|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$392.99 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$650.11
|
| Rate for Payer: Aetna Medicare |
$844.50
|
| Rate for Payer: BCBS Complete |
$412.64
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,125.42
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Meridian Medicaid |
$412.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.08
|
| Rate for Payer: Priority Health Narrow Network |
$828.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$649.97
|
| Rate for Payer: UHC Exchange |
$649.97
|
| Rate for Payer: UHCCP Medicaid |
$392.99
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,227.56 |
| Rate for Payer: Aetna Commercial |
$720.22
|
| Rate for Payer: Aetna Medicare |
$685.00
|
| Rate for Payer: BCBS Complete |
$455.79
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Meridian Medicaid |
$455.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.32
|
| Rate for Payer: Priority Health Narrow Network |
$914.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$697.02
|
| Rate for Payer: UHC Exchange |
$697.02
|
| Rate for Payer: UHCCP Medicaid |
$434.09
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$115.10
|
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$253.63
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.58
|
| Rate for Payer: Priority Health Narrow Network |
$143.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.28
|
| Rate for Payer: UHC Exchange |
$122.28
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$190.59 |
| Rate for Payer: Aetna Commercial |
$75.94
|
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$190.59
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.56
|
| Rate for Payer: Priority Health Narrow Network |
$92.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.76
|
| Rate for Payer: UHC Exchange |
$78.76
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$324.23 |
| Rate for Payer: Aetna Commercial |
$189.20
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCN Commercial |
$324.23
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.66
|
| Rate for Payer: UHC Exchange |
$170.66
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$455.45 |
| Rate for Payer: Aetna Commercial |
$340.39
|
| Rate for Payer: Aetna Medicare |
$257.00
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS Trust/PPO |
$173.28
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.30
|
| Rate for Payer: Priority Health Narrow Network |
$215.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.02
|
| Rate for Payer: UHC Exchange |
$241.02
|
| Rate for Payer: UHCCP Medicaid |
$100.96
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$1,952.60 |
| Rate for Payer: Aetna Commercial |
$41.28
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,952.60
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.33
|
| Rate for Payer: Priority Health Narrow Network |
$25.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.74
|
| Rate for Payer: UHC Exchange |
$73.74
|
| Rate for Payer: UHCCP Medicaid |
$12.99
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$799.32 |
| Rate for Payer: Aetna Commercial |
$208.46
|
| Rate for Payer: Aetna Medicare |
$163.50
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS Trust/PPO |
$799.32
|
| Rate for Payer: BCN Commercial |
$227.24
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.44
|
| Rate for Payer: Priority Health Narrow Network |
$49.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.33
|
| Rate for Payer: UHC Exchange |
$159.33
|
| Rate for Payer: UHCCP Medicaid |
$22.15
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.44
|
| Rate for Payer: UHC Exchange |
$0.44
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: BCN Commercial |
$0.68
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.07
|
| Rate for Payer: UHC Exchange |
$2.07
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$251.47 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Aetna Medicare |
$61.50
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$251.47
|
| Rate for Payer: BCN Commercial |
$63.53
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Meridian Medicaid |
$7.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.66
|
| Rate for Payer: UHC Exchange |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$192.83
|
| Rate for Payer: BCN Commercial |
$31.27
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.17
|
| Rate for Payer: Priority Health Narrow Network |
$38.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
| Rate for Payer: UHC Exchange |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$296.71 |
| Max. Negotiated Rate |
$2,402.71 |
| Rate for Payer: Aetna Commercial |
$603.17
|
| Rate for Payer: Aetna Medicare |
$759.00
|
| Rate for Payer: BCBS Complete |
$311.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.71
|
| Rate for Payer: BCN Commercial |
$666.06
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Meridian Medicaid |
$311.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.74
|
| Rate for Payer: Priority Health Narrow Network |
$702.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$527.18
|
| Rate for Payer: UHC Exchange |
$527.18
|
| Rate for Payer: UHCCP Medicaid |
$296.71
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$486.56 |
| Max. Negotiated Rate |
$1,823.20 |
| Rate for Payer: Aetna Commercial |
$1,376.05
|
| Rate for Payer: Aetna Medicare |
$1,243.00
|
| Rate for Payer: BCBS Complete |
$687.73
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$1,485.09
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Meridian Medicaid |
$687.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,823.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,220.63
|
| Rate for Payer: UHC Exchange |
$1,220.63
|
| Rate for Payer: UHCCP Medicaid |
$654.98
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,518.86 |
| Rate for Payer: Aetna Commercial |
$211.81
|
| Rate for Payer: Aetna Commercial |
$211.81
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Aetna Medicare |
$171.50
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.86
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.04
|
| Rate for Payer: Priority Health Narrow Network |
$66.04
|
| Rate for Payer: Priority Health Narrow Network |
$66.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.29
|
| Rate for Payer: UHC Exchange |
$195.29
|
| Rate for Payer: UHC Exchange |
$195.29
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$963.09 |
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Medicare |
$156.00
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Trust/PPO |
$963.09
|
| Rate for Payer: BCBS Trust/PPO |
$963.09
|
| Rate for Payer: BCN Commercial |
$246.78
|
| Rate for Payer: BCN Commercial |
$246.78
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.68
|
| Rate for Payer: Priority Health Narrow Network |
$64.68
|
| Rate for Payer: Priority Health Narrow Network |
$64.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.63
|
| Rate for Payer: UHC Exchange |
$159.63
|
| Rate for Payer: UHC Exchange |
$159.63
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$976.30 |
| Rate for Payer: Aetna Commercial |
$533.12
|
| Rate for Payer: Aetna Commercial |
$533.12
|
| Rate for Payer: Aetna Medicare |
$84.50
|
| Rate for Payer: Aetna Medicare |
$437.50
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS Trust/PPO |
$976.30
|
| Rate for Payer: BCBS Trust/PPO |
$976.30
|
| Rate for Payer: BCN Commercial |
$677.30
|
| Rate for Payer: BCN Commercial |
$677.30
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.11
|
| Rate for Payer: Priority Health Narrow Network |
$108.11
|
| Rate for Payer: Priority Health Narrow Network |
$108.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.69
|
| Rate for Payer: UHC Exchange |
$466.69
|
| Rate for Payer: UHC Exchange |
$466.69
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$864.78 |
| Max. Negotiated Rate |
$2,409.05 |
| Rate for Payer: Aetna Commercial |
$1,816.01
|
| Rate for Payer: Aetna Medicare |
$1,310.50
|
| Rate for Payer: BCBS Complete |
$908.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.26
|
| Rate for Payer: BCN Commercial |
$1,961.06
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Meridian Medicaid |
$908.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,409.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,409.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,604.21
|
| Rate for Payer: UHC Exchange |
$1,604.21
|
| Rate for Payer: UHCCP Medicaid |
$864.78
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$669.36 |
| Max. Negotiated Rate |
$2,349.98 |
| Rate for Payer: Aetna Commercial |
$1,773.70
|
| Rate for Payer: Aetna Medicare |
$1,290.50
|
| Rate for Payer: BCBS Complete |
$886.11
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: BCN Commercial |
$1,915.13
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Meridian Medicaid |
$886.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,349.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,349.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,569.55
|
| Rate for Payer: UHC Exchange |
$1,569.55
|
| Rate for Payer: UHCCP Medicaid |
$843.91
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$2,434.10 |
| Rate for Payer: Aetna Commercial |
$1,836.77
|
| Rate for Payer: Aetna Medicare |
$1,410.50
|
| Rate for Payer: BCBS Complete |
$917.86
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$1,984.03
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Meridian Medicaid |
$917.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,434.10
|
| Rate for Payer: Priority Health Narrow Network |
$2,434.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,626.25
|
| Rate for Payer: UHC Exchange |
$1,626.25
|
| Rate for Payer: UHCCP Medicaid |
$874.15
|
|
|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$394.90 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$817.73
|
| Rate for Payer: Aetna Medicare |
$1,066.00
|
| Rate for Payer: BCBS Complete |
$414.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,286.41
|
| Rate for Payer: BCN Commercial |
$895.74
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Meridian Medicaid |
$414.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,100.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,100.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$696.25
|
| Rate for Payer: UHC Exchange |
$696.25
|
| Rate for Payer: UHCCP Medicaid |
$394.90
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$673.72 |
| Max. Negotiated Rate |
$1,907.10 |
| Rate for Payer: Aetna Commercial |
$1,410.13
|
| Rate for Payer: Aetna Medicare |
$1,467.00
|
| Rate for Payer: BCBS Complete |
$707.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,303.84
|
| Rate for Payer: BCN Commercial |
$1,523.21
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Meridian Medicaid |
$707.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,876.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,275.46
|
| Rate for Payer: UHC Exchange |
$1,275.46
|
| Rate for Payer: UHCCP Medicaid |
$673.72
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$947.51
|
| Rate for Payer: Aetna Medicare |
$1,066.00
|
| Rate for Payer: BCBS Complete |
$476.15
|
| Rate for Payer: BCBS Trust/PPO |
$281.06
|
| Rate for Payer: BCN Commercial |
$1,030.14
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Meridian Medicaid |
$476.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,264.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$831.59
|
| Rate for Payer: UHC Exchange |
$831.59
|
| Rate for Payer: UHCCP Medicaid |
$453.48
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$508.22 |
| Max. Negotiated Rate |
$1,939.39 |
| Rate for Payer: Aetna Commercial |
$1,058.66
|
| Rate for Payer: Aetna Medicare |
$1,128.00
|
| Rate for Payer: BCBS Complete |
$533.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,939.39
|
| Rate for Payer: BCN Commercial |
$1,144.97
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Meridian Medicaid |
$533.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,412.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,412.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.68
|
| Rate for Payer: UHC Exchange |
$944.68
|
| Rate for Payer: UHCCP Medicaid |
$508.22
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$3,976.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$864.57 |
| Max. Negotiated Rate |
$2,584.40 |
| Rate for Payer: Aetna Commercial |
$1,821.39
|
| Rate for Payer: Aetna Medicare |
$1,988.00
|
| Rate for Payer: BCBS Complete |
$907.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.41
|
| Rate for Payer: BCN Commercial |
$1,964.49
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Meridian Medicaid |
$907.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,584.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,420.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,420.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,623.90
|
| Rate for Payer: UHC Exchange |
$1,623.90
|
| Rate for Payer: UHCCP Medicaid |
$864.57
|
|
