|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$1,923.54 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,923.54
|
| Rate for Payer: BCN Commercial |
$190.10
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Meridian Medicaid |
$46.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.69
|
| Rate for Payer: Priority Health Narrow Network |
$124.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.25
|
| Rate for Payer: UHC Exchange |
$59.25
|
| Rate for Payer: UHCCP Medicaid |
$44.73
|
|
|
PR FERN TEST
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.39
|
| Rate for Payer: UHC Exchange |
$5.39
|
|
|
PR FETAL CONTRACTION STRESS TEST
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 59020
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Aetna Commercial |
$74.73
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$103.11
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.24
|
| Rate for Payer: Priority Health Narrow Network |
$51.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.15
|
| Rate for Payer: UHC Exchange |
$75.15
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
|
|
PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 59074
|
| Min. Negotiated Rate |
$197.45 |
| Max. Negotiated Rate |
$561.98 |
| Rate for Payer: Aetna Commercial |
$338.16
|
| Rate for Payer: Aetna Medicare |
$421.00
|
| Rate for Payer: BCBS Complete |
$207.32
|
| Rate for Payer: BCBS Trust/PPO |
$488.15
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Meridian Medicaid |
$207.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$431.29
|
| Rate for Payer: Priority Health Narrow Network |
$431.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.69
|
| Rate for Payer: UHC Exchange |
$361.69
|
| Rate for Payer: UHCCP Medicaid |
$197.45
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$522.49 |
| Rate for Payer: Aetna Commercial |
$52.53
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$71.35
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Meridian Medicaid |
$19.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.52
|
| Rate for Payer: Priority Health Narrow Network |
$40.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.54
|
| Rate for Payer: UHC Exchange |
$51.54
|
| Rate for Payer: UHCCP Medicaid |
$18.53
|
|
|
PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 59076
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$759.41 |
| Rate for Payer: Aetna Commercial |
$572.27
|
| Rate for Payer: Aetna Medicare |
$533.00
|
| Rate for Payer: BCBS Complete |
$349.35
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: BCN Commercial |
$759.41
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Meridian Medicaid |
$349.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$727.06
|
| Rate for Payer: Priority Health Narrow Network |
$727.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.45
|
| Rate for Payer: UHC Exchange |
$601.45
|
| Rate for Payer: UHCCP Medicaid |
$332.71
|
|
|
PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 14350
|
| Min. Negotiated Rate |
$428.56 |
| Max. Negotiated Rate |
$5,240.72 |
| Rate for Payer: Aetna Commercial |
$734.78
|
| Rate for Payer: Aetna Medicare |
$646.50
|
| Rate for Payer: BCBS Complete |
$449.99
|
| Rate for Payer: BCBS Trust/PPO |
$5,240.72
|
| Rate for Payer: BCN Commercial |
$982.24
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Meridian Medicaid |
$449.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.12
|
| Rate for Payer: Priority Health Narrow Network |
$916.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.76
|
| Rate for Payer: UHC Exchange |
$780.76
|
| Rate for Payer: UHCCP Medicaid |
$428.56
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$513.21 |
| Rate for Payer: Aetna Commercial |
$121.91
|
| Rate for Payer: Aetna Commercial |
$121.91
|
| Rate for Payer: Aetna Medicare |
$368.00
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS Trust/PPO |
$405.74
|
| Rate for Payer: BCBS Trust/PPO |
$405.74
|
| Rate for Payer: BCN Commercial |
$513.21
|
| Rate for Payer: BCN Commercial |
$513.21
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.49
|
| Rate for Payer: Priority Health Narrow Network |
$144.49
|
| Rate for Payer: Priority Health Narrow Network |
$144.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.15
|
| Rate for Payer: UHC Exchange |
$132.15
|
| Rate for Payer: UHC Exchange |
$132.15
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$3,585.00 |
| Rate for Payer: Aetna Commercial |
$60.18
|
| Rate for Payer: Aetna Medicare |
$119.00
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,585.00
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.60
|
| Rate for Payer: Priority Health Narrow Network |
$73.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
| Rate for Payer: UHC Exchange |
$76.48
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$79.16
|
| Rate for Payer: Aetna Medicare |
$126.00
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$159.81
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.53
|
| Rate for Payer: Priority Health Narrow Network |
$97.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.93
|
| Rate for Payer: UHC Exchange |
$84.93
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$349.63 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$70.29
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.83
|
| Rate for Payer: Priority Health Narrow Network |
$66.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
| Rate for Payer: UHC Exchange |
$57.83
|
| Rate for Payer: UHCCP Medicaid |
$31.52
|
|
|
PR FINE NEEDLE ASP;W/IMAGING GUIDANCE
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 10022
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.85
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
|
|
PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$220.67 |
| Max. Negotiated Rate |
$1,577.50 |
| Rate for Payer: Aetna Commercial |
$443.17
|
| Rate for Payer: Aetna Medicare |
$481.00
|
| Rate for Payer: BCBS Complete |
$231.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.50
|
| Rate for Payer: BCN Commercial |
$699.79
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Meridian Medicaid |
$231.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.11
|
| Rate for Payer: Priority Health Narrow Network |
$612.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.93
|
| Rate for Payer: UHC Exchange |
$356.93
|
| Rate for Payer: UHCCP Medicaid |
$220.67
|
|
|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$664.07 |
| Rate for Payer: Aetna Commercial |
$35.00
|
| Rate for Payer: Aetna Medicare |
$33.50
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$52.78
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.44
|
| Rate for Payer: Priority Health Narrow Network |
$39.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.33
|
| Rate for Payer: UHC Exchange |
$39.33
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$2,269.05 |
| Rate for Payer: Aetna Commercial |
$55.97
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,269.05
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Meridian Medicaid |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.95
|
| Rate for Payer: Priority Health Narrow Network |
$67.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.98
|
| Rate for Payer: UHC Exchange |
$54.98
|
| Rate for Payer: UHCCP Medicaid |
$29.39
|
|
|
PR FITTING CONTACT LENS FOR MGMT OF KERATOCONUS 1ST
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 92072
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Aetna Commercial |
$104.39
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$183.25
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.19
|
| Rate for Payer: Priority Health Narrow Network |
$114.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.22
|
| Rate for Payer: UHC Exchange |
$113.22
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
|
|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$3,422.86 |
| Rate for Payer: Aetna Commercial |
$383.67
|
| Rate for Payer: Aetna Medicare |
$287.00
|
| Rate for Payer: BCBS Complete |
$201.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,422.86
|
| Rate for Payer: BCN Commercial |
$431.50
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Meridian Medicaid |
$201.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.62
|
| Rate for Payer: Priority Health Narrow Network |
$475.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.74
|
| Rate for Payer: UHC Exchange |
$362.74
|
| Rate for Payer: UHCCP Medicaid |
$191.49
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$543.58 |
| Max. Negotiated Rate |
$1,709.25 |
| Rate for Payer: Aetna Commercial |
$895.75
|
| Rate for Payer: Aetna Medicare |
$866.50
|
| Rate for Payer: BCBS Complete |
$570.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.25
|
| Rate for Payer: BCN Commercial |
$1,478.74
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Meridian Medicaid |
$570.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$543.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.93
|
| Rate for Payer: UHC Exchange |
$916.93
|
| Rate for Payer: UHCCP Medicaid |
$543.58
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,393.66 |
| Rate for Payer: Aetna Commercial |
$36.07
|
| Rate for Payer: Aetna Medicare |
$59.00
|
| Rate for Payer: BCBS Complete |
$21.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.66
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Meridian Medicaid |
$21.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.35
|
| Rate for Payer: Priority Health Narrow Network |
$42.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
| Rate for Payer: UHC Exchange |
$35.01
|
| Rate for Payer: UHCCP Medicaid |
$20.02
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$9.42
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.92
|
| Rate for Payer: UHC Exchange |
$8.92
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Exchange |
$22.34
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.71
|
| Rate for Payer: UHC Exchange |
$92.71
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$20.00
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Trust/PPO |
$53.36
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$190.90 |
| Rate for Payer: Aetna Commercial |
$121.09
|
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCN Commercial |
$190.90
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.23
|
| Rate for Payer: UHC Exchange |
$109.23
|
|
