
|
| Rate for Payer: Aetna Medicare |
$1,180.50
|
| Rate for Payer: BCBS Complete |
$414.20
|
| Rate for Payer: BCBS Trust/PPO |
$250.03
|
| Rate for Payer: BCN Commercial |
$887.44
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Meridian Medicaid |
$414.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$932.74
|
| Rate for Payer: Priority Health Narrow Network |
$932.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$672.76
|
| Rate for Payer: UHC Exchange |
$672.76
|
| Rate for Payer: UHCCP Medicaid |
$394.48
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$2,952.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$1,918.80 |
| Rate for Payer: Aetna Commercial |
$1,109.61
|
| Rate for Payer: Aetna Medicare |
$1,476.00
|
| Rate for Payer: BCBS Complete |
$577.24
|
| Rate for Payer: BCBS Trust/PPO |
$337.48
|
| Rate for Payer: BCN Commercial |
$1,235.86
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Meridian Medicaid |
$577.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,918.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,299.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,299.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$932.93
|
| Rate for Payer: UHC Exchange |
$932.93
|
| Rate for Payer: UHCCP Medicaid |
$549.75
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$575.25 |
| Rate for Payer: Aetna Commercial |
$361.78
|
| Rate for Payer: Aetna Medicare |
$442.50
|
| Rate for Payer: BCBS Complete |
$180.26
|
| Rate for Payer: BCBS Trust/PPO |
$555.24
|
| Rate for Payer: BCN Commercial |
$389.96
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Meridian Medicaid |
$180.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.09
|
| Rate for Payer: Priority Health Narrow Network |
$407.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.22
|
| Rate for Payer: UHC Exchange |
$327.22
|
| Rate for Payer: UHCCP Medicaid |
$171.68
|
|
|
PR FECAL BLOOD SCRN IMMUNOASSAY
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS G0328
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$1,270.03 |
| Rate for Payer: Aetna Commercial |
$17.15
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.03
|
| Rate for Payer: BCN Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
| Rate for Payer: UHC Exchange |
$13.67
|
|
